Behçet's Disease

Behçet's is markedly more common in Türkiye than in Western Europe, and our physicians see it regularly rather than occasionally. That matters for an international patient who has struggled to have the diagnosis recognised at home.

It is diagnosed clinically — there is no single confirmatory test — from the pattern of recurrent oral ulceration together with genital ulcers, eye inflammation, skin lesions or a positive pathergy test.

The arthritis of Behçet's is usually non-erosive and affects knees, ankles and wrists. It responds to the same principles as other inflammatory arthritis: maintain range during a flare, restore strength between flares, and protect the joint from the deconditioning that follows weeks of inactivity.

Where there has been neurological involvement — parenchymal neuro-Behçet's — rehabilitation follows the same structure as after other acquired brain injury, with gait, balance and cognitive work planned to what the lesion left behind.

Pathergy — the tendency of skin to react excessively to minor trauma — means needling techniques, adhesive taping and anything that breaks skin are used with care or avoided. Dry needling in particular is not our first choice in a patient with active pathergy.

Deep vein thrombosis is more common in this disease than in the general population. New calf swelling is investigated before any lower limb loading programme continues.

Injections and procedures carry a specific risk in Behçet’s: the pathergy phenomenon, where skin trauma provokes an inflammatory lesion at the site.

Vascular involvement and thrombosis are also more common, which changes what is appropriate around swelling and limb symptoms. New calf pain is assessed rather than treated as muscular.

Treatment is matched to the organs involved. For mouth and genital ulcers, skin lesions and arthritis, the 2025 European recommendations use colchicine first, with apremilast or immunosuppressive drugs such as tumour necrosis factor (TNF) inhibitors when it is not enough 2. Eye, blood-vessel, nervous-system and gut involvement is treated more aggressively, with glucocorticoids and immunosuppressives, to bring it under control quickly 2. For clots in the veins, the evidence supports immunosuppressive treatment, while the added value of blood thinners remains unclear 3.

The same recommendations stress that Behçet’s relapses and remits, and call for a multidisciplinary team, patient education and shared decisions 2. Rehabilitation fits inside that plan. It cannot prevent flares or protect the eyes, but it keeps joints moving and muscles strong between flares, rebuilds walking, balance and daily function after neurological or vascular events, and works around the skin’s reaction to needles and the higher risk of clots.