Medication can be essential to treating the symptoms of Behcet’s syndrome, which may come and go unpredictably, with periods of active symptoms, or flares, and periods of dormancy when symptoms disappear, known as remissions. NYU Langone rheumatologists prescribe medications based on your symptoms. The goal is to keep inflammation and painful symptoms in check for as long as possible.
The primary goal of most treatment for Behcet’s syndrome is to reduce inflammation. A doctor may prescribe a combination of anti-inflammatory medications called corticosteroids and immune-suppressing medications, which work together to help control the inflammation.
The types of corticosteroids and immunosuppressants, which usually come in pill form, prescribed depend on the severity of the disease and the parts of the body involved. People typically take a combination of these medications for several months or until symptoms subside. Side effects of corticosteroids include weight gain, heartburn, and high blood pressure.
To control symptoms during flare ups, doctors may also prescribe different topical medicines, depending on the part of the body involved. If a person has skin lesions or genital sores, a doctor may prescribe a topical skin cream, gel, or ointment to reduce swelling and pain. These medications usually contain a corticosteroid medication, such as prednisone, to reduce inflammation, and an anesthetic to relieve pain.
For people who find that topical medications don’t control skin lesions or genital sores, doctors may prescribe a medication called colchicine. Symptoms of arthritis may also improve with colchicine. People take this medication by mouth in pill form daily and usually continue it as a long-term treatment for the condition. Side effects include upset stomach, and, rarely, muscle pains, low numbers of blood cells, and thinning hair.
Most people with Behcet’s syndrome have painful, recurrent mouth ulcers. A doctor may prescribe special mouthwashes that contain corticosteroids and pain relievers to soothe mouth sores. Immunosupressive medications may be needed to control symptoms if topical measures are not enough.
If a person has inflammation in the eyes, doctors may prescribe eye drops containing corticosteroids or other anti-inflammatory medicines, such as the immune-suppressing medication azathioprine, to relieve pain and restore and preserve vision.
Anti-TNF medications block a substance called tumor necrosis factor, or TNF, which may play a role in triggering inflammation in people with Behcet’s syndrome. Doctors prescribe infliximab or adalimumab to treat eye conditions caused by Behcet’s syndrome or etanercept to treat skin lesions and mouth sores, usually in combination with azathioprine.
Doctors may recommend these anti-TNF medications for people who have not responded to routine corticosteroids and immunosuppressants or those with more severe complications, such as aneurysms in the arteries of the lungs. These medications are given either through a vein with an intravenous (IV) infusion or as an injection.
Side effects may include headache, skin rash, and increased risk for infections.
Medication can help put Behcet’s syndrome into remission, a period of time when the signs and symptoms of the condition disappear. But symptoms can return, or flare up, at any time, and it’s impossible to predict when that might happen. After treatment, most people stay in remission with no major symptoms related to Behcet’s. Sometimes flare-ups happen when people stop treatment or when doctors lower medication doses in an attempt to avoid side effects.
To maintain remission, you may take immunosuppressants with or without corticosteroids for several years. During this time, your doctor works with you to taper off corticosteroids or to lessen the dosage. Most people respond well to this course of treatment, enter remission, and eventually stop taking medication for long periods.
Behcet’s syndrome is a disease that improves with increasing age, and many people achieve medication-free remission with time.
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