Behçet's disease secondary prevention
|
Behçet's disease Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Behçet's disease secondary prevention On the Web |
|
American Roentgen Ray Society Images of Behçet's disease secondary prevention |
|
Risk calculators and risk factors for Behçet's disease secondary prevention |
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
There are no established measures for the secondary prevention of Behçet disease.
Secondary Prevention
There are no established measures for the secondary prevention of Behçet disease.
- General Principles
Aim is to control inflammation early and maintain remission to prevent organ damage.
Immunosuppressive therapy is central to relapse prevention.
Treatment must be individualized depending on organ involvement (mucocutaneous, ocular, vascular, neurologic, gastrointestinal).
- Mucocutaneous and Joint Disease
Colchicine: widely used for oral/genital ulcers and arthritis; helps reduce recurrence.
Topical corticosteroids: for oral/genital ulcers during flares.
Azathioprine or apremilast: options when colchicine is insufficient.
- Ocular Disease (Prevention of Vision Loss)
Azathioprine, cyclosporine, TNF inhibitors, or interferon-alpha are used to prevent relapses of uveitis and long-term blindness.
Early and aggressive therapy is recommended, particularly in young men with posterior uveitis or retinal vasculitis, who have the highest risk of vision loss.
- Vascular Disease
Immunosuppressive therapy (azathioprine, cyclophosphamide, TNF inhibitors) reduces risk of recurrence and catastrophic events such as pulmonary artery aneurysm rupture or Budd–Chiari syndrome.
Anticoagulation is controversial; immunosuppression is prioritized because vascular lesions are inflammatory rather than thrombotic in origin.
Secondary prevention of aneurysm rupture: immunosuppression before any surgical or endovascular repair.
- Neurologic Disease
High-dose corticosteroids for acute attacks, followed by immunosuppressive maintenance (azathioprine, cyclophosphamide, or TNF inhibitors) to reduce relapses and disability.
- Gastrointestinal Disease
Azathioprine, TNF inhibitors: prevent relapse of ulcerative lesions and reduce risk of perforation.
Surgery is reserved for emergencies; secondary prevention centers on ongoing immunosuppression to avoid recurrence at surgical sites.
- Biologic Therapies
TNF inhibitors (infliximab, adalimumab, etanercept): effective across multiple organ systems in preventing relapses.
Interleukin-1 and Interleukin-17 inhibitors: under investigation for refractory disease.