Medicine and treatment

The disease's management may involve ophthalmologists, rheumatologists, dermatologists, gastroenterologists, neurologists, and immunologists. It is necessary that these doctors all work closely together to provide the best care for the patient with Behcet. Attending physicians must take care to educate their patients regarding disease manifestations, long-term prognosis and medication side effects. If an attending physician seems unfamiliar with the disease, its treatment or medications, it is the patient's right and obligation to insist on seeing an experienced specialist. 

For children, a pediatric rheumatologist is preferable, with other consultations depending on signs and symptoms. 

Eye testing is usually recommended for all patients in 6 month intervals by an ophthalmologist experienced with Behcet's disease.

Medical Care: Although multiple therapeutic modalities have been employed for Behcet disease, treatment is far from satisfactory. Treatment of Behcet disease is symptomatic and empirical, and must be tailored to each patient's clinical manifestations. It is aimed toward individual symptoms as they occur. Medication is given to reduce the inflammatory response, as well as frequency and severity of recurrences.
Therapeutic efficacy has been difficult to evaluate due to the variable course of the disease and the limited number of cases for clinical investigation. Moreover, it appears some side-effects of the drugs used in treatment may be similar to certain manifestations of the disease, making it nearly impossible to differentiate between the two. The goal of treatment is decreasing morbidity and mortality.

Choice of medications depends on a patient's clinical manifestations. Ocular, CNS, and large vessel involvement is often given priority in terms of treatment.  Corticosteroids are considered palliative; they are useful in controlling acute manifestations, but progression of CNS and ocular disease may occur in patients treated with corticosteroids alone. Many physicians believe that the best results are obtained by using a combination of drugs, such as, in the example of ocular involvement, corticosteroids with either cytotoxic agents or cyclosporine. Drug side effects and efficacy should be monitored closely.

Patients should receive follow-up care as needed.  

  • Systemic therapy

    There is no single effective drug.

    In Japan, colchicine is considered the drug of choice because of its few side effects and because of the presumed poor long-term prognosis of systemic corticosteroids. It is also commonly prescribed in Israel. When colchicine fails to limit recurrences in eye patients, treatment is switched to or combined with cyclosporine.

    Corticosteroids are the mainstay of treatment for all the various clinical manifestations of Behcet disease. Although they have a beneficial effect on acute manifestations, there is no definite evidence that they are effective in controlling progression of Behcet disease, and they do not prevent dementia or blindness. In Japan, systemic corticosteroids are not used for ocular disease. This decision is based upon the findings of several retrospective studies that show long-term visual outcomes to be worse in patients who receive systemic corticosteroids compared to those who did not! The steroid side effects that can result from long-term use must be considered.  

    Mucocutaneous lesions and arthritis have been treated with nonsteroidal antiinflammatory drugs (NSAIDS), zinc sulfate, levamisole, colchicine, dapsone or sulfapyridine and thalidomide (use is strictly limited because of its teratogenicity). Immunosuppressive therapy with azathioprine, chlorambucil or cyclophosphamide has been used, and is sometimes considered effective in the long term, although side-effects can be severe.

    Uveitis and central nervous system involvement is treated with systemic corticosteroids, azathioprine or cyclosporine. The ophthalmology department in Haddassah, Jerusalem was the first group in the world to assess the benefits of cyclosporine A for the eye manifestations in Behcet's disease. 

    Anticoagulants are given to patients with thromboses. 

    Chlorambucil, cyclophosphamide and azathioprine are the cytotoxic agents used most commonly for treatment of Behcet disease. Chlorambucil was the first cytotoxic drug to be used in the treatment of ocular Behcet disease. Cyclophosphamide is superior to corticosteroids in the control of ocular inflammation in Behcet disease, but profound bone marrow toxicity limits its usage. Since cyclophosphamide acts faster and is more toxic than chlorambucil, its use is reserved for very refractory cases. Azathioprine is a mercaptopurine derivative that is effective in the treatment of Behcet disease. All of these cytotoxic agents may produce variable degrees of bone marrow suppression and may affect reproductive organs resulting in azoospermia and amenorrhea. A decade of taking these drugs has been reported to induce cancer in a large percentage of patients.

