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What treatments are there for Behçet’s syndrome?

While there's currently no cure for Behçet's syndrome, evidence shows that there is an improved prognosis with early diagnosis and prompt treatment.

And treatment can control the severity of your symptoms and improve your general well-being.

Because Behçet's can affect many parts of the body, you may see and be treated by several different specialists. Usually one specialist will co-ordinate your treatment. This is often a rheumatologist or immunologist, who frequently works with an ophthalmologist (who specialises in eye problems).

Drugs

Many drugs can be used to control Behçet's syndrome. Doctors aim to match the strength of the drug with the seriousness of the problem since the chances of side-effects are generally higher with more powerful drugs.

There are treatments that can be applied directly to the ulcers. These include:

  • mouthwashes with steroids and antibiotics
  • steroid paste
  • steroid sprays.

Most of these are only available on prescription. Steroids can also be prescribed to apply to the eye and to genital and skin ulcers.

Colchicine tablets are often prescribed for mouth or genital ulcers. Pentoxyfylline tablets and dapsone may also be effective.

The usual treatment for moderate to severe cases of Behçet's syndrome is a group of drugs that control inflammation by suppressing the body’s overactive immune system. Azathioprine is the most commonly prescribed but mycophenolate and ciclosporin are also used.

Some people need additional treatment with steroid tablets (usually prednisolone), although doctors try to limit the use of these because of their side-effects, particularly the increased risk of osteoporosis.

There's evidence that anti-TNF drugs, for example infliximab and adalimumab, may be effective if other treatments don't help. These have been highly successful in other inflammatory illnesses (such as rheumatoid arthritis) and are becoming more widely used in Behçet's syndrome. However, these drugs are expensive and approval for use needs to be given within the NHS on an individual patient basis.

Thalidomide can also be useful for treating severe ulceration, although doctors are cautious about giving this to women who may become pregnant. This is because of the risk of severe birth defects. It can also cause damage to nerves and its use is therefore becoming less common. Special arrangements apply for its prescription, so it's not always approved.

A drug called interferon alpha is currently being tested. It works by suppressing the immune system and may be helpful for all symptoms of Behçet's.

You may need painkillers in addition to the drugs mentioned above to ease joint pain. Over-the-counter painkillers (for example paracetamol) or non-steroidal anti-inflammatory drugs (NSAIDs) (for example ibuprofen) may be enough, but your doctor may be able to prescribe something stronger if not.

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