Behçet's disease diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
Currently, there is not a specific test to confirm the diagnosis of Behçet's disease. It is diagnosed clinically by specific patterns of symptoms and repeated outbreaks obtained by a thorough history of the patient's symptoms (outlined below). | Currently, there is not a specific test to confirm the diagnosis of Behçet's disease. It is diagnosed clinically by specific patterns of symptoms and repeated outbreaks obtained by a thorough history of the patient's symptoms (outlined below). Behçet's disease is a diagnosis of exclusion, and other [[Chronic (medical)|chronic]] [[Inflammation|inflammatory]] diseases should be evaluated for. The various [[Inflammation|inflammatory]] symptoms do not necessarily occur together, and they will vary in severity. | ||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
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=== Study of choice === | === Study of choice === | ||
* The pathergy test should be performed when:<ref name="pmid7582698">{{cite journal| author=Ferraz MB, Walter SD, Heymann R, Atra E| title=Sensitivity and specificity of different diagnostic criteria for Behçet's disease according to the latent class approach. | journal=Br J Rheumatol | year= 1995 | volume= 34 | issue= 10 | pages= 932-5 | pmid=7582698 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7582698 }} </ref> | * The pathergy test should be performed when:<ref name="pmid7582698">{{cite journal| author=Ferraz MB, Walter SD, Heymann R, Atra E| title=Sensitivity and specificity of different diagnostic criteria for Behçet's disease according to the latent class approach. | journal=Br J Rheumatol | year= 1995 | volume= 34 | issue= 10 | pages= 932-5 | pmid=7582698 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7582698 }} </ref> | ||
** The patient presented with symptoms of vision problems, mouth sores, and genital ulcers | ** The patient presented with symptoms of [[Visual impairment|vision problems]], mouth [[Sore|sores]], and [[Genital ulcer|genital ulcers]]. | ||
** A positive | ** A positive pathergy reaction (papule >2 mm dia. 24-48 hrs or more after needle-prick) is detected in the patient. | ||
* | * Behçet disease is mainly diagnosed based on clinical presentation. | ||
==Diagnostic Criteria== | ==Diagnostic Criteria== | ||
There are three levels of certainty for diagnosis: | There are three levels of certainty for diagnosis: | ||
*International Study Group diagnostic guidelines (very strict for research purposes) | |||
*Practical clinical diagnosis (generally agreed pattern but not as strict) | |||
*'Suspected' or 'Possible' diagnosis (incomplete pattern of symptoms) | |||
*International Criteria for Behçet's disease (ICBD) | |||
===International Study Group diagnostic guidelines=== | ===International Study Group diagnostic guidelines (ISGD)=== | ||
The ISGD guidelines recommend the following:<ref name="pmid1970380">{{cite journal| author=| title=Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. | journal=Lancet | year= 1990 | volume= 335 | issue= 8697 | pages= 1078-80 | pmid=1970380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1970380 }} </ref><ref name="pmid10568894">{{cite journal| author=Smith EL, Shmerling RH| title=The American College of Rheumatology criteria for the classification of systemic lupus erythematosus: strengths, weaknesses, and opportunities for improvement. | journal=Lupus | year= 1999 | volume= 8 | issue= 8 | pages= 586-95 | pmid=10568894 | doi=10.1191/096120399680411317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10568894 }} </ref> | The ISGD guidelines recommend the following:<ref name="pmid1970380">{{cite journal| author=| title=Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease. | journal=Lancet | year= 1990 | volume= 335 | issue= 8697 | pages= 1078-80 | pmid=1970380 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1970380 }} </ref><ref name="pmid10568894">{{cite journal| author=Smith EL, Shmerling RH| title=The American College of Rheumatology criteria for the classification of systemic lupus erythematosus: strengths, weaknesses, and opportunities for improvement. | journal=Lupus | year= 1999 | volume= 8 | issue= 8 | pages= 586-95 | pmid=10568894 | doi=10.1191/096120399680411317 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10568894 }} </ref> | ||
*Must have oral ([[aphthous]]) ulcers (any shape, size or number at least 3 times in any 12 months), along with 2 out of the next 4 "hallmark" symptoms: | *Must have oral ([[aphthous]]) ulcers (any shape, size or number at least 3 times in any 12 months), along with 2 out of the next 4 "hallmark" symptoms: | ||
* | **Genital ulcers (including [[anal]] ulcers and spots in the genital region and swollen [[testicle]]s or [[epididymitis]] in men) | ||
