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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.

Ana Poveda-Gallego, Iain Chapple, Marietta Iacucci, John Hamburger, Philip I
Murray, Saaeha Rauz, Graham R Wallace
Clinical and Experimental Rheumatology 2023 October
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.



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