Behcet’s Syndrome

Multisystem, inflammatory, relapsing chronic disorder – originally described as a triple symptom complex of recurrent oral and genital ulcers and relapsing iritis. More common in Japan (prevalence of 1/1000), the Middle East and the Mediterranean – rare in UK. M=F. Peak age of onset in late 30’s. Has been associated with HLA-B51, but its presence is not related to severity .

Clinical features:
Recurrent painful oral and/or genital ulcers (75% start with oral ulcers) – usually accompanied with fever and fatigue. 25% develop thromboblebitis. Peripheral venous occlusion can occur (12%) (vascular involvement is predominantly venous). CNS lesions can occur due to thromboembolic cerebrovascular events. Mean time between the appearance of the first and second symptom is 6 years
Joint symptoms (in 60%) – non-destructive - most commonly knees and ankles – insidious onset of pain swelling and morning stiffness - effusions
The foot is involved in about 10% of cases – can have heel pain.
Natural history is of exacerbation and remissions.

It has been noted that plantar heel pain can be a presenting feature .
“Chilblain” like lesions have been reported .\

http://www.thefootjournal.com/article/S0958-2592(15)00003-6/abstract
http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=47216

Differential diagnosis – Reiter’s syndrome, Stevens-Johnson syndrome, SLE, Crohn’s disease, ulcerative colitis, ankylosing spondylitis.

Treatment:
Local management of oral ulcers and eye disease.
NSAID’s and aspiration for joint disease.
Corticosteroids and immunosuppressives (especially if sight-threatening eye disease).

External Links:
Foot Arthritis in Behçet's disease (Podiatry Arena)

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