Some Bechet's patients with uveitis may require less aggressive immunosuppression therapy

A study appearing in Archives of Ophthalmology may prove helpful in predicting disease course in Behcet's patients with uveitis. It compares the findings and clinical outcomes among three groups of patients:  HLA B51 positive patients, HLA B51 and B27 positive patients, and non Behcet's uveitis patients who are HLA B27 positive.
 
The authors find that patients who were B51 and B27 positive faced a more benign prognosis for the uveitis largely because the pattern of uveitis more closely resembles the pattern of uveitis found in HLA-B27 non Behcet's uveitis.


The authors suggest that identification of the B27 locus may help predict a more mild disease course among Behcet's patients with uveitis. This is an interesting finding and may prove to be helpful in making a prognosis. The crucial question of the paper, which the authors acknowledge, is whether or not patients with B27 and B51 have Behcet’s-related uveitis or B27 related uveitis. 

It was stated that there was no difference in the systemic manifestations between the B27 positive and B27 non Bechet’s groups, but this data was not shown, nor was the exact criteria used to diagnose each patient.  It seems that oral and genital ulcerations and pathery were the most common systemic findings. The authors also state that uveitis was crucial in establishing the diagnosis of Behcet's in five patients, suggesting that these patients did not have many systemic findings of Behcet’s. It was also noted that other B27 related diseases occurred among the B27 positive Behcet's patients, suggesting that B27 disease can occur in the setting of Behcet's.

The take home message of this paper may be that when encountering a Bechet's patient with uveitis, one may want to take a more measured therapeutic approach if they are B27 positive. It’s an important finding because Behcet's patients often receive aggressive immunosuppressant therapy due to the potential for permanent vision loss from retinal vasculitis. If the findings of this study are confirmed, it may be useful in limiting the exposure of patients to potentially harmful and possibly unnecessary immunosuppressant therapies.