Babs wrote to ASA:

Welcome to ASA, although we're all sorry you had to come here.

I'm going to include some information I discovered about
Behcet's/Bechet's.

  Bechet's Disease

   * Overview
   * What is it?
   * What causes it?
   * What are the effects?
   * How is it diagnosed?
   * Treatment options
   * Who is at risk?

   What is it?

Bechet's disease is a chronic condition involving inflammation of
arteries and veins throughout the body. It also causes painful ulcers
in the mouth and on the genitals, inflammation in parts of the eye,
arthritis and skin sores. It is found most commonly along what is known
as the "silk road" - eastern Mediterranean, Middle East and East Asia.
It is rare in the United States. Symptoms can usually be controlled with
proper medication, rest and exercise and many patients eventually will
enter a period of remission.

   What causes it?

Most symptoms of Bechet's disease are caused by inflammation of the
blood vessels. It is thought that an autoimmune reaction, in which the
immune system mistakenly attacks and harms the body?s own tissues,
causes the inflammation. How a person develops this autoimmune disease
is not known. It is believed that abnormalities of the immune system,
perhaps inherited, make some people susceptible to the disease. Then,
something in the environment (possibly a bacterium or virus) triggers or
activates the disease in susceptible people.

   What are the effects?

Bechet's affects each person differently; some will have mild symptoms
while others will have more severe disease. Symptoms can last for a long
time or may disappear in a few weeks. Different symptoms may occur with
each flare. More severe symptoms usually appear months or years after
the initial disease symptoms are noticed.

The five most common symptoms of Behçet?s disease are mouth sores,
genital sores, other skin lesions, eye inflammation and arthritis.
Disease may become more severe over time.

   * *Mouth sores*: Aphthous [pronounced afthus] oral ulcers usually
     are the first and most persistent symptom. They are identical to
     the common canker sore; but in people with Bechet's disease the
     sores tend to be larger and more numerous. They can occur on the
     tongue and inside the lips and cheeks. They usually are very
     painful, make it difficult to eat or swallow and typically
     disperse in 10 to 14 days. Sores often recur and may leave scars.

   * *Genital sores*: While less common, the genital sores are visually
     similar to the mouth ulcers. They are often mistaken for herpes,
     but they are not caused by the herpes virus. Ulcers on the vulva
     or penis can be painful, but those inside the vagina, on the
     cervix or scrotum may not be. The ulcers can leave scars. More
     than half of people with Bechet's get genital ulcers.

   * *Skin lesions*: Red, raised bumps or bruises may appear on the
     legs and the upper torso. Sores may occur when healthy skin is
     scratched or pricked. Alone, they are not distinctive because they
     resemble common boils or acne.

   * *Uveitis and retinal vasculitis*: Uveitis, when the middle or back
     part of the eye becomes inflamed, can cause blurred vision and
     sometimes pain and redness. Uveitis can result in vision loss or
     complete blindness and must be treated immediately. Behcet?s
     disease can also affect the retina, which is the light-sensitive
     layer lining the inside of the eye. This is called retinal
     vasculitis and if left untreated, can result in blindness. Eye
     inflammation occurs in half of all people with Bechet's, more
     often among men than women. It typically begins within two years
     of the disease's first symptoms.

   * *Arthritis*: Inflammation in the knees, ankles, wrists, elbows, or
     hands causes pain, swelling, heat and redness of affected joints.
     Inflammation caused by Behçet?s usually lasts for a few weeks and
     does not result in permanent damage. About one-half of people with
     Behçet?s develop arthritis.

In addition to those five common manifestations, the circulatory system,
central nervous system and digestive tract can be affected by Bechet's
disease.

   * *Circulatory system*: Deep-vein thrombosis (blood clots in the
     deep veins of the legs) is the most common vascular complication.
     Pain, tenderness, warmth and swelling in the leg should be
     reported to your doctor immediately. Aneurysms (balloon-like
     swelling of an artery wall) may also occur.

   * *Central nervous system*: Inflammation of the brain and the
     meninges (membrane that covers the brain and spinal cord) can
     result in stroke if left untreated. Fever, headache, stiff neck
     and difficulty coordinating movement should be reported to your
     doctor immediately.

   * *Digestive tract*: Inflammation and ulceration throughout the
     digestive tract can cause abdominal pain, diarrhea and bleeding.
     These symptoms are similar to those of ulcerative colitis and
     Crohn's disease, so careful evaluation is necessary.

   How is it diagnosed?

