Comparison of diagnostic criteria in Moroccan patients with Behcet's disease

Background. Behcet's disease is a vasculitis with diverse systemic manifest ations usually involving the skin, eyes, joints and nerves. Clinical diagno sis is based on several signs, generally using the criteria established by the International Group for the Study of Behcet's disease, by O'Duffy, by H amza, by Mason and Barnes and by the Japanese Committee. The purpose of thi s retrospective study was to assess the frequency of clinical manifestation s in Behcet's disease and to apply the five diagnostic criteria scorings ci ted above to our patients to determine their sensitivity. Patients and methods, Between January 1988 and December 1997, 110 cases of Behcet's disease were seen at our Dermatology Unit in Casablanca as inpatie nts or outpatients. Complete history and clinical data including results of the ophthalmology exam and skin tests were available for 70 patients (29 m en and 41 women, mean age 31 years). Results. All 70 patients had buccal aphtosis and 88 p, 100 had genital apht osis. Ocular signs were found in 36 p. 100 of the patients and the skin tes t was positive in 57 p. 100. According to the criteria of the International Group for the Study of Behcet's disease, 65 patients (93 p, 100) had Behce t's disease. For the Japanese Committee criteria there were 61 (90 p. 100), for the O' Duffy criteria 48 (68 p. 100), for Hamza criteria 45 (64 p. 100 ) and for Mason and Barnes criteria 35 (50 p 100) Discussion. Our series is comparable to other Mediterranean series observed in dermatology units, but our patients had fewer systemic manifestations c ompared with another Moroccan series reported from an internal medicine war d. This could be due to recruitment bias and different medical education. F or positive diagnosis of Behcet's disease, the criteria established by the International Group for the Study of Behcet's disease, the Japanese Committ ee, O'Duffy and Hamza enabled the diagnosis in the majority of the cases. F ifty percent of the patients had all the criteria described in these scores . These criteria would appear to be both overly descriptive, with the risk of confounding other disease states such as enterocolopathy, or underly des criptive, making it impossible to classify certain patients as having Behce t's disease.