Skip to main content

Adamantiades-Behçet’s Disease

  • Chapter
  • First Online:
Auto-Inflammatory Syndromes
  • 950 Accesses

Abstract

Adamantiades-Behçet disease (ABD) is a distinct, chronic, relapsing systemic inflammatory disorder. ABD is not the typical autoinflammatory disease and should be viewed as a condition linking autoinflammation and autoimmunity classified among the primary systemic vasculitides. ABD exists worldwide, but it is more prevalent across the ancient trading route known as the “Silk Road”, i.e. in countries of the Mediterranean Basin, the Middle East and the Far East. The clinical spectrum is diverse, with significant differences in the prevalence of clinical manifestations between ethnic groups. Diagnosis is entirely clinical and in the absence of other explanations is based on the presence of recurring oral ulcerations (aphthous or herpetiform) at least three times in a 12-month period, plus at least any two of the following: recurrent genital aphthous ulceration or scarring, inflammation of the anterior and/or the posterior eye pole, skin lesions (erythema nodosum, pseudofolliculitis, papulopustular lesions or acneiform nodules in postadolescent patients not on corticosteroids) and a positive pathergy test (non-specific skin hyperreactivity in response to minor trauma). Intestinal, joint and central nervous system involvement and vascular thrombosis and formation of arterial aneurysms also frequently occur. Morbidity and mortality are significant; ocular involvement results in blindness if left untreated in more than 70% of those affected. Treatment should be individualized balancing the risks of therapy with the putative efficacy of a given approach. For self-limited manifestations, the aim is to control symptoms. The prompt use of immunosuppressive agents, including anti-TNF monoclonal antibodies, is mandatory for vital organ involvement.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 139.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Arida A, Vaiopoulos G, Markomichelakis N, Kaklamanis P, Sfikakis PP. Are clusters of patients with distinct clinical expression present in Behçet’s disease? Clin Exp Rheumatol. 2009;27(2 Suppl 53):S48–51.

    CAS  PubMed  Google Scholar 

  2. Arida A, Fragiadaki K, Giavri E, Sfikakis PP. Anti-TNF agents for Behçet disease: analysis of published data on 369 patients. Semin Arthritis Rheum. 2011;41:61–70.

    Article  CAS  Google Scholar 

  3. Arida A, Sfikakis PP. Anti-cytokine biologic treatment beyond anti-TNF in Behçet’s disease. Clin Exp Rheumatol. 2014;32(4 Suppl 84):S149–55.

    PubMed  Google Scholar 

  4. Burillo-Sanz S, Montes-Cano MA, García-Lozano JR, Ortiz-Fernández L, Ortego-Centeno N, García-Hernández FJ, Espinosa G, Graña-Gil G, Sánchez-Bursón J, Rosa Juliá M, Solans R, Blanco R, Barnosi-Marín AC, Gómez De la Torre R, Fanlo P, Rodríguez-Carballeira M, Rodríguez-Rodríguez L, Camps T, Castañeda S, Alegre-Sancho JJ, Martín J, González-Escribano MF. Mutational profile of rare variants in inflammasome-related genes in Behçet disease: a next generation sequencing approach. Sci Rep. 2017;7(1):8453.

    Article  Google Scholar 

  5. Criteria for diagnosis of Behcet’s disease: international study group for Behcet’s disease. Lancet. 1990;335:1078–80.

    Google Scholar 

  6. Curnow SJ, Pryce K, Modi N, Knight B, Graham EM, Stewart JE, Fortune F, Stanford MR, Murray PI, Wallace GR. Serum cytokine profiles in Behçet’s disease: is there a role for IL-15 in pathogenesis? Immunol Lett. 2008;121(1):7–12.

    Article  CAS  Google Scholar 

  7. Dalghous AM, Freysdottir J. Fortune F Expression of cytokines, chemokines, and chemokine receptors in oral ulcers of patients with Behcet's disease (BD) and recurrent aphthous stomatitis is Th1-associated, although Th2-association is also observed in patients with BD. Scand J Rheumatol. 2006;35(6):472–5.

