Behçet’s Disease
Description
● Introduction:
➣ The traditional triad—oral aphthae + genital ulcers + uveitis—was initially defined in 1937 by Turkish dermatologist Hulusi Behçet. Historical note: ➣ Hippocrates' works from the fifth century BC contained comparable descriptions.
➣ Epidemiology:
• Turkey has the greatest incidence worldwide.
• Rare in Western countries: UK (0.64/100,000), USA (0.12–0.33/100,000).
➣ Onset: Peak age 20–30 years.
• Earlier onset → more severe, multi-organ involvement.
➣ Nature: Chronic, recurrent, multisystem inflammatory disease of unknown cause (possible viral/autoimmune).
● Behçet's Disease Clinical Features:
→ Mucocutaneous Manifestations (BD hallmark)
➣ In more than 95% of instances, oral ulcers are the initial symptom (80%).
• Painful, frequent, and leaves scars.
• Types include Herpetiform (clustered), Minor (less than 1 cm), and Major (more than 1 cm, deep, scarring).
➣ Genital ulcers are similar to oral ulcers, but they are deeper, less frequent, and can form scars. They are common in the scrotum in men and the labia majora in women, and they can result in fistulas.
➣ Skin abnormalities (48–88%):
• Lower limb erythema nodosum.
• Lesions called papulopustular.
• Serum thrombophlebitis and vasculitic lesions.
● Involvement of the Eye (30–70%)
More common among men.
➣ includes retinal vasculitis, hypopyon, iridocyclitis, and iritis.
➣ It can cause blindness in 25% of patients and is frequently bilateral.
● Additional Systemic Signs
Neurological (5–10%): psychosis, psychiatric symptoms, and meningoencephalitis.Vascular
• The two most prevalent types are superficial thrombophlebitis and deep vein thrombosis.
• More prevalent in men.
➣45–60% of joints:
• Arthritis or arthralgia that is non-deforming and non-erosive.
•Involves the hips, wrists, ankles, and knees.
The digestive system (3–26%):
• In Japan, more prevalent.
• Perforation, colitis, ulcers.
Although rare, renal, respiratory, and cardiac involvement has been documented.
● Discussion:
→ The classic triad is present: eye lesions, genital ulcers, and oral ulcers.
→ Erythema nodosum, arthritis-like symptoms, and systemic inflammation are associated characteristics.
➣ Pemphigus vulgaris is one of the differentiators taken into account.
• Multiforme erythema.
• Vulvar ulcers that are acute.
• Behçet's Disease (oculo-bucco-genital syndrome) was diagnosed based on the patient's medical history, clinical symptoms, and laboratory results.
● Presentation of the Case:
➣ Patient: a married 29-year-old mother of three.
➣ History:
• Persistently painful mouth ulcers (lower lip, tongue) for a year.
• Provided partial relief through symptomatic treatment (antibiotics, vitamin C, and antiseptics).
• Three months later, several people had severe, painful, recurring, and scarred genital ulcers.
• Eye involvement: iridocyclitis, chronic recurrent conjunctivitis.
• Skin lesions: Lower limb erythema nodosum (hyperpigmentation, papules).
➣ Examining:
• Erosion of the oral mucosa.
•Genital mucosa: round ulcer (1 x 1 cm), erosion close to the vaginal introitus, and post-ulceration scarring of the labia.
• Skin: bilateral legs with erythema nodosum.
➣ Lab results:
• Mild anaemia (Hb 74%).
Additionally, leukocytosis (14.3 × 10⁹/L).
• Increased C3 complement and IgA.
Anti-DNA antibodies that are positive.
• Urine: bacteriuria and pyuria.
• Enterococcus, E. coli, and Staphylococcus aureus vaginal/ulcer swabs.
Chronic recurrent conjunctivitis is an ophthalmology condition.
➣Corticosteroids are the treatment administered.
• Antibiotics (vaginal geonistin, erythromycin, and nystatin).
• Supplementing with vitamin C.
• A notable improvement in symptom alleviation.
Protocol
● Management
➣ Objectives:
• Induce and sustain remission.
• Prevent irreversible consequences, such as blindness, and relapses.
Enhance the standard of living.
➣ Approaches to treatment:
• Local: Silver nitrate, corticosteroid ointments, and local anaesthetics.
• Systemic:
→ Biologics (anti-TNF, interferon-α) for resistant cases;
→ Immunosuppressants (azathioprine, cyclophosphamide, cyclosporine); → Colchicine, Dapsone;
→ Corticosteroids.
• Supportive: In certain situations, gamma globulin, vitamin C, and antibiotics.
● Issues Met
• High rates of readmission to the hospital as a result of worsening symptoms are common among patients with heart failure.
• A higher chance of death and severe physical restrictions.
• Decreased quality of life, encompassing exhaustion, dyspnoea, and mental anguish.
● Management Techniques
→Symptom management is one of the comprehensive nursing treatments. Nurses keep an eye on vital signs, identify early signals of deteriorating heart failure, and take prompt action to avoid readmissions.
•Education: Nurses provide patients and their families with information on diet, activity limitations, fluid balance, and medications.
• Psychosocial support: Counselling is offered to promote mental health by managing depression and anxiety.
• Care coordination: Nurses help patients, families, and diverse healthcare professionals communicate, which guarantees follow-up visits and treatment plan compliance.
● Important Nursing Interventions
➣ Reduction of Fluid Overload:
• Track fluid levels using daily weights and intake-output records.
•As directed, limit sodium and fluid intake to two to three grammes per day and two to three litres per day, respectively.
•Take prescription diuretics as directed and keep an eye out for any negative effects.
➣Management of Symptoms and Activities:
• Evaluate and treat dyspnoea (shortness of breath), using more oxygen if necessary.
• To foster tolerance without causing undue exhaustion, promote rest intervals with active times.
• Balance activities based on patient tolerance and teach energy-saving strategies.
➣ Patient education and counselling:
• Explain the significance of taking medications as prescribed and the function of each drug.
• Instruct students in self-monitoring techniques, such as daily weight checks, fluid recognition, and when to alert the medical staff.
• Provide guidance on managing fluid intake and dietary constraints.
•Offer advice on quitting alcohol and tobacco, controlling weight, and managing comorbid conditions like diabetes and hypertension.
•If prescribed, describe the significance of using sleep apnoea devices.
➣ Psychosocial Support:
• Provide counselling and emotional support to address sadness, anxiety, or anxieties associated with the diagnosis and treatment of heart failure.
➣Discharge and Transition Planning:
• Clearly explain to the patient how to take their medications, what to eat, how to stay active, and when to schedule follow-up appointments.
At discharge, schedule nurse-led education sessions, which have been demonstrated to increase adherence and lower readmission rates.
➣ Care Coordination
To guarantee continuity and efficacy of care, coordinate with doctors, cardiologists, chemists, and other members of the multidisciplinary team.
•Throughout hospitalisation and after release, keep in constant contact with any changes in requirements or symptoms.
➣Continuous Monitoring Following Discharge: Nurses frequently follow up by phone or in person to confirm education, look for issues, and make sure care plans are being followed.
Notes
For more details visit 10.3889/oamjms.2018.393