    Recent therapeutic approaches for Behcet disease have included cyclosporine (CYA), thalidomide, interferon alpha, interferon gamma, acyclovir, high-dose corticosteroids or cyclophosphamide pulse therapy and FK506 (an immunosuppressive agent similar to cyclosporine).

    FK506 is a recent disappointment. The Japanese FK506 Study Group reported that FK506 was effective in treating refractory uveitis in a dosage-dependent manner. The side effects most often reported were renal impairment (28.3%), neurological symptoms (20.8%), gastrointestinal symptoms (18.9%) and hyperglycemia (13.2%). The study group also noted the need for further clinical investigations on FK506 before more widespread application, and results yielded by those were not enough to convince the Japanese Health and Welfare ministry to include it under the national insurance, as it did not seem to differ much from CYA. However, topical use of this drug has been reported as useful by a BIG member.

    • Surgical Care:

    Consultations:

     

    Medication

    Israel

    The goal of pharmacotherapy is to reduce morbidity and prevent complications, suppress inflammation, prevent sequelae and minimize the systemic side effects of treatment. Corticosteroids have been used for all the various clinical manifestations of Behcet disease. Anti-inflammatory and immunosuppressive agents have been used to treat mucocutaneous lesions and arthritis associated with this disease. Anticoagulants are administered to patients with thromboses.

    Overall, no safe and conclusive treatment exists for patients with Behcet disease. The treatment regimen is usually tailored to the severity and extent of disease in each individual case.

    The following is by no means a full list of drugs for use in Behcet Disease, rather a sample of some of the more commonly used medications. Before using any of these, you should consult with your attending physician. This site is not responsible for any problems resulting from the use of any of these or other medications (see disclaimer).

    WARNING:
    Most of the drugs used to treat Behcet syndrome are immunosuppressive, with associated risk of serious life-threatening infections that patients should be warned about. In addition, cytotoxics increase the risk of malignancy, and communication of these risks should be clearly delineated and documented in the medical record. (This warning is a legal advice as it appears in a medical textbook for Medical Doctors; please make sure both your practitioner and yourself are well familiar with the possible adverse effects of any medicine taken before beginning to use it).
    Drug Category: Immunomodulators - Anti-inflammatory agents that modulate the immune system through a variety of mechanisms, thus decreasing the autoimmune symptoms characteristic of Behcet disease. Immunomodulators do not, however, cause the generalized immunosuppression characteristic of immunosuppressive drugs.

    Colchicine (Acetycol, Colsalide) - Not a truly immunomodulator and sometimes classified as an anti-inflammatory agent. Colchicine is a plant alkaloid that interferes with microtubule function, which results in dysfunction of neutrophils. It decreases leukocyte motility and phagocytosis in inflammatory responses; inhibits cellular microtubule formation and may cause a transient leukopenia, followed by leukocytosis. Use in autoimmune disease primarily is empiric, and mechanism of action in decreasing inflammation is not clear, but may have to do with decreased motility of leukocytes. Used to prevent recurrent attacks. Colchicine may be used with other drugs and may enable the disease to be controlled using lower doses of immunosuppressants. First line therapy for oral ulcerations, ocular manifestations, and skin lesions. This medication is useful in decreasing frequency of mucosal ulcerations, the skin findings of pseudofolliculitis and erythema nodosum-like lesions, and can be useful in the management of uveitis and retinal vasculitis. Contraindicated in pregnancy. Please check for other precautions and drug interactions with your physician.

    Sulfasalazine (Azulfidine) - A conjugate of 2 drugs, sulfapyridine and 5-aminosalicylic acid, which originally was developed for the treatment of rheumatoid arthritis. Enteric coated pills may decrease gastrointestinal adverse effects. Usually considered safe in pregnancy as long as benefits outweigh the risks. Please check for other precautions and drug interactions with your physician.