Diagnosing Bechet's disease can be quite difficult because no test can
confirm that you have it. Your doctor will examine you and may run tests
to rule out other conditions that cause similar symptoms, such as
Crohn's disease and reactive arthritis. Because it may take several
months or even years for all of the common symptoms to appear, diagnosis
may take a long time. The presence of the following key symptoms will
help your doctor make a diagnosis:

   * Mouth sores at least three times in 12 months

   * Any two of the following symptoms:
         o Recurring genital sores
         o Eye inflammation with loss of vision
         o Characteristic skin lesions (see the symptoms section for
           description)
         o Positive pathergy test. In this test, a doctor pricks your
           skin with a small needle; one to two days after the test,
           people with Bechet's disease may develop a red bump where
           the skin was pricked. This reaction is not common among
           patients in the United States, but if you do have the
           reaction, Bechet's disease is likely.

A dermatologist may perform biopsies of mouth, genital and skin lesions
to help distinguish Bechet's disease from other disorders that cause
similar sores.

   Treatment options

Although a rheumatologist (doctor specializing in arthritis and related
inflammatory diseases) will probably coordinate your care, you may need
to see several different specialists, depending on your symptoms.

   * *Rheumatologist*: treats arthritis and related diseases;
     coordinates care

   * *Gynecologist*: treats genital sores in women

   * *Urologist*: treats genital sores in men

   * *Dermatologist*: treats skin and mucous membrane symptoms, as well
     as genital sores in both sexes

   * *Ophthalmologist*: treats eye inflammation

   * *Gastroenterologist*: treats digestive tract symptoms

   * *Hematologist*: treats circulatory system problems

   * *Neurologist*: treats central nervous system symptoms

Doctors can use medicines to relieve pain, treat symptoms and prevent
such serious complications of Bechet's disease as blindness or
disability from arthritis. When treatment is effective, flares become
less frequent. While there is no cure for Bechet's disease, you may
enter a period of remission. For some people, treatment does not relieve
symptoms, and more serious symptoms and complications may develop. Most
likely a combination of treatments will ease your symptoms.

   * *Topical corticosteroids*: Rinses and gels that contain
     corticosteroids and anesthetics are used to treat mouth sores.
     Creams and ointments are used for genital and skin lesions.

   * *Dapsone*: This oral antibiotic may be prescribed to treat oral or
     genital sores.

   * *Corticosteroids*: Oral steroids may be prescribed to reduce pain
     and inflammation throughout the body. They can be effective for
     treating severe joint pain, skin sores, eye disease and central
     nervous system problems. They are useful in early stages of the
     disease and for treatment during an acute flare. They are not
     generally used for long-term management of the disease.

   * *Azathioprine*: This immunosuppressant (a medicine that controls
     an overactive immune system) is used to treat uveitis
     (inflammation of the inner part of the eye), aphthous oral ulcers,
     arthritis and deep vein thrombosis. It may improve long-term
     prognosis.

   * *Chlorambucil or cyclophosphamide*: These immunosuppressants are
     used to treat uveitis and meningoencephalitis (inflammation of
     the brain and lining of the brain and spinal cord).

   * *Cyclosporine*: This immunosuppressant is used to treat uveitis
     and other uncontrolled symptoms.

   * *Colchicine*: This medicine reduces inflammation throughout the
     body and may be used to treat arthritis, skin symptoms, and
     aphthous lesions.

   * *Methotrexate*: This medicine suppresses the immune system and
     reduces inflammation throughout the body and can be used to treat
     any uncontrolled symptoms.

   * *Combination therapy*: If a single one of these treatments does
     not control your symptoms adequately, your doctor may try
     different combinations of them.

   * *Surgery*: If you develop an aneurysm (balloon-like swelling in
     an artery wall), surgical treatment will be necessary.

In addition to medical treatment, it is important for people with
Bechet's disease to balance rest and exercise in their lives. When
joints are warm and swollen, rest will help settle the disease.
Unnecessary activities should be avoided, and adequate sleep is
essential. A nap or relaxation period each day may be helpful. And
although it's important to reduce activity, it's also important to
maintain joint mobility. This can be accomplished by doing
range-of-motion exercises, light exercises designed to help reduces
stiffness and keep joints flexible. Moderate exercises when symptoms
abate can include walking and swimming.

   Who is at risk?

Bechet's disease is most common along what has been called the "Silk
Road" - countries of the eastern Mediterranean, the Middle East and
East Asia. It is not as common in the United States and other Western
countries. The disease occurs primarily in young adults; the mean age
at onset is 25 to 30 years. Women are more likely to be affected than
men. However, men and young people (15 to 25 years old) tend to have
a more severe form of the disease than women and older people.

... How do I spell "relief"?  E-X-L-A-X.
___ Blue Wave/QWK v2.12