Behçet's disease risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2] Dheeraj Makkar, M.D.[3]
Overview
Common risk factors in the development of Behcet disease may be occupational, environmental, genetic, and viral. Behçet's disease can affect people in any age, but the most common age is 20~30 years old. Behçet's disease is more common in Middle East and Japan then in other race. It is rare in America. Researches demonstrate that the presence of the gene HLA–B51 is a risk factor for Behçet's disease.
Risk Factors
The underlying cause of Behçet’s disease is not clear. It is suggested that the following factors may be associated with the disease:
- Genetic predisposition: Researches demonstrate that the presence of the gene HLA–B51 is a risk factor for Behçet's disease.[1][2]
- Age: Behçet's disease can affect people in any age, but the most common age is 20~30 years old.
- Gender: Behçet's disease most commonly affects men than women.
- Race: Behçet's disease is more common in Middle East and Japan then in other race. It is rare in America.[3]
Risk Factors for Behçet’s Syndrome
- Geographic and Ethnic Factors
Historically most common along the ancient Silk Road.
Highest prevalence: Turkey (≈420 per 100,000).
Higher prevalence in Middle East, East Asia, and Mediterranean countries compared with Northern Europe or the U.S.
Immigrants from high-prevalence regions carry higher risk than natives in low-prevalence countries, though lower than in their country of origin .
- Genetic Risk Factors
HLA-B*51: strongest genetic association; carriers are ~6 times more likely to develop Behçet’s syndrome.
Additional associated genes:
ERAP1, IL23R–IL12RB2, STAT4, IL10 (immune regulation, T-cell polarization).
KLRC4 (NK-cell regulation), CCR1–CCR3 (chemotaxis).
TNFAIP3 (A20 haploinsufficiency), MEFV (familial Mediterranean fever gene).
Epigenetics: altered DNA methylation and histone activation in immune cells amplify susceptibility .
- Demographic Factors
Age:
Mean age at diagnosis ≈30 years.
Most patients present between 15–45 years.
Sex:
Overall incidence similar between men and women.
Men are more likely to have severe forms of the disease, with higher risk of ocular, vascular, and neurologic involvement.
Male sex is associated with increased mortality (hazard ratio 4.94) .
Family history: familial aggregation reported, especially in early-onset cases.
- Environmental and Lifestyle Triggers (not direct causes, but risk enhancers for onset/flares)
Microorganisms: Streptococcus species, HSV-1, bacterial/viral byproducts.
- Diet: histamine-releasing foods (citrus fruits, nuts, cheese).
Poor oral hygiene.
Psychological stress.
Dysbiosis: gut and salivary microbiome imbalance .
References
- ↑ Treudler R, Orfanos CE, Zouboulis CC (1999). "Twenty-eight cases of juvenile-onset Adamantiades-Behçet disease in Germany". Dermatology. 199 (1): 15–9. doi:10.1159/000018197. PMID 10449951.
- ↑ Soy M, Erken E, Konca K, Ozbek S (2000). "Smoking and Behçet's disease". Clin Rheumatol. 19 (6): 508–9. PMID 11147770.
- ↑ Yazici H, Fresko I, Yurdakul S (2007). "Behçet's syndrome: disease manifestations, management, and advances in treatment". Nat Clin Pract Rheumatol. 3 (3): 148–55. doi:10.1038/ncprheum0436. PMID 17334337.