    Article  CAS  Google Scholar 

  8. Diri E, Mat C, Hamuryudan V, Yurdakul S, Hizli N, Yazici H. Papulopustular skin lesions are seen more frequently in patients with Behçet’s syndrome who have arthritis: a controlled and masked study. Ann Rheum Dis. 2001;60(11):1074–6.

    Article  CAS  Google Scholar 

  9. Elezoglou AV, Sfikakis PP, Vaiopoulos G, Kapsimali V, Kaklamanis PG. Serum levels of soluble TNF-alpha receptor-II (P75), circulating gamma delta T-cells and Adamantiades-Behçet’s disease activity. Adv Exp Med Biol. 2003;528:261–5.

    Article  CAS  Google Scholar 

  10. Elezoglou A, Kafasi N, Kaklamanis PH, Theodossiadis PG, Kapsimali V, Choremi E, Vaiopoulos G, Sfikakis PP. Infliximab treatment-induced formation of autoantibodies is common in Behçet’s disease. Clin Exp Rheumatol. 2007;25(4 Suppl 45):S65–9.

    CAS  PubMed  Google Scholar 

  11. Emmi G, Silvestri E, Bella CD, Grassi A, Benagiano M, Cianchi F, Squatrito D, Cantarini L, Emmi L, Selmi C, Prisco D, D'Elios MM. Cytotoxic Th1 and Th17 cells infiltrate the intestinal mucosa of Behcet patients and exhibit high levels of TNF-α in early phases of the disease. Medicine (Baltimore). 2016;95(49):e5516.

    Article  CAS  Google Scholar 

  12. Gül A, Inanç M, Ocal L, Aral O, Koniçe M. Familial aggregation of Behçet’s disease in Turkey. Ann Rheum Dis. 2000;59(8):622–5.

    Article  Google Scholar 

  13. Gul A, Ohno S. HLA-B*51 and Behçet Disease. Ocul Immunol Inflamm. 2012;20:37–43.

    Article  CAS  Google Scholar 

  14. Hatemi G, Fresko I, Tascilar K, Yazici H. Increased enthesopathy among Behçet’s syndrome patients with acne and arthritis: an ultrasonography study. Arthritis Rheum. 2008;58(5):1539–45.

    Article  Google Scholar 

  15. Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gul A, Houman MH, Kotter I, Olivieri I, Salvarani C, Sfikakis PP, Siva A, Stanford MR, Stubiger N, Yurdakul S, Yazici H. EULAR recommendations for the management of Behcet disease. Ann Rheum Dis. 2008;67:1656–62.

    Article  CAS  Google Scholar 

  16. Hatemi G, Melikoglu M, Tunc R, Korkmaz C, Turgut Ozturk B, Mat C, Merkel PA, Calamia KT, Liu Z, Pineda L, Stevens RM, Yazici H, Yazici Y. Apremilast for Behçet’s syndrome–a phase 2, placebo-controlled study. N Engl J Med. 2015;372(16):1510–8.

    Article  CAS  Google Scholar 

  17. Kalra S, Silman A, Akman-Demir G, Bohlega S, Borhani-Haghighi A, Constantinescu CS, Houman H, Mahr A, Salvarani C, Sfikakis PP, Siva A, Al-Araji A. Diagnosis and management of Neuro-Behçet’s disease: international consensus recommendations. J Neurol. 2014;261(9):1662–76.

    Article  Google Scholar 

  18. Koné-Paut I, Shahram F, Darce-Bello M, Cantarini L, Cimaz R, Gattorno M, Anton J, Hofer M, Chkirate B, Bouayed K, Tugal-Tutkun I, Kuemmerle-Deschner J, Agostini H, Federici S, Arnoux A, Piedvache C. Ozen S; PEDBD group. Consensus classification criteria for paediatric Behçet’s disease from a prospective observational cohort: PEDBD. Ann Rheum Dis. 2016;75(6):958–64.

    Article  Google Scholar 

  19. Kural-Seyahi E, Fresko I, Seyahi N, Ozyazgan Y, Mat C, Hamuryudan V, Yurdakul S, Hl Y. The long-term mortality and morbidity of Behçet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center. Medicine (Baltimore). 2003;82:60–76.

