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Behçet disease — SCE Rheumatology MCQ

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HardVasculitisBehçet diseaseSCE Rheumatology

A 38-year-old woman has recurrent oral ulcers, genital ulcers and painful red eyes. Examination shows papulopustular lesions and a positive pathergy test are present. Investigations show HLA-B51 is positive. The diagnosis is established and symptoms remain clinically important despite initial supportive measures. There is no contraindication to disease-modifying or anti-inflammatory escalation. What is the most appropriate management?

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Correct answer: C — Colchicine

Colchicine is the best answer because colchicine is the most appropriate next step for behçet disease in this clinical setting. Cyclophosphamide induction is a plausible distractor, but it does not account for the key discriminator in the stem. Immediate high-dose glucocorticoid therapy and Tocilizumab with glucocorticoid taper would be more appropriate in a different clinical pattern or at another point in the pathway, while Bisphosphonate therapy is suboptimal for this presentation. Clinical pearl: rheumatology management is generally treat-to-target, but infection risk, pregnancy plans and shared-care monitoring often determine the safest answer.

Reference: BSR GCA guideline; EULAR ANCA-associated vasculitis recommendations; BNF