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Philip Ian Murray, Tim Blake, David Carruthers, Erika Damato, Alastair K Denniston, John Hamburger, Andrea Richards, Ana Poveda-Gallego, Vicky Sewell, Debbie Mitton, Deva Situnayake; The Impact Of Applying The Proposed New 2014 International Criteria For Behçet's Disease: The Birmingham UK Experience. Invest. Ophthalmol. Vis. Sci. 2016;57(12):4126.
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© ARVO (1962-2015); The Authors (2016-present)
As there is no diagnostic test for Behçet's Disease (BD), multidisciplinary assessment remains the gold standard for diagnosis. Nevertheless the 1990 International Study Group (ISG) clinical classification criteria are widely adopted. In 2014 a team from 27 countries described the New International Criteria for Behçet's Disease (ICBD). The ICBD appeared discriminatory with a higher specificity for BD compared with the ISG criteria regardless of country and thought easy to use in a wide variety of settings. The major difference between criteria is that only oro-genital ulceration is required to make a diagnosis of BD using the new ICBD criteria. We wished to assess the potential impact of the proposed new ICBD criteria for BD in a UK setting.
Patients attending the Birmingham Behçet Syndrome National Centre of Excellence were diagnosed according to multidisciplinary clinical assessment and using the ISG 1990 and the proposed 2014 ICBD criteria. Patient demographics, frequency distribution of clinical characteristics of BD for patients with clinically confirmed BD, partial/incomplete BD and a rejected diagnosis of BD were recorded. The 1990 ISG criteria were compared with the proposed 2014 ICBD criteria in comparison to the gold standard multidisciplinary clinical assessment (ophthalmologist, rheumatologist, oral medicine specialist).
There were 311 patients (64% female, 71% aged 19-50 yrs and 84% were White British). 41 cases were diagnosed following multidisciplinary review but failed to meet ISG 1990 criteria. 35 of these did meet the ICBD 2014 criteria. 34 cases were ISG+ but BD was not confirmed clinically (including 14 clinically rejected BD diagnosis). This increased to 88 cases for the ICBD 2014 criteria (including 42 clinically rejected BD diagnosis). ISG Sensitivity: 79.19%, Specificity: 70.18%; ICBD Sensitivity: 96.95%, Specificity: 22.81%.
The proposed ICBD 2014 criteria were more sensitive than the ISG 1990 criteria using the multidisciplinary assessment process as the gold standard. Specificity was less than expected for both criteria, as some clinical features were not always judged either to be attributable to a possible BD diagnosis or confidently ascertained. ICBD may serve as a useful screening tool but in a mainly UK population we may over diagnose BD in patients referred to our National Behçet Centre.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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