Identification of physical and psychosocial problems based on symptoms in patients with Behçet’s disease

Abstract

The purpose of this study was to use the International Classification of Functioning, Disability and Health (ICF) to identify physical and psychosocial problems associated with symptoms of Behçet's disease (BD) in Japanese patients. Thirty patients with BD were interviewed in a pilot study using the "ICF Checklist", and a team of medical experts selected categories related to physical and psychosocial aspects of BD. To identify specific physical and psychosocial problems of Japanese patients with BD, 100 new patients were interviewed using the selected categories. Among the 128 categories in the original ICF Checklist, 80 categories were identified as impaired, and another 12 ICF categories were added based on expert discussion of patients input. The number of problem categories was significantly greater in patients with BD with eye involvement and fatigue (eye involvement, 25.7 categories; fatigue, 25.2 categories; both P < 0.001). Specifically, patients with eye involvement had more difficulties with problems in daily life, such as writing (odds ratio 4.2), understanding such nonverbal messages as gestures and facial expressions (13.7), moving (5.7), walking in intense sunlight and bright light (17.6), and patients with fatigue had more difficulties with climate problems such as symptoms getting worse at the turn of the seasons or on cold days (2.5), compared to those without these symptoms. This study demonstrated that support focusing not only on physical symptoms but on other aspects of life as well is necessary for patients with BD, particularly patients with eye involvement and fatigue.

Are mucocutaneous lesions seasonal in Behçet's disease?

“…However, the status of individual symptoms in these seasonal aggravations was not mentioned in these reports. A study from Japan, reported in 2019, dealt with mucocutaneous symptoms of Behçet's disease as only three categories, namely oral aphthous ulcers, genital ulcers, and skin involvement 6 . Patients with skin involvement reported worse symptoms based on climate, as compared with patients without skin involvement.…”

“…However, there are only several studies aimed to answer the question about seasonality in Behçet's disease. While some studies were not on mucocutaneous symptoms 2,3 , some did not specificially deal with individual mucocutaneous symptoms [4][5][6] . One of the studies evaluated skin manifestations, oral ulcers, and genital ulcers in terms of seasonality, but involved only 16 patients 7 .…”

The psychological impact of Behçet's disease

“…The presence of arthritis can worsen fatigue (Moses Alder et al, 2008). In return, fatigue can worsen the quality of sleep (Tascilar et al, 2012) and functional status (Tsutsui et al, 2020).…”

“…The presence of arthritis can worsen fatigue (Moses Alder et al., 2008). In return, fatigue can worsen the quality of sleep (Tascilar et al., 2012) and functional status (Tsutsui et al., 2020). Depression and anxiety are significantly associated with fatigue (Ilhan et al., 2018; Murray et al., 2021).…”