J Korean Orthop Assoc.  2008 Apr;43(2):220-226. 10.4055/jkoa.2008.43.2.220.

Behcet's Arthritis

• Yang IH
• Han CD
• Oh HC
• Kim JY

• KMID: 2106443
• DOI: http://doi.org/10.4055/jkoa.2008.43.2.220

Abstract

PURPOSE: The clinical manifestations of Behcet's arthritis are similar to those of rheumatoid arthritis, and they need to be differentiated. The objective of this study was to evaluate the past history, diagnosis, treatments and clinical findings of Behcet's arthritis.
MATERIALS AND METHODS
Among 1,602 cases with Behcet's disease, 87 cases with Behcet's arthritis were enrolled in this study between January 1990 and December 2000. A thorough review of each case was done by examining the patients' medical charts and personal interview. The clinical manifestation, the existence of morning stiffness and laboratory studies including ESR, CRP, AS, and RF were investigated. The Shimizu classification was used as diagnostic criteria.
RESULTS
There was no preponderance of gender and the most prevalent age group was in their 3rd and 4th decades. The most common involved site was the knee joint (60 of 87 cases), and multiple site involvement was common (56.0%). Clinically, symptoms such as pain, tenderness and joint swelling were common. According to the Shimizu classification, the incomplete type was the most common (67.8%). The symptoms improved after conservative treatment, but 12 cases (21.0%) recurred within one year. Arthroscopic synovectomy was performed in 2 cases, but these cases showed no improvement.
CONCLUSION
Behcet's arthritis should be differentiated from rheumatoid arthritis, and conservative treatment showed good clinical results.

Keyword

Arthritis; Behcet's disease

MeSH Terms

Arthritis
Arthritis, Rheumatoid
Humans
Joints
Knee Joint

Figure

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  Fig. 1 Radiological finding of Behçet's arthritis shows only soft tissue swelling and joint space widening to joint effusion. Articular surfaces show no specific finding.

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  Fig. 2 Histological finding of Behçet's arthritis. Lymphatic vasculitis is noted (H-E stain, ×100).

Reference

1. Addy M, Tapper-Johns L, Seal M. Trial of astringent and antibacterial mouthwashes in the management of recurrent aphthous ulceration. Br Dent J. 1974. 136:452–455.

2. Agata T, Nakae K, Naeda K, Aoki K, Mizushima Y. Lehner T, Barnes CG, editors. The epidemiological features and trends of Behçet's disease, in Japan from 1972 to 1985. Recent advances in Behçet's disease. 1986. London: Royal Society of Medicine Service;187–198.

3. Arbesfeld SJ, Kurban AK. Behçet's disease. J Am Acad Dermatol. 1988. 19:767–779.

4. Bang D, Lee S, Kim DH, Nam IW. Investigation of cell-mediated immunity in patients with Behçet's syndrome using the DNCB sensitization. Kor J Dermatol. 1985. 23:769–773.

5. Behçet H. Der rezidivierende, aphthose, durch ein virus verursachte Geschwere an Mund, am Auge, und an den Genitalien. Dermatol Wchnschr. 1937. 105:1152–1157.

6. Chajek T, Fainaru M. Behçet's disease with decreased fibrinolyses and superior vena caval obstruction. Br Med J. 1973. 1:782–783.

7. Chajek T, Fainaru M. Behçet's disease: reports of 41 cases and a review of the literature. Medicine. 1975. 54:179–196.

8. Cho MY, Lee SH, Bang DS, Lee SN. Epidemiologic findings of Behçet's syndrome. Kor J Dermatol. 1988. 26:320–329.

9. Choi EH, Bang DS, Lee SH, Lee ES, Lee SN. Epidemiologic findings of Behçet's syndrome. 1991. Yonsei University.

10. Corley CC, Lessner HE, Larsen WE. Azathioprine therapy of autoimmune disease. Am J Med. 1966. 41:404–412.

11. Denman AM, Hylton W, Pelton BK, Palmer RG, Topper R, Burchenell CS. Lehner T, Barnes CG, editors. The viral aetiology of Behçet's syndrome. Recent advances in Behçet's disease. 1986. London: Royal Society of Medicine Service;23–30.

12. Eun HC, Chung H, Choi SJ. Clinical Analysis of 114 Behçet's disease. Kor J Med. 1984. 27:933–937.

13. Feigenbaum A. Description of Behçet's syndrome in the Hippocratic third book of endemic disease. Br J Ophthalmol. 1956. 40:355–357.

14. Gamble CM, Weisner KB, Shapiro RF, Boyer WJ. The immune complex pathogenesis of glomerulonephritis and pulmonary vasculitis in Behçet's disease. Am J Med. 1979. 66:1031–1039.

15. Haim S. The pathogenesis of lesions of Behçet's disease. Clin Exp Immunol. 1978. 34:213–218.

16. Hills EA. Behçet's syndrome with aortic aneurysms. Br Med J. 1967. 4:152–154.

17. Hooks JJ. Possibility a viral etiology in recurrent aphthous ulcers and Behçet's syndrome. J Oral Pathol. 1978. 7:365–371.

