Improving care
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EULAR – The European Alliance of Associations for Rheumatology – has updated its recommendations on the management of Behçet’s syndrome, a systemic vasculitis with heterogeneous manifestations that requires individualised treatment strategies to preserve organ function and quality of life – and makes it impossible to develop one standard approach.

The EULAR recommendations for the management of Behçet’s syndrome were first published in 2008, and updated in 2018. Since that time, new evidence has become available, including trials
of biologic disease-modifying antirheumatic drugs, as well as observational studies that answer important questions around concomitant therapies, and what to do in the case of relapse or remission.

Researchers, healthcare professionals, and patients worked together to develop this new set of recommendations. Of note, no individual recommendation is the same as the previous version: seven have content modifications, four have minor wording amends, and one is entirely new.

The new work, published in the March 2026 issue of the Annals of the Rheumatic Diseases, includes five overarching principles and 12 recommendations. The overarching principles state that Behçet’s syndrome has a relapsing and remitting course that may be organ- or life-threatening, but that disease manifestations may ameliorate over time. As such, the goal of treatment is to prevent irreversible organ damage and to maximise quality of life. To support this, organ involvement should be evaluated throughout the disease course, and treatment should be individualised according to each person’s age, sex, type, and severity of organ involvement, disease duration, and their own personal preferences. Finally, Behçet’s syndrome requires a multidisciplinary approach and shared decision making, alongside patient education, adherence to treatment, and any lifestyle changes that are necessary to achieve optimal care.

The recommendations are tabulated according to the core manifestations of mucocutaneous, joint, eye, arterial, vascular, gastrointestinal, and parenchymal nervous system involvement. Each sets out the preferred first-line treatment approach, with some also specifying diagnostic measures. In brief, apremilast and immunosuppressives such as TNF inhibitors are recommended for refractory mucocutaneous and joint disease. For those with organ involvement, the recommendation is to achieve rapid remission with more aggressive treatment with glucocorticoids and immunosuppressives, and early use of monoclonal antibodies against TNF is encouraged where there are organ- or life-threatening manifestations.

The most important changes from the 2018 version are the preference for monoclonal TNFi in patients with eye, vascular, or nervous system involvement – both for induction of remission of the current attack, and as maintenance to prevent relapse.

“These updated recommendations provide clinicians with practical, evidence-based guidance to support treatment decisions across the diverse manifestations of Behçet’s syndrome” said Gulen Hatemi – lead author on the paper and Professor at Istanbul University-Cerrahpaşa in Turkey. “We aim to promote earlier recognition, more consistent care, and better outcomes for patients. Our task force hopes these recommendations will help to harmonise clinical practice internationally and support shared decision-making between patients and healthcare providers.”

EULAR hopes the updated recommendations will provide guidance for all stakeholders involved in managing Behçet’s syndrome, and ultimately help to improve the quality of care for people with this disease.

Source
Hatemi G, et al. EULAR Recommendations for the Management of Behçet’s Syndrome: 2025 Update. Annals of the Rheumatic Diseases 2026; doi.org/10.1016/j.ard.2026.02.009

About EULAR
EULAR is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with rheumatic and musculoskeletal diseases (RMDs). EULAR aims to reduce the impact of RMDs on individuals and society, as well as improve RMD treatments, prevention, and rehabilitation. To this end, EULAR fosters excellence in rheumatology education and research, promotes the translation of research advances into daily care, and advocates for the recognition of the needs of those living with RMDs by EU institutions.

Contact
EULAR Communications, communications@eular.org

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