    Dapsone (Avlosulfon) - May be useful for erythema nodosum and genital ulcers. In the US, it is not approved for this use, but it is  approved for the treatment of dermatitis herpetiformis (and leprosy). Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Levamisole (Ergamisol) - An immunomodulator approved for the treatment of colon cancer. Restores immune function and stimulates T-cell activation and proliferation and monocyte function. Stimulates neutrophil chemotaxis, adhesion, and mobility. Used to treat genital and aphthous ulcers. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Tacrolimus FK506 (Prograf, Tacrine) - Immunomodulator produced by the bacteria Streptomyces tsukubaensis. Sometimes classified as immunosuppressant, it suppresses humoral immunity (T-lymphocyte) activity. Mechanisms of action similar to cyclosporine (see below). Primarily used in transplants, but used in Behcet disease to treat uveitis. Usually considered safe in pregnancy as long as benefits outweigh the risks. Please check for other precautions and drug interactions with your physician.

    Thalidomide (Thalidomid) -- Immunomodulatory agent, whose mode of action is not fully known, that may suppress excessive production of tumor necrosis factor-alpha (TNF-alpha) and may downregulate selected cell-surface adhesion molecules involved in leukocyte migration. Used for aphthous ulcerations and also may be effective in erythema nodosum lesions. Contraindicated in pregnancy. Please check for other precautions and drug interactions with your physician.This drug has many severe side-effects, and must not be taken prior to full understanding of possible consequences. 
    See also Thalidomide- the story of a Behcet patient and Tahlidomide neuropathy by Dr. Colin Crawford.
     
    Drug Category: Antibiotics - May be immunomodulatory. Physicians who prescribe these believe that empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting, and that antibiotic selection should be guided by blood culture sensitivity whenever feasible. Sometimes these drugs are prescribed to deal with adverse side-effects of immunosuppressive agents (see below). Supplementation with probiotics is recommended for the duration of antibiotic treatment and a minimum of two weeks thereafter in order to prevent complications of candida type pathogens.
     
    Tetracycline (Sumycin) - Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s). Has anti-inflammatory activity. Used topically or systematically. Unsafe in pregnancy. Please check for other precautions and drug interactions with your physician.
     
    Drug Category: Antiulcer agents - Topical treatment for aphthae.
     
    Amlexanox (Aphthasol) - 5% paste. Topical mucosal anti-inflammatory agent, the exact mechanism of action remains unknown.
    Treatment normally begins as soon as patient notices symptoms. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.
     
    Sucralfate (Carafate, Sulcrate) - Forms viscous adhesive substance that protects GI lining against pepsin, peptic acid, and bile salts. Use for short-term management of ulcers. Usually considered safe in pregnancy as long as benefits outweigh the risks. Please check for other precautions and drug interactions with your physician.

    Drug Category: Corticosteroids - Modify the body's immune response to diverse stimuli and therefore have anti-inflammatory properties and cause profound and varied metabolic effects. In addition, these agents modify the body's immune response to diverse stimuli. May be used orally or parenterally for systemic symptoms, topically for ulcers or ocular involvement, or intra-articularly for arthritis. Corticosteroids are immunosuppressive and effect the replication, movement, and activity of virtually all cells involved with inflammation. They may decrease acute inflammatory manifestations. Systemic corticosteroids are not useful in the long-term management of Behcet disease. Some doctors use corticosteroids as initial therapy including in mild cases, while other authorities state that there is no role for corticosteroids in the treatment of this disease. Systemic corticosteroids should be used only for short periods of time and some believe in combination with immunosuppressive therapy. Topical or sub-Tenon corticosteroids have proven effective. Please make sure your prescribing physician is aware of all other medications taken. These are prescribed drugs with many severe side-effects. If you feel unwell upon taking any of these medications, please consult your physician immediately. Sudden discontinuation of steroidal therapy must be avoided, as it is very dangerous, and can even lead to death. 

    Prednisone (Deltasone, Orasone, Meticorten, Sterapred) - Immunosuppressant for treatment of autoimmune disorders; may decrease inflammation by reversing increased capillary permeability and suppressing PMN (polymorphoneuclear) activity. Stabilizes lysosomal membranes and also suppresses lymphocytes and antibody production. Decreases release of inflammatory mediators, monocytes, neutrophil migration, and T-cell function. Used in smallest dose for shortest duration to achieve therapeutic effect, and/or in combination with immunosuppressive therapy; also in a pulse mode intravenously. Another doctrine: Low-dose, second-line therapy for erythema nodosum-like lesions, anterior uveitis, retinal vasculitis, and arthritis. High-dose, first-line therapy for GI lesions, acute meningoencephalitis, chronic progressive CNS lesions and arthritis; second-line treatment for retinal vasculitis and venous thrombosis. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Methylprednisolone (Medrol, Solu-Medrol) - Used as first-line therapy for acute meningoencephalitis, chronic progressive CNS lesions, and arteritis. Decreases release of inflammatory mediators, monocytes, neutrophil migration, and T-cell function. Alternate therapy for GI lesions and venous thrombosis. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Hydrocortisone (Solu-Cortef) - Decreases inflammation by suppressing migration of polymorphonuclear leukocytes and reversing increased capillary permeability. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Prednisolone acetate 1% (Pred Forte) - Treats acute inflammations following eye surgery or other types of insults to eye. Useful for acute iritis. Decreases inflammation and corneal neovascularization. Suppresses migration of polymorphonuclear leukocytes and reverses increased capillary permeability. In cases of bacterial infections, concomitant use of anti-infective agents is mandatory; signs and symptoms should improve after 2 days if effective. Tapering must be done gradually.  Useful for acute iritis as initial frequent dosing followed by gradual tapering. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Triamcinolone acetonide ointment (Aristocort, Flutex, Kenalog) - Topical treatment is useful to decrease the pain and inflammation of oral ulcers. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Betamethasone ointment (Alphatrex, Diprolene, Maxivate) - Useful to decrease the pain and inflammation of genital ulcers. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Dexamethasone injectable (Decadron) - Indicated for retinal vasculitis, injected below the Tenon capsule for an ocular attack. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Drug Category: Nonsteroidal Anti-inflammatory agents (NSAIDS) - Systemically interfere with events leading to inflammation. Although most NSAIDs are used primarily for their anti-inflammatory effects, they are effective analgesics and are useful for the relief of mild to moderate pain. Most are prescription drugs, and although not as strong as steroids can still have significant side-effects. Please consult with your attending physician before using any of them.

    Ibuprofen (Ibuprin, Advil, Motrin) - DOC (Drug Over the Counter) for mild-to-moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis. Usually considered safe in pregnancy as long as benefits outweigh the risks; however, it is categorised as unsafe in the third trymester. Please check for other precautions and drug interactions with your physician.

    Naproxen (Anaprox, Naprelan, Naprosyn) - For relief of mild-to-moderate pain; inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which is responsible for prostaglandin synthesis. Usually considered safe in pregnancy as long as benefits outweigh the risks; however, it is categorised as unsafe in the third trymester. Please check for other precautions and drug interactions with your physician.

    Ketoprofen (Oruvail, Orudis, Actron) - For relief of mild to moderate pain and inflammation. Small dosages are indicated initially in patients with small body size, the elderly, and those with renal or liver disease. Doses > 75 mg do not increase therapeutic effects. Usually considered safe in pregnancy as long as benefits outweigh the risks; however, it is categorised as unsafe in the third trymester. Please check for other precautions and drug interactions with your physician.

    Drug Category: Immunosuppressive agents (most also Cytotoxic agents) - Indicated for the treatment of autoimmune diseases. Used to treat acute attacks, to reduce frequency of recurrences, and for the more serious long-term effects of Behcet, eye, CNS involvement and severe vasculitis. These drugs, like corticosteroids, can have acute side-effects, and a large portion of them is carcinogenic. Please consult with your attending physician before trying any new treatment.  

    Azathioprine (Imuran) - Antagonizes purine metabolism and inhibits synthesis of DNA, RNA, and proteins. Metabolized to 6-mercaptopurine in the liver and red blood cells. May decrease proliferation of immune cells, which results in lower autoimmune activity. Used as alternate therapy for retinal vasculitis, arthritis, chronic progressive CNS lesions, arteritis and venous thrombosis. Unsafe in pregnancy. Please check for other precautions and drug interactions with your physician.

    Chlorambucil (Leukeran) - Aromatic nitrogen mustard derivative, which acts slowly as a bifunctional alkylating agent. Alkylates and cross-links strands of DNA, inhibiting DNA replication and RNA transcription (impaired DNA synthesis, and cell death). Alkylation takes place through the formation of a highly reactive ethylenimonium radical. Probable mode of action involves cross-linkage of the ethylenimonium derivative between 2 strands of helical DNA and subsequent interference with replication. Onset of action is slower than cyclophosphamide. Used as alternate therapy for retinal vasculitis, arthritis, chronic progressive CNS lesions, arteritis and venous thrombosis.  Unsafe in pregnancy. Please check for other precautions and drug interactions with your physician.

    Cyclophosphamide (Cytoxan, Neosar) - Chemically related to nitrogen mustards. Used as a potent alkylating agent that inhibits a variety of cellular functions. Alkylation of DNA results in cross-linking, which may interfere with growth of normal and neoplastic cells, as well as impaired DNA synthesis and cell death. A cell cycle phase nonspecific antineoplastic agent and a pro-drug that requires activation by the cytochrome P-450 system in order to be cytotoxic. DOC (Drug Of Choice) for severe Behcet disease. Used as alternate therapy for retinal vasculitis, arthritis, chronic progressive CNS lesions, arteritis and venous thrombosis. Must be administered by an experienced clinician. Unsafe in pregnancy. Please check for other precautions and drug interactions with your physician.

    Cyclosporine (Sandimmune, Neoral) - Sometimes classified as an immunomodulator. Originally was used for transplant patients, and its use has been expanded to a variety of autoimmune diseases. Potent immunosuppressive agent with narrow therapeutic range, shown to decrease number and severity of attacks of Behcet disease. Inhibits cellular activation, most prominently T lymphocytes, at an early phase without being cytotoxic, although renal complications may occur. Cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cell-mediated immune reactions such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft vs host disease for a variety of organs. Used for uveitis, first-line therapy for retinal vasculitis and effectively limits the frequency of ocular inflammatory attacks in patients who previously had refractory disease. Cyclosporine does not appear to induce permanent immunosuppression; therefore, patients need continuous treatment for many years. However, it is one of few substances capable of crossing the brain-barrier, and can therefore induce CNS symptoms even in patients who previously did not demonstrate them regardless of dosage or duration of use. A rebound phenomenon has been noted after withdrawal of cyclosporine therapy. Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.

    Methotrexate (Folex PFS, Rheumatrex) - Unknown mechanism of action in treatment of inflammatory reactions (although may involve adenosine receptors and cell-cell adhesion); may affect immune function. Ameliorates symptoms of inflammation (e.g., pain, swelling, stiffness). An antimetabolite that interferes with the enzyme dihydrofolate reductase leading to depletion of DNA precursors and inhibition of DNA and purine synthesis, particularly adenosine. Dosage is usually adjusted gradually to attain satisfactory response. Unsafe in pregnancy. Please check for other precautions and drug interactions with your physician.

    Anti TNF-alpha (Tumor Necrosis Factor- alpha) therapy - Originally prescribed for RA patients and later for many more autoimmune diseases, this entry actually represents four different drugs: Remicade (Infliximab), Enbrel (Enteracept), Kineret (Anakinra) and Humira. The 4 forms of anti TNF-alpha therapy differ somewhat in mechanism, and include chimeric monoclonal antibodies, which contain human and mouse components, soluble TNF receptor fragments, which are human in peptide sequence, but artificial in construct, and most recently, human monoclonal antibodies. (Please click here for more information about the differences between them). Elevated levels of TNF-alpha are associated with disease activity. 
    Used for uveitis, joint problems, skin complications and other symptoms, with immediate effects.
    Side effects vary greatly between patients and include immediate and delayed, local and systemic reactions, and may be of severe nature. In some patients treatment had to be discontinured for sensitivity reactions, and in others for developing lupus-like disease (varified by ANA testing). Most common side effects include respiratory problems, rash and general ill-feeling. Life-threatning infections and liver dysfunction have also been reported. More recently this therapy has been implicated in causing lymphoma (please see articles here and here). For more about side effects please click here. For a summary of some of the dangers of this treatment please see article here.
    Safety for use during pregnancy has not been established. Please check for other precautions and drug interactions with your physician.
    For Prof. Ohno's comments about the treatment please click here. For our survey please click here.

     

    Israel- According to Prof. Eldad Ben-Chetrit of Hadassah Medical Centre, the most popularly used drugs in Israel are corticosteroids and colchicine; anticoagulants are used in cases of thromboembolic events; cyclosporin and chlorambucil for the eyes. .In severe cases of systemic involvement in Behcet's anti TNF alfa and beta or soluble TNF receptor are offered, but due to their high price their use is very limited.
     

    Natural medicine

    Since most conventional treatment for BD involves strong drugs and severe side effects, many people feel it is better to use natural medicines to relieve their symptoms and achieve remission.

    As with all other medicine, side effects can still occur, and there can be undesirable interactions between natural medicines and other drugs. Please consult with your attending physician before trying any new therapy.

    General life style - Obviously, we all know the basics of good health. However, I cannot stress how important it is for BD patients to try harder. Flares can occur due to stress, shock, overwork, changes in weather, changes in normal living patterns, vaccinations, cold and other illnesses and many other reasons. Prevention of flares is therefore very important.
    Pollutants from various sources can always harm our body. Organic foodstuffs, clean water and clean air should help.
    Exercising is always difficult to balance in the right amount, too much or too little is potentially harmful. However, reaching that balance is exceedingly important and useful for many patients.

    Shiatsu (acupressure) and acupuncture - these are traditional Japanese and Chinese healing methods, respectively. Shiatsu is pressure applied by fingertips to tsubo (pressure points) that are not necessarily obviously related to the symptom treated. Acupuncture is the same, but instead of pressure, needles are applied. For patients suffering from pathergy, acupuncture is best avoided, but very good results can be obtained by either of these methods.

    Dietary supplements and dietary habits- Low levels of vitamin B-12, iron, calcium and potassium are often associated with BD. Specifically patients with GI involvement are susceptible to vitamin/mineral deficiencies. Supplements are usually taken orally, but in severe iron deficiencies iron-shots or iron-infusion (IV) is administered. The same is true for severe B-12 deficiencies.
    Other potentially useful natural medicines are propolis, pollen, aloe-vera drinks, and foodstuffs with live friendly bacteria (such as acidophilus found in yoghurt) or strong friendly enzymes. Aloe-vera and the foodstuffs mentioned are of particular benefit for patients with gastrointestinal symptoms.
    Many patients find that certain foods trigger flares in them, and that elimination of these can mean anything from some relief to full remission. You can find what triggers it for you by writing a diary of everything that goes in through your mouth and all your symptoms for a few months or as long as needed.
    For Chinese herbal medicines which proved helpful for some BD patients click here.
    For a personal account from a BIG member about his own experience with natural medicines click here.

    Other systemic therapies - these include nutritional medicine (hidden allergies, primarily foods, are identified by blood tests, so the patient can avoid those allergens); enzyme potentiated desensitisation; and homeopathy (an attempt to restore the balance of the system using dilute solutions of natural substances specific to the disorder).

    Topical natural aides - propolis drops and aloe-vera gel for skin lesions (specifically ulcers and acneiform); aloe-vera drink for GI ulcers; tiger balm and similar ointments and creams for joint and muscle pain; and green-tea pads for relieving eye-pain and conjunctivitis and for acneiform lesions.

    For more details about natural medicine and Behcet, please click here.

    For more details about natural medicine in general, please visit The Medical Library

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    (The above material has been amended by the author and does not necessarily reflect the views of the sources)

    Sources

    e-medicine - Behcet Disease - Sungnack Lee, M.D. et al (March 2003)   For up to date medical information, visit emedicine.com

    e-medicine - Behcet Disease - Jeffrey R Lisse, M.D. et al (March 2003)   For up to date medical information, visit emedicine.com

    e-medicine - Behcet Disease - C Egla Rabinovich, M.D. et al (March 2003)   For up to date medical information, visit emedicine.com

    e-medicine - Behcet Disease - Mounir Bashour, M.D. et al (March 2003)   For up to date medical information, visit emedicine.com

    Vanderbilt University Medical Center - Allergy/Immunology - Behcet Disease (June 1998)

    The Doctor's Medical Library - Ron Kennedy, M.D.