Behçet refractory ocular disease — SCE Rheumatology MCQ

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HardVasculitisBehçet refractory ocular diseaseSCE Rheumatology

A 31-year-old man with Behçet disease has recurrent posterior uveitis despite an adequate course of azathioprine and systemic corticosteroids. His visual acuity is deteriorating, and fluorescein angiography confirms active occlusive retinal vasculitis. Following multidisciplinary review, escalation to biologic therapy is planned. Which biologic is the most appropriate next systemic treatment?

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Correct answer: E — Adalimumab

Adalimumab is the best answer. Recurrent posterior uveitis with active retinal vasculitis and falling visual acuity represents sight-threatening Behçet organ involvement refractory to conventional immunosuppression. Current EULAR guidance supports early monoclonal TNF-alpha inhibition in organ-threatening disease, and its supporting review specifically supports this drug class for ocular involvement. Adalimumab is also UK-authorised for adult non-infectious posterior and panuveitis. Etanercept is a soluble TNF receptor rather than a monoclonal antibody and is not preferred for Behçet uveitis. Secukinumab, tocilizumab and canakinumab have limited or rescue-level evidence and should not be selected ahead of a monoclonal TNF inhibitor here. Infliximab would also be clinically appropriate but is not among the options.

Reference: Hatemi G et al. EULAR recommendations for the management of Behçet's syndrome: 2025 update, recommendations on organ and eye involvement, published 2026. https://pubmed.ncbi.nlm.nih.gov/41876291/