*[[ | **[[Skin]] [[lesion]]s (papulo-pustules, [[folliculitis]], [[erythema nodosum]], [[acne]] in post-adolescents not on corticosteroids) | ||
*[[ | **[[Eye]] inflammation (iritis, uveitis, retinal vasculitis, cells in the vitreous) | ||
* | **Pathergy reaction (papule >2 mm diameter 24-48 hrs or more after needle-prick) | ||
===Practical clinical diagnosis=== | ===Practical clinical diagnosis=== | ||
The practical clinical diagnosis for | The practical clinical diagnosis for Behçet disease recommend the following:<ref name="pmid7582698">{{cite journal| author=Ferraz MB, Walter SD, Heymann R, Atra E| title=Sensitivity and specificity of different diagnostic criteria for Behçet's disease according to the latent class approach. | journal=Br J Rheumatol | year= 1995 | volume= 34 | issue= 10 | pages= 932-5 | pmid=7582698 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7582698 }} </ref> | ||
*[[ | *[[Mouth]] ulcers, along with 1 of the 4 hallmark symptoms above and with 2 of the symptoms below: | ||
*[[ | **[[Arthritis]]/[[arthralgia]] | ||
*[[ | **[[Nervous system]] symptoms | ||
*[[ | **[[Stomach]] and/or [[bowel]] inflammation | ||
* | **Deep [[vein]] [[thrombosis]] | ||
* | **Superficial thrombophlebitis | ||
* | **[[Cardio]]-[[vascular]] problems of [[Inflammation|inflammatory]] origin | ||
* | **[[Inflammation|Inflammatory]] problems in [[chest]] and [[lungs]] | ||
* | **Problems with [[Hearing (sense)|hearing]] and/or balance | ||
* | **Extreme exhaustion | ||
* | **Changes of personality, [[psychoses]] | ||
* | **Any other members of the family with a diagnosis of Behçet disease | ||
==='Suspected' or 'Possible' diagnosis=== | ==='Suspected' or 'Possible' diagnosis=== | ||
Usually assigned when someone does not have mouth ulcers, or has mouth ulcers but does not have 1 of the 4 hallmark symptoms but has other symptoms and signs of inflammation, and other causes for these have been ruled out. | Usually assigned when someone does not have mouth ulcers, or has [[Oral ulcer|mouth ulcers]] but does not have 1 of the 4 hallmark symptoms but has other [[Symptom|symptoms]] and [[Medical sign|signs]] of [[inflammation]], and other causes for these have been ruled out. | ||
===International Criteria for Behçet's disease (ICBD)=== | ===International Criteria for Behçet's disease (ICBD)=== | ||
The International Criteria for Behçet's disease (ICBD) were developed in 2006 | *The International Criteria for Behçet's disease (ICBD) were developed in 2006 and require a total of at least three points for diagnosis of Behçet syndrome:<ref name="pmid21961081">{{cite journal| author=Davatchi F| title=Diagnosis/Classification Criteria for Behcet's Disease. | journal=Patholog Res Int | year= 2012 | volume= 2012 | issue= | pages= 607921 | pmid=21961081 | doi=10.1155/2012/607921 | pmc=3180812 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21961081 }} </ref> | ||
**[[Genital skin lesions|Genital]] aphthosis – 2 points | |||
**[[Ocular]] lesions ([[Uveitis|anterior uveitis]], posterior [[uveitis]], or [[retinal]] [[vasculitis]]) – 2 points | |||
**[[Mouth|Oral]] aphthosis – 1 point | |||
**[[Skin lesion|Skin lesions]] ([[Pseudofolliculitis barbae|pseudofolliculitis]] or [[erythema nodosum]]) – 1 point | |||
**[[Vascular]] lesions (superficial [[Thrombophlebitis|phlebitis]], [[deep vein thrombosis]], large [[Venous thromboembolism|vein thrombosis]], [[arterial thrombosis]], or [[aneurysm]]) – 1 point | |||
**Pathergy – 1 point | |||
*[[Sensitivity (tests)|Sensitivity]] of 87 to 96.5 percent and [[Specificity (tests)|specificity]] of 88.9 to 97.3 percent<ref name="pmid21961081">{{cite journal| author=Davatchi F| title=Diagnosis/Classification Criteria for Behcet's Disease. | journal=Patholog Res Int | year= 2012 | volume= 2012 | issue= | pages= 607921 | pmid=21961081 | doi=10.1155/2012/607921 | pmc=3180812 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21961081 }} </ref> | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category: | |||
[[Category:Medicine]] | |||
[[Category:Up-To-date]] | |||
[[Category:Dermatology]] | [[Category:Dermatology]] | ||
[[Category:Rheumatology]] | [[Category:Rheumatology]] | ||
Latest revision as of 20:35, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hamid Qazi, MD, BSc [2]
Overview
Currently, there is not a specific test to confirm the diagnosis of Behçet's disease. It is diagnosed clinically by specific patterns of symptoms and repeated outbreaks obtained by a thorough history of the patient's symptoms (outlined below). Behçet's disease is a diagnosis of exclusion, and other chronic inflammatory diseases should be evaluated for. The various inflammatory symptoms do not necessarily occur together, and they will vary in severity.
