If you have recurrent oral ulcers that do not heal, be alert to Behcet's disease!

Author: Mu Rong, Chief Physician, Peking University Third Hospital

Reviewer: Wu Xueyan, Chief Physician, Peking Union Medical College Hospital

Oral ulcers are not unfamiliar to everyone. I think everyone has had oral ulcers in life. For common oral ulcers, they usually heal themselves within seven days, and the frequency of occurrence is not very high.

If oral ulcers occur repeatedly and do not heal, and you find that they are different from ordinary oral ulcers, you should screen for secondary factors, such as Behcet's disease, systemic lupus erythematosus, tumors, and other diseases, because these diseases can all manifest as oral ulcers.

You may not be very familiar with Behcet's disease because the incidence of this disease is relatively low and has a certain geographical distribution, such as Japan and the Middle East region of China. The incidence is higher, which may be related to environmental factors. It is relatively rare in Western countries.

Today we will learn about Behcet's disease.

1. What is Behçet’s disease?

Behcet's disease is a chronic systemic vascular inflammatory disease that mainly affects large and small blood vessels throughout the body, so all organs in the body can be affected. If inflammatory lesions occur in any blood vessel, clinical symptoms will appear in the corresponding part or organ, so the symptoms are very widespread.

The most common symptom of Behcet's disease is recurrent oral ulcers that do not heal. Other common symptoms include skin erythema nodosum, acne-like rash, phlebitis, and vulvar ulcers. Some people have recurrent eye inflammation, such as uveitis.

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In addition to symptoms of the skin and mucous membranes, arthritis may also occur, and various internal organs may also be affected. If the gastrointestinal tract is affected, gastrointestinal inflammation, gastrointestinal ulcers, and gastrointestinal perforation may occur; if the central nervous system is affected, white matter lesions or brain parenchymal lesions may occur, such as cerebral infarction, cerebral hemorrhage, or epilepsy; if the peripheral nervous system is affected, numbness, tingling, or sensory impairment may occur in the hands and feet.

The pathogenesis of Behcet's disease is not very clear at present, but it is certain that this disease is caused by a specific genetic background, which is affected by the environment and eventually leads to autoimmune dysfunction, which in turn leads to the occurrence of Behcet's disease. However, so far, the pathogenic gene has not been fully identified, but it has been found that the probability of Behcet's disease patients carrying the HLA-B5 gene is relatively high, but not all people carrying this gene will suffer from Behcet's disease, and some Behcet's disease patients are not HLA-B5 positive.

The most regrettable thing about Behcet's disease at present is that it is diagnosed and treated too late. The main reason is that people do not have a sufficient understanding of it. Some patients are diagnosed with the disease only after they develop eye lesions and become blind. What is most needed at present is to raise everyone's awareness of this disease.

If multiple systems are affected, no clear cause can be found, and other diseases cannot explain it, it is recommended to go to the rheumatology and immunology department for screening to avoid delays in diagnosis and treatment.

2. How is Behçet’s disease diagnosed?

So far, there are no characteristic serological markers to help diagnose Behcet's disease, so a comprehensive diagnosis is needed. First, other diseases should be ruled out based on symptoms, and of course a series of tests will be done, such as erythrocyte sedimentation rate, C-reactive protein, and HLA-B5 testing.

Patients with Behcet's disease will have a positive reaction to acupuncture. After pricking the skin of patients with Behcet's disease with a needle, many patients will experience redness, swelling, and rashes at the puncture site. Sometimes, you don't need to do this test deliberately. You can find abnormalities by observing during blood draws or other puncture examinations. If you have Behcet's disease, you may develop pustules at the site of blood draws or punctures, which can also help diagnose Behcet's disease.

3. How to treat Behcet’s disease?

The main treatment method at present is drug therapy, including local and systemic medications, and the specific treatment method is selected according to the severity of the disease.

The condition is relatively mild, only involving the skin and mucous membranes, and the internal organs are not affected. Relatively weaker drugs, such as colchicine and thalidomide, can be used. In addition, it is necessary to pay special attention to contraception when taking colchicine and thalidomide, because these two drugs have teratogenic effects on the fetus.

For more serious cases, treatment should be strengthened. If there are lesions in the eyes, in addition to local application of eye drops containing hormones or immunosuppressants, systemic medication may be required. For most visceral or vascular involvement, hormones and immunosuppressants are needed for treatment. Commonly used hormones, such as prednisone and methylprednisolone, there are many types of immunosuppressants, both oral and intravenous. Targeted drug therapy can also be used.

At present, there are more and more new drugs for the treatment of Behcet's disease, and the success rate of treatment is getting higher and higher. The prognosis of most patients is very good and can be controlled to be completely normal. Unfortunately, most patients cannot stop taking the drug and need to take it for a long time. After stopping the drug, the disease may relapse. In addition, regular check-ups are required during the medication period, and the medication should be adjusted at any time according to the condition.

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For patients with Behcet's disease, if their condition is stabilized by long-term medication, they can live like normal people, get married and have children. If they plan to get pregnant, they can choose some medicines that can be taken before and during pregnancy under the guidance of a doctor. If their condition is well controlled, they can give birth normally.

It is important for patients with Behcet's disease to maintain a happy mood. Finally, I hope that every patient with Behcet's disease can live a healthy and happy life.