    Article  Google Scholar 

  20. Lopalco G, Lucherini OM, Lopalco A, Venerito V, Fabiani C, Frediani B, Galeazzi M, Lapadula G, Cantarini L. Iannone F Cytokine signatures in mucocutaneous and ocular Behçet’s disease. Front Immunol. 2017;8:200. https://doi.org/10.3389/fimmu.2017.00200. eCollection 2017.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Markomichelakis NN, Theodossiadis PG, Pantelia E, Papaefthimiou S, Theodossiadis GP, Sfikakis PP. Infliximab for chronic cystoid macular edema associated with uveitis. Am J Ophthalmol. 2004;138(4):648–50.

    Article  CAS  Google Scholar 

  22. Markomichelakis N, Delicha E, Masselos S, Fragiadaki K, Kaklamanis P, Sfikakis PP. A single infliximab infusion vs corticosteroids for acute panuveitis attacks in Behçet’s disease: a comparative 4-week study. Rheumatology (Oxford). 2011;50(3):593–7.

    Article  CAS  Google Scholar 

  23. Markomichelakis N, Delicha E, Masselos S, Sfikakis PP. Intravitreal infliximab for sight-threatening relapsing uveitis in Behçet disease: a pilot study in 15 patients. Am J Ophthalmol. 2012;154(3):534–41.

    Article  CAS  Google Scholar 

  24. Markomichelakis NN, Aissopou EK, Maselos S, Tugal-Tutkun I, Sfikakis PP. Biologic treatment options for retinal neovascularization in Behçet’s disease. Ocul Immunol Inflamm. 2017;12:1–7. https://doi.org/10.1080/09273948.2017.1332228. [Epub ahead of print].

    Article  CAS  Google Scholar 

  25. McGonagle D, McDermott MF. A proposed classification of the immunological diseases. PLoS Med. 2006;3(8):e297.

    Article  Google Scholar 

  26. Mendoza-Pinto C, García-Carrasco M, Jiménez-Hernández M, Jiménez Hernández C, Riebeling-Navarro C, Nava Zavala A, Vera Recabarren M, Espinosa G, Jara Quezada J, Cervera R. Etiopathogenesis of Behcet’s disease. Autoimmun Rev. 2010;9:241–5.

    Article  CAS  Google Scholar 

  27. Mizuki N, Meguro A, Ota M, Ohno S, Shiota T, Kawagoe T, Ito N, Kera J, Okada E, Yatsu K, Song YW, Lee EB, Kitaichi N, Namba K, Horie Y, Takeno M, Sugita S, Mochizuki M, Bahram S, Ishigatsubo Y, Inoko H. Genome-wide association studies identify IL23R-IL12RB2 and IL10 as Behçet’s disease susceptibility loci. Nat Genet. 2010;42:703–6.

    Article  CAS  Google Scholar 

  28. Özdemir FT, Demiralp EE, Aydın SZ, Atagündüz P, Ergun T, Direskeneli H. Immune and inflammatory gene expressions are different in Behçet’s disease compared to those in Familial Mediterranean Fever. Eur J Rheumatol. 2016;3(4):146–52.

    Article  Google Scholar 

  29. Protogerou AD, Sfikakis PP, Stamatelopoulos KS, Papamichael C, Aznaouridis K, Karatzis E, Papaioannou TG, Ikonomidis I, Kaklamanis P, Mavrikakis M, Lekakis J. Interrelated modulation of endothelial function in Behcet’s disease by clinical activity and corticosteroid treatment. Arthritis Res Ther. 2007;9(5):R90.

    Article  Google Scholar 

  30. Remmers EF, Cosan F, Kirino Y, Ombrello MJ, Abaci N, Satorius C, et al. Genome-wide association study identifies variants in the MHC class I, IL10, and IL23R-IL12RB2 regions associated with Behçet’ disease. Nat Genet. 2010;42:698–702.

    Article  CAS  Google Scholar 

  31. Saadoun D, Wechsler B, Desseaux K, Le Thi HD, Amoura Z, Resche-Rigon M, Cacoub P. Mortality in Behcet’s disease. Arthritis Rheum. 2010;62:2806–12.

