Behçet’s disease can cause a range of symptoms, but it is rare for someone with the condition to have them all.
The symptoms of Behçet’s disease are outlined below.
Almost all cases of Behçet’s disease begin with the symptoms of mouth ulcers. The ulcers have the same appearance as normal mouth ulcers but they tend to be more numerous and painful. The ulcers often develop on the:
- inside of the cheek
The ulcers usually heal within 10 days, although they often return.
Like mouth ulcers, genital ulcers are also a common symptom of Behçet’s disease, occurring in an estimated 70-95% of cases.
In men, the ulcers usually appear on the scrotum and in women they usually appear on the cervix (neck of the womb), vulva or vagina. However, genital ulcers can appear anywhere in the groin area, including on the penis.
The genital ulcers are usually painful and leave scarring in around half of all cases. Men may also experience inflammation (swelling) of the testicles and women may find that the ulcers make having sex painful.
Genital ulcers that are caused by Behçet’s disease are not contagious and cannot be spread through sexual intercourse.
Around 80% of people with Behçet’s disease will develop skin lesions, usually on their lower limbs. A lesion is any type of unusual growth or abnormality that develops on your skin, such as a bump or a discoloured area of skin.
Outbreaks of acne, which are similar to teenage acne, are also common. Skin lesions and patches of acne should heal within 14 days, although they may come back frequently.
Around two-thirds of people with Behçet’s disease will experience inflammation and swelling in their joints, with the knees, ankles and wrists often being affected. The inflammation and swelling can produce arthritis-like symptoms, such as stiffness and pain, in the affected joints.
Inflammation of the eyes is another common symptom of Behçet’s disease, occurring in an estimated 30% of cases.
Inflammation usually affects the uveal tract, which is a group of connected structures inside the eye. The uveal tract is made up of the:
- iris – the coloured part of the eye
- ciliary body – the ring of muscle behind the iris
- choroid – the layer of tissue that supports the retina
Inflammation of the uveal tract is known as uveitis and the symptoms can cause:
- painful, red eyes
- sensitivity to light (photophobia)
- floaters (dots that move across the field of vision)
- blurred vision
In the most severe cases of Behçet’s disease, inflammation of the eyes can lead to permanent visual impairment. However, visual impairment is now far less likely to occur if you are receiving treatment with immunosuppressants.
Pathergy (sensitive skin)
Pathergy is a term used to describe skin that is particularly sensitive to injury or irritation. For example, if a needle is used to prick the skin of someone who has pathergy, a large red bump would develop that appears out of proportion to the original needle prick.
Pathergy is more common among people of Middle Eastern origin and less common in Asian and white people.
Inflammation of the veins and arteries occurs in an estimated one in 20 people with Behçet’s disease. It produces redness, pain and swelling in the limbs.
Behçet’s disease can cause inflammation of the stomach and intestine. This occurs most frequently in people of Japanese origin with Behçet’s disease. The inflammation can cause symptoms such as:
- vomiting (being sick)
- loss of appetite
- diarrhoea (loose, watery stools)
- abdominal (tummy) pain
Inflammation of the nervous system
Inflammation of the central nervous system (CNS) causes the most serious symptoms associated with Behçet’s disease. CNS inflammation occurs in an estimated 5-10% of cases of Behçet’s disease, usually within five years of the initial symptoms.
The symptoms of CNS inflammation are most common in men and usually develop quickly, over the space of a few days. Symptoms can include:
The inflammation of the blood vessels associated with Behçet’s disease can sometimes cause blood clots to form. The medical term for blood clots is thrombosis.
The most common type of blood clot to affect people with Behçet’s disease is deep vein thrombosis (DVT), which affects around one in 20 people with the condition. DVT is where a blood clot develops in one of the deep veins of the body, usually in the legs.
Symptoms of DVT include:
- pain, swelling and tenderness in one of your legs (usually in the calf)
- a heavy ache in the affected area
- warm skin in the area of the clot
- redness of your skin, particularly at the back of your leg, below the knee
While a blood clot in your leg is not immediately life-threatening, there is a risk that it will travel out of your leg and block the supply of blood to your lungs. This is known as a pulmonary embolism, and is potentially life-threatening.
Symptoms of a pulmonary embolism include:
- breathlessness, which may come on suddenly or gradually
- chest pain, which may be worse when you breathe in
- coughing up blood
Both DVT and pulmonary embolism require immediate medical treatment. If you suspect that you or someone in your care is experiencing either condition you (or they) should go to the nearest accident and emergency (A&E) department immediately.
A less common type of blood clot associated with Behçet’s disease is cerebral venous thrombosis (CVT). CVT affects a small number (0.5-1.5%) of people with Behçet’s disease. It occurs when a blood clot develops inside blood vessels that run through channels known as the dural venous sinuses. These are located between the outer and inner layer of your brain.
The blood clot can increase the pressure inside your brain and also lead to an interruption of the blood supply to the brain.
Symptoms of a CVT include:
- severe headache – this has been described as throbbing, piercing, a band of pain or as a ‘thunderclap headache’, which is a very severe pain that suddenly appears out of nowhere
- slurred speech
- fits (seizures)
- deafness in one ear
- double vision
- stroke-like symptoms, such as muscle weakness or paralysis – unlike most strokes, both sides of the body can be affected
CVT is a type of stroke because it leads to a reduction in the blood supply to the brain. Like all cases of stroke, CVT should be regarded as a medical emergency. If you suspect that you or someone you know is experiencing CVT, you should dial 999 immediately to request an ambulance.
Inflammation of the blood vessels can cause part of your blood vessels' walls to weaken. This causes the walls to bulge outwards as a result of blood pressure. The bulge is known as an aneurysm.
Aneurysms do not usually cause any noticeable symptoms unless the wall of the blood vessel becomes so weak that it splits leading to internal bleeding and possible organ failure.
The symptoms of a ruptured aneurysm can vary depending on where in the body the aneurysm developed. Possible symptoms include:
- shortness of breath
- mental confusion
- loss of consciousness