EULAR recommendations for the management of Behçet's disease: report of a task force of the European Standing Committee for International Clinical Sstudies Including Therapeutics (ESCISIT)

G Hatemi ¹, A Silman ², D Bang ³, B Bodaghi ⁴, A M Chamberlain ⁵, A Gül ⁶, M H Houman ⁷, I Kötter ⁸, I Olivieri ⁹, C Salvarani ¹⁰, P P Sfikakis ¹¹, A Siva ¹, M R Stanford ¹², N Stübiger ⁸, S Yurdakul ¹ and H Yazici ^1*

¹ Cerrahpasa Medical School, Istanbul University, Turkey
² Manchester University, United Kingdom
³ Yonsei University College of Medicine, Korea, Republic of
⁴ Pitie-Salpetriere Hospital, France
⁵ University of Leeds, United Kingdom
⁶ Istanbul University, Istanbul Faculty of Medicine, Turkey
⁷ Hospital La Rabta, Tunisia
⁸ University Hospital Tübingen, Germany
⁹ San Carlo Hospital, Italy
¹⁰ Arcispedale S. Maria Nuova, Italy
¹¹ Athens University Medical School, Greece
¹² St Thomas hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: hyazici{at}attglobal.net.

Accepted 20 January 2008

Abstract

Objectives: To develop evidence based EULAR recommendations for the management of Behçet’s Disease (BD) supplemented where necessary by expert opinion.

Methods: The multidisciplinary expert committee consisted of 9 rheumatologists (1 also a clinical epidemiologist and 1 also a Rehabilitation Medicine physician), 3 ophthalmologists, 1 internist, 1 dermatologist and 1 neurologist, representing 6 European countries, Tunisia and Korea. A patient representative was also present. Problem areas and related keywords for systematic literature research were identified. Systematic literature research was performed using MedLine and Cochrane library through December 2006. Forty initial statements were generated based on the systematic literature research. These yielded the final recommendations developed from 2 blind Delphi rounds of voting.

Results: Nine recommendations were developed for the management of different aspects of BD. The strength of each recommendation was determined by the level of evidence and the experts’ opinions. The level of agreement for each recommendation was determined using a visual analogue scale for both the whole committee, and for each individual aspect the subgroup, who considered themselves experts in that field of BD. There was excellent concordance between the level of agreement of the whole group and the "experts of the field".

Conclusion: Recommendations related to the eye, skin - mucosa disease and arthritis are mainly evidence based, but recommendations on vascular disease, neurological and gastrointestinal involvement are based largely on expert opinion and uncontrolled evidence from open trials and observational studies. The need for further properly designed controlled clinical trials is apparent.

Keywords: Behcet's Disease, EULAR, management, recommendation, treatment

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