title: Unmet need in Behcet's disease: most patients in routine follow-up continue to have oral ulcers.
abstract: The clinical course of Behcet's disease (BD) as a multisystemic disorder with a remitting-relapsing nature is insufficiently explored. As complete remission should be aimed in all inflammatory diseases, we investigated the frequency of complete remission in patients with BD followed in long-term, routine practice. In this retrospective study, 258 patients with BD who were regularly followed in outpatient clinics were assessed. The demographic and clinical data for active organ manifestations and treatment protocols were evaluated, and "complete remission" for this study was defined as no sign of any disease manifestation in the current visit and the preceding month. Two hundred fifty-eight patients with BD (F/M 130/128, mean age 41.1 ± 11.5 years) were included to the study. Mucocutaneous disease was present in 48.4 % (n = 125). Mean visit number was 6.8 ± 2.7, and mean follow-up duration was 45.8 ± 36.5 months. Patients were clinically active in 67.2 % (n = 1,182) of the total visits (n = 1,757), which increased to 75.6 % (68.1-90.3) when the month preceding the visit was also included. The most common active manifestation was oral ulcers (39.4-63.2 %) followed by other mucocutaneous manifestations and musculoskeletal involvement. When multivariate analysis was performed, oral ulcers, which are the main cause of the clinical activity, negatively correlated with immunosuppressive treatments (β = -0.356, p < 0.000) and age (β = -0.183, p = 0.04). It is fairly difficult to achieve complete remission in BD with current therapeutic regimens. The reluctance of the clinician to be aggressive for some BD manifestations with low morbidity, such as mucocutaneous lesions and arthritis, might be influencing the continuous, low-disease activity state, especially due to oral ulcers, in BD patients.
authors.affiliation: Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey, falibaz@gmail.com.
authors.forename: Fatma
authors.initials: F
authors.lastname: Alibaz-Oner
authors.forename: Gonca
authors.initials: G
authors.lastname: Mumcu
authors.forename: Zeynep
authors.initials: Z
authors.lastname: Kubilay
authors.forename: Gulsen
authors.initials: G
authors.lastname: Ozen
authors.forename: Gulce
authors.initials: G
authors.lastname: Celik
authors.forename: Aslı
authors.initials: A
authors.lastname: Karadeniz
authors.forename: Meryem
authors.initials: M
authors.lastname: Can
authors.forename: Sibel Yilmaz
authors.initials: SY
authors.lastname: Oner
authors.forename: Nevsun
authors.initials: N
authors.lastname: Inanc
authors.forename: Pamir
authors.initials: P
authors.lastname: Atagunduz
authors.forename: Tulin
authors.initials: T
authors.lastname: Ergun
authors.forename: Haner
authors.initials: H
authors.lastname: Direskeneli
mesh_terms: D000284:Administration, Oral; D000328:Adult; D001528:Behcet Syndrome / Q000150:complications* / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019226:Oral Ulcer / Q000150:complications* / Q000188:drug therapy; D011788:Quality of Life; D012017:Referral and Consultation; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
references.citation: Oral Dis. 2006 Mar;12(2):145-51
references.pmid: 16476035
references.citation: Clin Exp Rheumatol. 2011 Jul-Aug;29(4 Suppl 67):S58-63
references.pmid: 21968238
references.citation: Clin Exp Rheumatol. 2012 Jul-Aug;30(4 Suppl 73):S112-5
references.pmid: 23072706
references.citation: J Oral Pathol Med. 2007 Mar;36(3):147-52
references.pmid: 17305636
references.citation: Arthritis Rheum. 2008 Feb 15;59(2):285-90
references.pmid: 18240181
references.citation: J Oral Pathol Med. 2005 Jan;34(1):13-6
references.pmid: 15610401
references.citation: Ann Rheum Dis. 2004 Nov;63(11):1450-2
references.pmid: 15479894
references.citation: Ann Rheum Dis. 2011 Nov;70(11):1999-2002
references.pmid: 21803747
references.citation: Lancet. 1990 May 5;335(8697):1078-80
references.pmid: 1970380
references.citation: Clin Exp Rheumatol. 2007 Jul-Aug;25(4 Suppl 45):S27-33
references.pmid: 17949548
references.citation: Nat Genet. 2013 Mar;45(3):319-24
references.pmid: 23396137
references.citation: J Oral Pathol Med. 2009 Nov;38(10):785-91
references.pmid: 19614861
references.citation: N Engl J Med. 1999 Oct 21;341(17):1284-91
references.pmid: 10528040
references.citation: Arthritis Care Res (Hoboken). 2012 Apr;64(4):607-11
references.pmid: 22162223
references.citation: Clin Exp Rheumatol. 2012 Jul-Aug;30(4 Suppl 73):S149-53
references.pmid: 23079158
references.citation: Int J Dermatol. 2003 May;42(5):346-51
references.pmid: 12755969
references.citation: J Clin Gastroenterol. 2012 May-Jun;46(5):e38-45
references.pmid: 22298088