18. Houba V, Bardfeld R. Serum immunoglobulin in juvenile rheumatoid arthritis. Ann Rheum Dis. 1969. 28:55–57.

19. Hrncir Z, Tichy M, Varina J. Immunoglobulins A.G. and M in synovial fluid in rheumatoid arthritis: Reactive synovitis of local origin and in post mortem synovial fluid. Ann Rheum Dis. 1972. 31:325–329.

20. Ishikawa S, Miyata M, Fujiwara N, Hori Y, Nakamo K, Miyazawa S, Morohoshi Y. Dilsen N, Konice M, Ovnl C, editors. Experimental "muco-cutaneo-enterogenital syndrome" in pedigreed miniature swine (toxicological study). Behçet's disease. 1979. Amsterdam-Oxford: Excerpta Medica.

21. James DG. Behçet's syndrome. N Engl J Med. 1979. 301:431–432.

22. Jorizzo JL, Hudsson RT, Schmalsteg FC, et al. Behçet's syndrome: immune regulation, circulating immune complexes, neutrophil migration and colchicine therapy. J Am Acad Dermatol. 1978. 10:205–214.

23. Kaneco F, Koneda T, Ohnishi O. Behçet's disease and bacterial infections allergy. Jpn J Allergol. 1978. 27:440–451.

24. Kim HJ, Lee SH, Lee SN, Kim SM. A clinical analysis of 7 patients with neuro-Behçet's syndrome. Kor J Dermatol. 1987. 25:91–97.

25. Lee S, Koh YJ, Kim DH, et al. A study of HLA antigens in Behçet's syndrome. Yonsei Med J. 1988. 29:259–262.

26. Lee YP, Cho CH, Chi HS, Kim BR, Lee KS. Intestinal Behçet's disease. Kor J Surg. 1988. 35:310–315.

27. Lehner T. Behçet's syndrome and autoimmunity. Br Med J. 1967. 1:465–467.

28. Lehner T. Characterization of mucosal antibodies in recurrent ulceration and Behçet's syndrome. Arch Oral Biol. 1969. 14:843–853.

29. Lehner T, Batchelor IR, Challacombe SJ, Kennedy L. An immunogenic basis for the tissue involvement in Behçet's syndrome. Immunology. 1979. 37:895–900.

30. Lever WF, Schaumburg-Lever G. Systemic disease with cutaneous manifestations. Histopathology of the skin. 1991. 7th ed. Philadelphia: J.B. Lippincott Co.;213–214.

31. Mamo JG, Bughdassarian A. Behçet's disease. Arch Ophthalmol. 1964. 71:4–14.

32. Mason RM, Barnes CG. Behçet's syndrome with arthritis. Ann Rheum Dis. 1969. 28:95–103.

33. Min HW, Cho SY, Chun SI, Bang DS. A case of Behçet's syndrome associated with the superior vena cava syndrome. Kor J Med. 1986. 30:401–407.

34. Mineshita S, Ogino T, Shimizu T. Zinc therapy in Behçet's disease. In proceedings of an international symposium on Behçet's disease. 1977. 301–304.

35. Mortada A, Imam IZE. Virus aetiology of Behçet's syndrome. Br J Ophthalmol. 1964. 48:250–259.

36. Namba K. Lehner T, Barnes CG, editors. Behçet's disease and streptococcal infection. Recent advances in Behçet's disease. 1986. London: Royal Society of Medicine Service;79.

37. O'Duffy JD, Goldstein NP. Neurologic involvement in seven patients with Behçet's disease. Am J Med. 1976. 61:170–176.

38. Ohno S. Lehner T, Barnes CG, editors. Behçet's disease in the world. Recent advances in Behçet's disease. 1986. London: Royal Society of Medicine Service;181–186.

39. Oshima Y, Shimizu T, Yokohari R, et al. Clinical studies on Behçet's syndrome. Ann Rheum Dis. 1963. 22:36–45.

40. Ruddy S, Austin KF. The complement system in rheumatoid arthritis: an analysis of complement component activities in rheumatoid synovial fluid. Arthritis Rheum. 1970. 13:713–723.

41. Shimizu T, Ehrlich GE, Inaba G, Hayashi K. Behçet's disease. Semin Arthritis Rheum. 1979. 8:223–260.

42. Su WPP, Chin SI, Lee S. Cutaneous lesions in Behçet's syndrome (abstract). J Cutan Pathol. 1987. 373.

43. Yamamoto S, Toyokawa H, Matsubara H, et al. A nationwide survey of Behçet's disease in Japan. Jap J Ophthalmol. 1974. 18:282–290.

44. Yurdakul S, Yazici H, Tuzun Y, et al. The arthritis of Behçet's disease: a prospective study. Ann Rheumatol Dis. 1983. 42:505–515.

45. Wong RC, Ellis CN, Diaz LA. Behçet's disease. Int J Dermatol. 1984. 23:25–32.