There's currently no cure for Behet's disease, but a number of treatmentscan help to relieve symptoms and reduce the risk of serious complications.
Once a diagnosis of Behet's disease has been confirmed, you'll usually be referred to several different specialists who have experience of treating the condition. They'll help draw up a specific treatment plan for you.
The specialists involved in your care may include:
You may see more than one specialist during the same visit to hospital, to help with diagnosis and creating a treatment plan.
Your treatment plan usually involves the use of a combination of different medications. Depending on the type and severity of your symptoms, you may only need to take medication when you have a flare-up.
Alternatively, you may have to take medication on a long-term basis to stop serious complications developing, such as vision loss.
A number of different medications can be used to treat the various symptoms of Behet's disease, but the main types of medication used can be broadly divided into:
Corticosteroids are powerful anti-inflammatory medications that can be useful in reducing the inflammation associated with Behet's disease.
Depending on the specific symptoms being treated, corticosteroids are available as:
Occasionally, corticosteroid injections may also be used.
Side effects depend on the form of corticosteroid you are taking. Side effects associated with topical corticosteroids are uncommon, but long-term use may lead to problems such as a thinning of your skin.
The long-term use of oral corticosteroids is associated with some potentially more serious side effects, including:
Immunosuppressants are a type of medication that reduces the activity of the immune system, which in turn interrupts the inflammation process that causes most of the symptoms of Behets disease.
Examples of immunosuppressants used to treat Behet's disease include azathioprine, ciclosporine, methotrexate, mycophenolate mofetil and thalidomide.
These medications are usually available as tablets, capsules and injections. Colchicine, an anti-inflammatory medication often used for gout, may also be beneficial.
While immunosuppressants can be useful in treating a wide range of Behet's disease symptoms, they can also cause some potentially significant side effects.
For this reason, you'll be given carefuladvice about potential side effects and monitoring through blood tests. This is often co-ordinated by a specialist nurse.
General side effects of these medications can include:
Some immunosuppressants can also cause birth defects and shouldn't be taken if you're pregnant or planning a pregnancy.
If you're taking any of these medications, you should ensure you talk to your specialist or GP about the possible effects of your medication on a potential pregnancy.
Biological therapies are a newer type of medication that target the biological processes involved in the process of inflammation more selectively.
For example, one group of medications called tumour necrosis factor alpha inhibitors (TNFa-inhibitors) work by targeting the antibodies thought to cause much of the inflammation associated with Behet's disease.
Biological therapies used to treat Behet's disease include infliximab and interferon alpha. These may either be given directly into a vein (intravenously) or by injection under the skin (subcutaneous injection) at varying intervals.
While they're often effective, biological therapies are also very expensive. Your local hospital will usually only agree to fund biological therapies on the NHS if your symptoms are severe and other medications haven't been effective.
Biological therapies can also cause a range of side effects, including:
As with immunosuppressant treatment, you should report any symptoms of a possible infection to your GP or healthcare team as soon as possible.
The specific medications used forBehet's disease vary depending on the symptom being treated. The treatments for some of the main symptoms associated withthe condition are outlined below.
Topical corticosteroids such ascreams, lozenges, mouthwashes andsprays are usually the first treatment recommended for mouth and genital ulcers.
Some people find that using a corticosteroid inhaler is effective. These inhalers are commonly used to treat asthma and are normally used to spray the medication into the lungs. However, rather than inhaling the steroids, you can use the inhaler to spray the steroids directly on toan ulcer.
If you havered, tender swellings on yourlegs (erythema nodosum), you may be prescribed colchicine tablets to reduce the inflammationof your skin.
For severe ulcers and lesions that don't respond to other treatments, other immunosuppressant tablets or biological therapiesmay be recommended.
Because ofthe potential risk of vision loss in serious cases,any eye inflammation caused byBehet's disease should be carefully monitored by an ophthalmologist.
Treatment for eye problems often involves taking azathioprine and corticosteroid tablets, although corticosteroid eye drops may also be useful.
In severe cases where these treatments haven't helped, mycophenolate mofetil, ciclosporine or biological therapies may alsobe recommended.
For people withjoint pain caused by Behet's disease, conventional painkillers such as paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) may sometimes help relieve the pain.
Daily colchicine tablets can also help byreducing the inflammation in your joints.
In severe cases where these treatments haven't helped, azathioprine or biological therapies may be recommended.
A number of different medications may be used to help reduce inflammationof the stomach and bowel caused byBehet's disease, including corticosteroids, immunosuppressants and biological therapies.
Sometimesthe inflammation in your bowel causes it to become damaged and bleed. Medical treatment is usually successful, though rarely emergency surgery may be needed to stop the bleeding and remove the affected section of bowel.
In cases of Behet's disease, headaches are usually treated in the same way as migraines . This means there are two types of medication that can be used:
Anticoagulants are only used if you've been screenedtomake sure there are noaneurysms.
Aneurysms caused by Behet's disease are normally treated with a combination of corticosteroid and immunosuppressant tablets, or infusions of cyclophosphamideto reduce inflammation in the affected blood vessel and stop the aneurysm getting worse.
Surgery or procedures may also be considered. The aneurysmmay berepaired or bypassed using small tubes called stents, or it can be blocked off.This is often combined with medical treatment to reduce or prevent the risk of recurrence.
For more information about how surgery is used to treat some common types of aneurysm, see treating brain aneurysms and treating abdominal aortic aneurysms .
Relatively minor symptoms of central nervous system inflammation, such as double vision , may get better on their own without the need for treatment.
However, more serious symptoms, such as paralysis and behavioural changes, usually require treatment with medication. This willoften be in the form of corticosteroid or immunosuppressant injections, or biological therapies.
Fertility is usually unaffected in women with Behet's disease, but it's important that any pregnancy is planned where possible. This is because many of themedications used to treat the condition, such as thalidomide, can cause birth defects.
It's recommended that you use at least onereliable method of contraception until you decide that you want to have a baby. You should discuss your plans to have a baby with your care team, who will be able to adjust your treatment plan to make your pregnancy as safe as possible.
There's little evidence that havingBehet's disease increases your risk of pregnancy-related complications, although there's a very small chance of your baby being born with a temporary condition called neonatalBehet's disease.
The fertility of men with Behet's disease may be affected. This can be the result of the condition itself or of a side effect of some of the immunosuppressant medications. Colchicine may temporarily lower sperm count, but this often improves when treatment is stopped.
Where fertility is affected, further investigation and, in some cases, fertility treatment such as in vitro fertilisation (IVF) may be needed to conceive successfully.
This type of Behet's disease, known as neonatal Behet's disease, isextremely rare, with only one or two cases being reported every few years.
Corticosteroids can be used to help relieve symptoms of neonatal Behet's disease. The condition usually resolves within six to eight weeksof the birth.
Read about Behet's disease, a rare and poorly understood condition in which blood vessels and tissues may become inflamed (swollen)
Read about the symptoms of Behet's disease. It can cause a wide range of symptoms, but it's rare for someone with the condition to have all of them at once
Read about treating Behet's disease. A number of treatments are available to help relieve many symptoms of the condition, but there's currently no cure