Behçet Disease

Behçet disease is a relapsing multisystem vasculitis that can inflame arteries and veins of any calibre. The clinical pattern is more informative than any isolated laboratory result: recurrent oral ulceration becomes much more suggestive when it occurs with genital ulcers, inflammatory eye disease, characteristic skin lesions, vascular events, neurologic findings, or gastrointestinal ulceration. The immediate clinical question is whether the disease is limited to mucocutaneous or peripheral joint symptoms, or whether an organ is at risk. Colchicine is the usual first-line systemic treatment for the former. Ocular, vascular, neurologic, and gastrointestinal involvement can threaten vision, cause major bleeding or thrombosis, or produce permanent neurologic injury; these presentations require high-dose glucocorticoids and specialist-directed immunosuppression. A patient with recurrent mouth ulcers and a newly painful, red eye should not be managed as though this were routine aphthous ulceration. The eye finding changes the priority. Use the International Criteria for Behçet’s Disease (ICBD) to structure diagnosis, actively search for organ involvement, and escalate urgently when red-flag symptoms appear.