Etiopathogenic Therapeutic Strategies in Behcet's Disease, with Ocular Complications

Behcet's disease is a chronic, relapsing inflammatory condition with evolving primary non-necrotizing, occlusive, arterial, and venous vasculitis with unpredictable inflammatory episodes followed by remissions and sequelae.

Idiopathic, multi-systemic Behcet's disease has a complex symptomatology manifested by skin lesions with recurrent oral and genital ulcerations, ocular, cardiovascular, neurological, articular, gastrointestinal manifestations. Ocular manifestations in Behcet's disease with non-granulomatous anterior uveitis with hypopyon, recurrent, possibly complicated with secondary glaucoma, posterior uveitis with retinal vasculitis in a young man with an acute course. Visual prognosis in Behcet's syndrome is reserved by the recurrent evolution of ocular manifestations and is associated with complications and sequelae. Treatment in Behcet's disease must be individualized, preventive and curative to improve clinical manifestations to suppress the exacerbation of the inflammatory process, prevent recurrences and serious adverse evolution of the disease. Local (topical, periocular, intravitreal) and systemic (oral, intravenous) corticosteroid treatment alone or associated with colchicine, interferon alfa, cyclosporine, azathioprine with possible side effects. Periodically evaluated immunosuppressive treatment is an effective therapeutic alternative in Behcet's syndrome.

Biologic therapy with TNF-alfa inhibitors can reduce disease signs immediately and significantly, can reduce the dose of immunosuppressant, and is effective in young men with severe disease progression. The treatment of the ocular manifestations of Behcet's disease is initially with local and systemic corticosteroids alone or combined with immunosuppressants (azathioprine, cyclosporine), the second line of therapy interferon alfa, TNF-alfa inhibitors, the third line of treatment: methotrexate, mycophenolate mofetil, cyclophosphamide, rituximab (minimum treatment 2 years with periodic reassessment of inflammation). Cutaneous mucosal lesions require local treatment with solutions, ointments, creams with glucocorticoids diluted on the lesion and systemic treatment with colchicine, corticosteroids, immunosuppressants, interferon alfa 2b, TNF-alfa inhibitors, apremilast for recurrent lesions, biological agents, joint lesions requires colchicine, azathioprine in recurrent attacks, TNF-alfa inhibitors, IFN alfa in severe forms, neurological determinations benefit from corticosteroid therapy associated with immunosuppressants (azathioprine), TNF-alfa inhibitors or cyclophosphamide in severe forms, IFN, methotrexate, mycophenolate mofetil in selected cases, deep vein thrombosis is difficult to treat with immunosuppressants, debatably associated or NOT with anticoagulants. Behcet's disease with explosive onset, with unpredictable evolution, requires complex treatment with drug combinations with corticoids, immunosuppressants, biological agents that alleviate the disease, but with limited cure. Behcet's disease remains a very serious disease, which must be treated interdisciplinary for a long time, with evolution with complications and sequelae, sometimes even vital.