Infliximab in Refractory Behcet's Disease

Objective: To describe the use of infliximab in a patient with refractory Behcet's disease (BD). Clinical features: The patient, a 39‐year‐old woman, had been suffering from BD for over 15 years. Previous therapy, including cyclophosphamide, methotrexate, interferon alpha‐ 2a and steroids, was not controlling her symptoms of severe cutaneous/oral/genital ulcers, uveitis, iritis, chronic sinusitis, diarrhoea, abdominal cramps and severe joint pain. A trial of infliximab, an anti‐tumour necrosis factor alpha (TNFα) monoclonal antibody, was commenced to control the symptoms. Outcome: A course of IV infliximab at 3 mg/kg was administered at weeks zero, two and six. During this period progress was measured using various indices, including the Health Assessment Questionnaire (HAQ) Disability Index and the Arthritis Impact Measurement Scale (AIMS) Anxiety Score, as well as a personal diary. The patient described almost immediate relief from diarrhoea and abdominal cramps. At the end of the six week treatment period, both the HAQ Disability Index and AIMS Anxiety score had decreased from 2.1 and 4.6 respectively, to zero, and the patient reported relief from joint pain, and healing of oral and genital ulcers. Six weeks after treatment finished the patient suffered a relapse of ulcers, joint pain and abdominal symptoms. Maintenance infliximab was commenced at 3 mg/kg IV every eight weeks. Discussion: This case, and other published reports describing short‐term use of infliximab in BD, suggest that infliximab may be suitable for the treatment of refractory BD. However maintenance therapy may be required to achieve long‐term symptom control in some patients, such as the one described in this report.