Diagnostic Study of Choice
Study of choice
- The pathergy test should be performed when:[1]
- The patient presented with symptoms of vision problems, mouth sores, and genital ulcers.
- A positive pathergy reaction (papule >2 mm dia. 24-48 hrs or more after needle-prick) is detected in the patient.
- Behçet disease is mainly diagnosed based on clinical presentation.
Diagnostic Criteria
There are three levels of certainty for diagnosis:
- International Study Group diagnostic guidelines (very strict for research purposes)
- Practical clinical diagnosis (generally agreed pattern but not as strict)
- 'Suspected' or 'Possible' diagnosis (incomplete pattern of symptoms)
- International Criteria for Behçet's disease (ICBD)
International Study Group diagnostic guidelines (ISGD)
The ISGD guidelines recommend the following:[2][3]
- Must have oral (aphthous) ulcers (any shape, size or number at least 3 times in any 12 months), along with 2 out of the next 4 "hallmark" symptoms:
- Genital ulcers (including anal ulcers and spots in the genital region and swollen testicles or epididymitis in men)
- Skin lesions (papulo-pustules, folliculitis, erythema nodosum, acne in post-adolescents not on corticosteroids)
- Eye inflammation (iritis, uveitis, retinal vasculitis, cells in the vitreous)
- Pathergy reaction (papule >2 mm diameter 24-48 hrs or more after needle-prick)
Practical clinical diagnosis
The practical clinical diagnosis for Behçet disease recommend the following:[1]
- Mouth ulcers, along with 1 of the 4 hallmark symptoms above and with 2 of the symptoms below:
- Arthritis/arthralgia
- Nervous system symptoms
- Stomach and/or bowel inflammation
- Deep vein thrombosis
- Superficial thrombophlebitis
- Cardio-vascular problems of inflammatory origin
- Inflammatory problems in chest and lungs
- Problems with hearing and/or balance
- Extreme exhaustion
- Changes of personality, psychoses
- Any other members of the family with a diagnosis of Behçet disease
'Suspected' or 'Possible' diagnosis
Usually assigned when someone does not have mouth ulcers, or has mouth ulcers but does not have 1 of the 4 hallmark symptoms but has other symptoms and signs of inflammation, and other causes for these have been ruled out.
International Criteria for Behçet's disease (ICBD)
- The International Criteria for Behçet's disease (ICBD) were developed in 2006 and require a total of at least three points for diagnosis of Behçet syndrome:[4]
- Genital aphthosis – 2 points
- Ocular lesions (anterior uveitis, posterior uveitis, or retinal vasculitis) – 2 points
- Oral aphthosis – 1 point
- Skin lesions (pseudofolliculitis or erythema nodosum) – 1 point
- Vascular lesions (superficial phlebitis, deep vein thrombosis, large vein thrombosis, arterial thrombosis, or aneurysm) – 1 point
- Pathergy – 1 point
- Sensitivity of 87 to 96.5 percent and specificity of 88.9 to 97.3 percent[4]
References
- ↑ 1.0 1.1 Ferraz MB, Walter SD, Heymann R, Atra E (1995). "Sensitivity and specificity of different diagnostic criteria for Behçet's disease according to the latent class approach". Br J Rheumatol. 34 (10): 932–5. PMID 7582698.
- ↑ "Criteria for diagnosis of Behçet's disease. International Study Group for Behçet's Disease". Lancet. 335 (8697): 1078–80. 1990. PMID 1970380.
- ↑ Smith EL, Shmerling RH (1999). "The American College of Rheumatology criteria for the classification of systemic lupus erythematosus: strengths, weaknesses, and opportunities for improvement". Lupus. 8 (8): 586–95. doi:10.1191/096120399680411317. PMID 10568894.
- ↑ 4.0 4.1 Davatchi F (2012). "Diagnosis/Classification Criteria for Behcet's Disease". Patholog Res Int. 2012: 607921. doi:10.1155/2012/607921. PMC 3180812. PMID 21961081.