Behçet’s disease is a multi-organ disorder that is more common in countries around the Silk Road, and manifests as mucosal ulcers and skin lesions, and with ocular involvement. As a systemic disease, it can also involve gastrointestinal organs and the central nervous or cardiovascular systems. Although the etiology of Behçet’s disease is not clearly identified, the pathogenesis of the disease is most commonly hypothesized as a profound inflammatory response triggered by an infectious agent in a genetically susceptible host. As there are no single specific manifestations or specific diagnostic tests, various diagnostic criteria have been proposed around the world, and, among them, the International Study Group criteria have been most commonly used. As the clinical expression of Behçet’s disease is heterogeneous, the treatment should be individualized based on involved organs, severity of the disease, and patient’s background. The choice of therapeutic agents is limited by lack of clinical trials and is based largely on case reports, case series, and several open-label clinical trials. Corticosteroids, colchicine, and traditional immunosuppressive agents, including azathioprine and cyclosporine, have been used for the treatment of Behçet’s disease. Recently, tumor necrosis factor (TNF) inhibitors have become available for several rheumatic diseases, and considerable published data suggest that TNF inhibitors represent an important therapeutic advance for patients with severe and resistant disease, as well as for those with contraindications or intolerance to these treatments.

Objective To investigate the effect of the coronavirus disease (COVID-19) pandemic on lifestyle behaviour and clinical data in a population who underwent an annual health check-up in Tokyo, Japan. Methods A self-report questionnaire was completed regarding changes in their physical activities, diet, alcohol intake, smoking and mental stress. For those recommended to undergo further examination or treatment, their intention to do so was also questioned. The clinical results of the check-ups across three different periods (before and during the pandemic and survey period) were statistically compared. Results During the survey period, 838 examinees responded. While physical activities decreased due to teleworking, changes in food intake and dietary patterns were varied. Furthermore, changes in mental stress were also diverse. As for the intention to undergo further clinical examination or treatment, 23.5% answered that they thought they would wait until the government lifted the state of emergency or the pandemic subsided. Compared with before the pandemic, diastolic blood pressure, liver function, kidney function and bone density tended to deteriorate. Conclusions The COVID-19 pandemic affected the lifestyle of the current study population. To prepare for future outbreaks, real-world information should be collected and shared so that effective measures for health promotion can be developed.

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Background Early optimization of conventional disease modifying anti-rheumatic drugs (cDMARD) treatment is imperative as delay of biologics in certain patients can lead to irreversible functional disability. Bucillamine (BUC) is a unique cDMARD available in Japan in the past twenty years which was recently shown to augment the efficacy of methotrexate (MTX) and salazosulfapyridine (SASP) when they are administered together. Objectives We examined the early institution of the triple combination therapy (TriD) before judging requirement of biologics by comparing to combination of TNF inhibitors and MTX (TNFI) in daily practice setting. Methods 152 patients of early rheumatoid arthritis with worse prognosis based on the activity and known prognostic factors were incorporated in the study from 32 institutions belonging to Japan Association of Rheumatologists in Private practice (JARP). After careful informed consent, 114 patients by themselves decided to receive TriD therapy or TNFI therapy. Primary endpoint is average DAS28 score at 6 and 12 months, and secondary endpoint is clinical remission rate, functional remission rate and serum MMP-3 value at 3, 6 and 12 months, and modified Total Sharp Score at 12 months. Results Sixty patients on TriD and 46 patients on TNFI completed 6 months treatment. Baseline DAS28 were 4.91±1.06 in TriD and 5.12±1.21 in TNFI (p=0.306). In 6 months the averages of DAS28 3.34±1.40 and 3.15±1.47 (p=0.470) in TriD and TNFI groups, respectively. EULAR Response and DAS28 at 3 and 6 months were also comparable and not statistically different. Image/graph Conclusions Patient preference to receive cDMARD or biologics after careful informed consent of treatment options can be acceptable in the first 6 months when another decision to switch therapy based on clinical and radiological evaluation in daily practice. This patient-oriented approach can lead to more patients satisfaction and reduction of medical cost. Disclosure of Interest None Declared