    Article  CAS  Google Scholar 

  32. Sfikakis PP. The first decade of biologic TNF antagonists in clinical practice: lessons learned, unresolved issues and future directions. Curr Dir Autoimmun. 2010;11:180–210.

    Article  CAS  Google Scholar 

  33. Sfikakis PP, Theodossiadis PG, Katsiari CG, Kaklamanis P, Markomichelakis NN. Effect of infliximab on sight-threatening panuveitis in Behçet’s disease. Lancet. 2001;358:295–6.

    Article  CAS  Google Scholar 

  34. Sfikakis PP. Behçet’s disease: a new target for anti-tumour necrosis factor treatment. Ann Rheum Dis. 2002;61(Suppl 2):ii51–3.

    Article  Google Scholar 

  35. Sfikakis PP, Kaklamanis PH, Elezoglou A, Katsilambros N, Theodossiadis PG, Papaefthimiou S, Markomichelakis N. Infliximab for recurrent, sight-threatening ocular inflammation in Adamantiades-Behçet disease. Ann Intern Med. 2004;140(5):404–6.

    Article  CAS  Google Scholar 

  36. Sfikakis PP, Markomichelakis N, Alpsoy E, Assaad-Khalil S, Bodaghi B, Gul A, et al. Anti-TNF therapy in the management of Behcet’s disease: review and basis for recommendations. Rheumatology (Oxford). 2007;46:736–41.

    Article  CAS  Google Scholar 

  37. Sfikakis PP, Arida A, Panopoulos S, Fragiadaki K, Pentazos G, Laskari K, Tektonidou M, Markomichelakis N. Drug-free long-term remission in severe Behcet’s disease following withdrawal of successful anti-TNF treatment. Arthritis Rheumatol. 2017; https://doi.org/10.1002/art.40235. [Epub ahead of print].

    Article  CAS  Google Scholar 

  38. Sugita S, Kawazoe Y, Imai A, Kawaguchi T, Horie S, Keino H, Takahashi M, Mochizuki M. Role of IL-22- and TNF-α-producing Th22 cells in uveitis patients with Behcet’s disease. J Immunol. 2013;190(11):5799–808.

    Article  CAS  Google Scholar 

  39. Vaiopoulos AG, Sfikakis PP, Kanakis MA, Vaiopoulos G, Kaklamanis PG. Gastrointestinal manifestations of Behçet’s disease: advances in evaluation and management. Clin Exp Rheumatol. 2014;32(4 Suppl 84):S140–8.

    PubMed  Google Scholar 

  40. Wu Z, Zhang S, Li J, Chen S, Li P, Sun F, Wen X, Zheng W, Zhang F, Li Y. Association between MEFV mutations M694V and M680I and Behçet’s disease: a meta-analysis. PLoS One. 2015;10(7):e0132704. https://doi.org/10.1371/journal.pone.0132704. eCollection 2015.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Yazici H, Fresko I, Yurdakul S. Behcet’s syndrome: disease manifestations, management, and advances in treatment. Nat Clin Pract Rheumatol. 2007;3:148–55.

    Article  Google Scholar 

  42. Yazici H, Pazarli H, Barnes CG, Tuzun Y, Ozyazgan Y, Silman A, Serdaroglu S, Oguz V, Yurdakul S, Lovatt GE, et al. A controlled trial of azathioprine in Behcet’s syndrome. N Engl J Med. 1990;322:281–5.

    Article  CAS  Google Scholar 

  43. Yazici H, Seyahi E, Yurdakul S. Behcet’s syndrome is not so rare: why do we need to know? Arthritis Rheum. 2008;58:3640–3.

    Article  Google Scholar 

  44. Zouboulis CC, Keitel W. A historical review of early descriptions of Adamantiades- Behcet’s disease. J Invest Dermatol. 2002;119:201–5.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Petros P. Sfikakis .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Sfikakis, P.P. (2019). Adamantiades-Behçet’s Disease. In: Efthimiou, P. (eds) Auto-Inflammatory Syndromes. Springer, Cham. https://doi.org/10.1007/978-3-319-96929-9_21

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-96929-9_21

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-96928-2

  • Online ISBN: 978-3-319-96929-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics