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How to recognise a Behçet’s ulcer from other types of oral ulceration? Defining Behçet’s ulceration by an International Delphi Consultation

1, 2, 3, 4, 5, 6, 7
Collaborator/s: G. Hatemi1, D. Bang2, C. Chams-Davatchi3, Y. Yazici4, R. Kucukoglu5, G. Mumcu6, J. Nowatzky7, D. Saadoun8, B. Bodaghi9, A. Richards10, B. Rajlawat11, J.G. Ovalles-Bonilla12, J. Higham13, R. Ariyaratnam14, R. Albuquerque15

 

  1. Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham; School of Dentistry, Institute of Medical and Dental Sciences, College of Medical and Dental Sciences, University of Birmingham; and Birmingham Dental Hospital, Birmingham Community Health Foundation Trust, Birmingham, UK. p.g.ana@bham.ac.uk
  2. School of Dentistry, Institute of Medical and Dental Sciences, College of Medical and Dental Sciences, University of Birmingham; Birmingham’s NIHR BRC in Inflammation Research, University of Birmingham; and Birmingham Dental Hospital, Birmingham Community Health Foundation Trust, Birmingham, UK.
  3. Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, UK.
  4. School of Dentistry, Institute of Medical and Dental Sciences, College of Medical and Dental Sciences, University of Birmingham, UK.
  5. Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, and Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
  6. Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, and Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
  7. Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, UK.

  1. Division of Rheumatology, Department of Internal Medicine and Behçet's Disease Research Center, Istanbul University - Cerrahpasa, Istanbul, Turkey.
  2. Department of Dermatology, Yonsei University College Medicine, Seoul, Republic of Korea.
  3. Behçet’s Disease Unit, Rheumatology Research Centre, Shariati Hospital, Tehran University of Medical Sciences; and Department of Dermatology, Autoimmune Bullous Diseases Research Centre, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran.
  4. Division of Rheumatology, New York University School of Medicine, New York, NY, USA.
  5. Division of Dermatology, Istanbul University, Istanbul Medical Faculty, Turkey.
  6. Oral Medicine, Istanbul University, Istanbul Medical Faculty, Turkey.
  7. New York University School of Medicine, USA.
  8. Internal Medicine, Groupe Hospitalier Pitié Salpétrière, Service de Médecine Interne, DHU i2B, Paris, France.
  9. Service d'Ophthalmologie, Sorbonne University, Paris, France.
  10. Department of Oral Medicine, Birmingham Dental Hospital, School of Dentistry, UK.
  11. Oral Medicine, Liverpool Dental Hospital, School of Dentistry, UK.
  12. Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
  13. Oral Medicine, Birmingham Dental Hospital, School of Dentistry, UK.
  14. Oral Medicine, Manchester Dental Hospital, School of Dentistry, UK.
  15. Consultant in Oral Medicine, Guy’s Hospital, London, UK.

Behçet's Disease Expert Panel

CER16442
2023 Vol.41, N°10
PI 2048, PF 2055
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PMID: 37902271 [PubMed]

Received: 06/12/2022
Accepted : 27/03/2023
In Press: 30/10/2023
Published: 30/10/2023

Abstract

OBJECTIVES:
To define the clinical characteristics of oral ulceration (OU) in Behçet’s disease (BD), to allow differentiation from other causes of OU, including aphthous ulcers, by an International Delphi consultation. To develop a clinical guideline on how to recognise BD ulcers.
METHODS:
Round 1. 40 clinical images of OU in BD, recurrent aphthous stomatitis (RAS), inflammatory bowel disease (IBD) and mucous membrane pemphigoid (MMP) were shown. Participants answered, independently, which images would be consistent with a BD ulcer. Round 2. The results from marking independently were shown. The panel remarked the questions through iteration process. The images not agreed to be a possible BD ulcer were discarded. Round 3. 10 clinical descriptors that may define BD ulcers were suggested. Participants ranked the level of importance for each descriptor on each image presented. Round 4. Participants re-ranked their level of agreement for each descriptor through iteration process. Whether the clinical pictures would be different from RAS was also explored. A final agreement was reached.
RESULTS:
This study has shown clear differentiation between BD, IBD and MMP ulcers when defining them by phenotype through clinical images only. On the other hand, no differentiation between RAS and BD ulcers was found. The most important clinical descriptors that define BD ulcers have been agreed.
CONCLUSIONS:
New clinical guidance for Health Care Professionals (HCP) on how to recognise a BD ulcer has been proposed. This should elucidate an earlier diagnosis, quicker access to treatment and control of the disease enhancing patient’s quality of life.

DOI: https://doi.org/10.55563/clinexprheumatol/joeacu

Rheumatology Article

Rheumatology Addendum