Behçet's disease

Behçet's disease is a form of vasculitis, meaning the immune system mistakenly inflames blood vessels, which can be of any size. This inflammation is what produces the recurrent ulcers, eye problems and other features, rather than an infection you can catch or pass on.

The underlying cause is not fully understood. It is thought to arise when a genetic susceptibility, in particular a gene called HLA-B51, combines with an immune response that may be triggered by environmental or microbial factors. It is not inherited in a simple way, and most relatives are unaffected.

Behçet's tends to begin in early adulthood, often between the twenties and forties. It is more frequent in people with ancestry along the historic Silk Road, from the Mediterranean through the Middle East to East Asia, though it occurs worldwide.

Behçet's can affect several parts of the body. Features may include:

• Recurrent mouth ulcers, often the first and most persistent feature
• Genital ulcers
• Eye inflammation, which needs prompt attention
• Skin changes
• Joint pain and swelling
• Less commonly, effects on the gut, blood vessels or nervous system

There is no single test for Behçet's. The diagnosis is based on the pattern of symptoms over time, an examination and tests to support the picture and exclude other causes. Because the features can appear at different times, the diagnosis sometimes becomes clearer over time, and specialist assessment helps draw the threads together.

Where joints are involved, ultrasound can help assess inflammation. Dr Borukhson uses point-of-care ultrasound during the consultation. You can read more on the ultrasound clinic page.

Treatment aims to control the inflammation, manage symptoms such as ulcers and joint pain, and protect any organs that may be affected. Colchicine, a tablet that calms inflammation, is often used for the mouth and genital ulcers, skin lesions and joint symptoms of Behçet's. Corticosteroids such as prednisolone help settle flares, and where the eyes or other organs are involved, immunosuppressant or biological medicines, for example anti-TNF agents, may be needed. These stronger treatments need monitoring and can increase the risk of infection, so they are used under specialist supervision and discussed fully with you.

Treatment is individual, depends on which areas are involved, and is reviewed over time. Because Behçet's can affect several systems, care is often coordinated with other specialists. The plan is agreed with you.

Behçet's disease can affect the mouth, eyes, skin and joints, and less commonly the gut, blood vessels or nervous system, so care often needs the involvement of more than one specialty. Dr Borukhson practises within a world-renowned tertiary centre, with ready access to consultant colleagues across the other specialties that may be involved in caring for this condition. Where appropriate, she can involve those specialists directly, and bring particularly complex cases to a multidisciplinary team meeting (MDT) with minimal delay. This means that, when more than one area of expertise is needed, your care can be joined up and decisions reached promptly.

Behçet's is a long-term condition that tends to settle into flares and quieter spells, and most people, with the right plan, keep it well controlled and lead full lives.

A few practical measures help day to day:

• Track your symptoms, noting ulcers, eye changes, and skin or joint flares, so patterns and triggers become clearer over time.
• Attend follow-up and monitoring blood tests without gaps, especially while on immunosuppressant or biological treatment.
• Keep eye checks up to date, as eye involvement can be quiet early on.
• Stay active within comfort; gentle exercise supports joints, mood and sleep.
• Not smoking and managing blood pressure help protect your blood vessels.

Fatigue and the unpredictability of flares can wear you down, so pacing, good sleep and sharing how you feel with your team all matter.

Some features of Behçet's need same-day attention, because acting quickly helps protect sight and other organs. Seek urgent help if you notice:

• New eye symptoms: pain, redness, blurred or reduced vision, floaters or sensitivity to light.
• Sudden severe headache, new weakness, numbness, slurred speech or confusion.
• Breathlessness, coughing up blood, or chest pain.
• A painful, swollen or red limb, which can signal a clot.
• Severe abdominal pain, or blood in your stools or vomit.

If you take immunosuppressant or biological medicines and feel feverish or unwell, contact your team promptly, as these treatments lower your resistance to infection.

For a gradual increase in mouth ulcers, joint aches or skin lesions without the warning signs above, a routine review to adjust your plan is the right step.

Behçet's is uncommon and varied, so an accurate diagnosis and a tailored, regularly reviewed plan make a real difference, particularly where the eyes or other organs are involved. If you have recurrent mouth ulcers alongside other unexplained symptoms, a specialist review can help bring clarity.

How is Behçet's disease diagnosed?

There is no single test that confirms Behçet's, so the diagnosis rests on the overall pattern of symptoms over time, a careful examination and tests that support the picture and rule out other causes. Because the features can appear at different points, clarity sometimes builds gradually. Where joints are involved, Dr Borukhson uses point-of-care ultrasound during the consultation to assess inflammation, helping draw the threads together in one visit.

Is Behçet's disease curable, and what can I expect over time?

Behçet's is a long-term condition rather than something that is cured, but for most people it is very manageable. Symptoms often come in flares and settled periods, and treatment aims to control inflammation, ease symptoms and protect any organs involved, which matters most when the eyes, nervous system or blood vessels are affected. With a tailored plan that is reviewed regularly, most people keep symptoms well controlled and get on with daily life.

Why are recurrent mouth ulcers taken so seriously here?

Occasional mouth ulcers are common and usually harmless. In Behçet's, ulcers tend to recur often and may appear alongside other features such as genital ulcers, eye inflammation, skin changes or joint pain. It is this combination, rather than ulcers alone, that prompts assessment. If you have frequent mouth ulcers together with other unexplained symptoms, a specialist review can help establish whether Behçet's is involved.

When should I seek urgent help with Behçet's?

Any new eye symptom, such as pain, redness, blurring or sensitivity to light, needs prompt attention, as eye inflammation requires quick treatment to protect your sight. You should also seek advice for severe headache, new weakness or numbness, breathlessness, or a painful swollen limb. Because some treatments lower your resistance to infection, contact your team promptly if you feel unwell or feverish while on them.

Will I need to see more than one specialist?

Often, yes. Because Behçet's can affect the mouth, eyes, skin and joints, and less commonly the gut, blood vessels or nervous system, more than one area of expertise may be helpful. Dr Borukhson practises within a tertiary centre with ready access to consultant colleagues across the relevant specialties, so where appropriate she can involve them directly or bring complex cases to a multidisciplinary meeting, keeping your care joined up.