Can Behcet's Disease cause painful skin patches?

Question

Hi doctor,

I am having a major flare-up of Behçet's Disease, and I am experiencing painful patches of skin that hurt from the inside (like nerve pain), yet the skin in those areas is peeling and bruising. I am at a loss on what to do. I am taking tablet Azathioprine, but I do not know how to deal with the symptoms or this unusual pain.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

I reviewed your images and reports (attachment removed to protect the patient's identity). If your condition appears resistant, you should speak to your Rheumatologist about B DMARDS (drugs that delay the progression of RA by affecting the body's biological response to various cytokines, particularly TNF-a (Tumor necrosis factor - Alpha)). For this type of disease, two drugs have been approved. Infliximab (Remicade) IV (intravenous) and Adalimumab (Humira) IV (intravenous) have high effectiveness for severe Behcet's disease (a rare disorder causing inflammation in blood vessels), and you will require a short course of steroids. However, I am certain that it will react to the therapy.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern. There is a checklist before starting a patient on B DMARDs. It includes HBsAg (hepatitis B surface antigen), Anti HCV (hepatitis C virus), HIV (human immunodeficiency virus) serology, and QuantiFERON-TB Gold (QFT). Before starting DMARDs (a group of medications commonly used in people with rheumatoid arthritis), these tests must be negative. Online recommendations of B DMARDS are not permitted as they need monitoring, so they are only given at the clinic in the presence of a doctor. Yes, I would suggest tablet Duloxetine (Cymbalta) 30mg once daily and increase after ten days to twice daily.

Thank you.