Background/Purpose

Little is known about the impact of Behçet’s Syndrome (BS) within the UK.  The recent establishment of National Centres of Excellence now allows a systematic and holistic investigation of both physical and psychological effects of BS. This study investigates the relationship between disease characteristics and psychological status reported by attendees at one Centre. 

Methods

Psychological questionnaires measuring depression, anxiety, pain, fatigue and condition intrusion were sent to all patients with a diagnosis of BS and attending a Behçet’s Centre of Excellence (N=106). Associations between psychological scores and responses from the Behçet’s Disease Activity Index (BDAI), a subjective measure of BS symptoms, were analysed using Spearman’s correlation. 

Results

Response rate was 51%.  A high proportion of patients scored above the clinical cut off for depression (88.9%) and anxiety (74.1%).  High levels of pain, fatigue and condition intrusion were also recorded.  Female patients reported higher scores on all measures.  On average, 4 out of 12 active BS symptoms were reported.       

Overall, whilst psychological scores and BDAI responses indicated statistically significant positive correlations, associations were only moderate or low. 

Surprisingly of the 12 BS symptoms measured by the BDAI, headache, arthralgia, arthritis, nausea, diarrhoea and erythema were significantly associated with higher psychological scores with no association between psychological scores and mouth ulcers, genital ulcers or skin pustules.  Certain symptoms domains were not reported to be present by the majority of patients, notably eye, nervous system or major vessel problems, reflecting the spectrum of disease observed in the UK.

Table 1. Summary of results
Psychological Measure	Spearman’s rhoa (p-value)	Headacheb	Skin Pustuleb	Arthralgiab	Mouth Ulcerb	Genital Ulcerb	Arthritisb	Nauseab	Diarrhoeab	Erythemab
PHQ 9	0.426 (0.002)	0.017	0.581	0.004	0.759	0.993	0.011	0.003	0.051	0.135
GAD 7	0.305 (0.027)	0.373	0.505	0.017	0.412	0.709	0.271	0.061	0.075	0.021
MAF Total	0.374 (0.006)	0.198	0.739	0.017	0.138	0.624	0.026	0.009	0.371	0.024
BPI severity	0.556 (<0.001)	0.012	0.352	0.003	0.316	0.127	0.098	<0.001	0.033	<0.001
BPI interference	0.481 (<0.001)	0.041	0.161	0.030	0.299	0.277	0.036	<0.001	0.015	0.034
WSAS Total	0.428 (0.001)	0.060	0.914	0.037	0.060	0.900	0.008	<0.001	0.305	0.021
Rank correlation coefficient for the association between BDAI Total Score and psychological scores Mann-Whitney U test

Conclusion

Whilst high levels of psychological morbidities were present within this UK BS cohort, psychological status was not strongly associated with BS symptoms. Surprisingly, many symptoms typically associated with BS and usually considered to be most debilitating (e.g. mouth and genital ulcers or eye problems), were not associated with increased psychological scores, whereas symptoms generally though to be less significant (eg headache, nausea, pain, diarrhoea) were more closely associated with poorer psychological status.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-psychological-status-related-to-symptom-experience-in-behcets-syndrome/