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2018 update of the EULAR recommendations for the management of Behçet’s syndrome
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  1. Gulen Hatemi1,
  2. Robin Christensen2,
  3. Dongsik Bang3,
  4. Bahram Bodaghi4,
  5. Aykut Ferhat Celik5,
  6. Farida Fortune6,
  7. Julien Gaudric7,
  8. Ahmet Gul8,
  9. Ina Kötter9,
  10. Pietro Leccese10,
  11. Alfred Mahr11,
  12. Robert Moots12,
  13. Yesim Ozguler1,
  14. Jutta Richter13,
  15. David Saadoun14,15,16,17,
  16. Carlo Salvarani18,
  17. Francesco Scuderi19,
  18. Petros P Sfikakis20,
  19. Aksel Siva21,
  20. Miles Stanford22,
  21. Ilknur Tugal-Tutkun23,
  22. Richard West24,
  23. Sebahattin Yurdakul1,
  24. Ignazio Olivieri25,
  25. Hasan Yazici1
  1. 1 Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
  2. 2 Musculoskeletal Statistics Unit, The Parker Institute, Bispebjerg and Frederiksberg Hospital & Department of Rheumatology, Odense University Hospital, Copenhagen, Denmark
  3. 3 Department of Dermatology, Catholic Kwandong University International St. Mary’s Hospital, Incheon, Korea
  4. 4 Department of Ophthalmology, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
  5. 5 Division of Gastroenterology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
  6. 6 Centre for Clinical and Diagnostic Oral Sciences, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, and the London Behçet’s Centre, Barts Health London, London, UK
  7. 7 Department of Vascular Surgery, Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France
  8. 8 Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  9. 9 Department of Rheumatology, Immunology and Nephrology, Asklepios Clinic Altona, Hamburg, Germany
  10. 10 Rheumatology Institute of Lucania (IRel) and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, Potenza and Matera, Italy
  11. 11 Department of Internal Medicine, Hospital Saint-Louis, Paris, France
  12. 12 National Behcet’s Syndrome Centre of Excellence, Aintree University Hospital, Liverpool, UK
  13. 13 Institute for Haematopathology Hamburg, Hamburg, Germany
  14. 14 Department of Inflammation-Immunopathology-Biotherapy, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
  15. 15 INSERM, Paris, France
  16. 16 CNRS, Paris, France
  17. 17 Department of Internal Medicine and Clinical Immunology, Centre de Référence des Maladies Auto-Immunes et Systémiques Rares, Centre de Référence des Maladies Auto-Inflammatoires, AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
  18. 18 Division of Rheumatology, Azienda USL-IRCCS di Reggio Emilia, University of Modena and Reggio Emilia, Modena and Reggio Emilia, Italy
  19. 19 Patient Research Partner, Catania, Italy
  20. 20 First Department of Propaedeutic and Internal Medicine & Rheumatology Unit, National Kapodistrian University of Athens Medical School, Athens, Greece
  21. 21 Department of Neurology, Cerrahpasa Medical School, Istanbul University, Istanbul, Turkey
  22. 22 Department of Ophthalmology, St. Thomas’ Hospital, London, UK
  23. 23 Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
  24. 24 Patient Research Partner, Member of the UK Behcet’s Syndrome Society and Director of Behcets International, London, UK
  25. 25 Rheumatology Institute of Lucania (IRel) and the Rheumatology Department of Lucania, San Carlo Hospital of Potenza and Madonna delle Grazie Hospital of Matera, and the Basilicata Ricerca Biomedica (BRB) Foundation, Potenza and Matera, Italy
  1. Correspondence to Dr Gulen Hatemi, Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical School, Istanbul University, Istanbul 34098, Turkey; gulenhatemi{at}yahoo.com

Abstract

Several new treatment modalities with different mechanisms of action have been studied in patients with Behçet’s syndrome (BS). The aim of the current effort was to update the recommendations in the light of these new data under the auspices of the European League Against Rheumatism (EULAR) Standing Committee for Clinical Affairs. A task force was formed that included BS experts from different specialties including internal medicine, rheumatology, ophthalmology, dermatology, neurology, gastroenterology, oral health medicine and vascular surgery, along with a methodologist, a health professional, two patients and two fellows in charge of the systematic literature search. Research questions were determined using a Delphi approach. EULAR standardised operating procedures was used as the framework. Results of the systematic literature review were presented to the task force during a meeting. The former recommendations were modified or new recommendations were formed after thorough discussions followed by voting. The recommendations on the medical management of mucocutaneous, joint, eye, vascular, neurological and gastrointestinal involvement of BS were modified; five overarching principles and a new recommendation about the surgical management of vascular involvement were added. These updated, evidence-based recommendations are intended to help physicians caring for patients with BS. They also attempt to highlight the shortcomings of the available clinical research with the aim of proposing an agenda for further research priorities.

  • behcet’s disease
  • anti-tnf
  • treatment

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Footnotes

  • Handling editor Josef S Smolen

  • Contributors All authors participated in the activities of the EULAR task force and have provided important contributions to the manuscript.

  • Funding This project was funded by the European League Against Rheumatism.

  • Competing interests BB received consultant fees from Santen, AbbVie, Allergan, Xoma and research grants from Novartis and Bayer. ITT received honoraria from Servier, AbbVie and Allergan. GH received research grants from Celgene, honoraria from Pfizer and speaker’s fees from Abbvie, MSD and UCB.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.