White plug disease mouth ulcers, these treatment options are all brilliant! EULAR 2020.

EULAR 2020, let's listen! On June 3, 2020, the European annual meeting on rheumatism (EULAR) officially opened.due to the impact of the covid-19 epidemic, this meeting was held online.in order to grasp the latest and hottest international frontier trends in the field of rheumatic immunology, Liu Tian, deputy chief physician of Department of Rheumatology and immunology, Peking University People's Hospital, was specially invited by the "medical rheumatism and nephropathy channel" to present a wonderful report on the meeting! 01 re validation, APR treatment of Behcet's disease ulcer is effective! This EULAR special session on Behcet's disease was conducted by famous Behcet disease experts from Istanbul University, Turkey Gulen.Hatemi The professor gave a special report, and she and other scholars brought a lot of progress in the treatment and management of Behcet's disease.at present, the most popular drug in the treatment of Behcet's disease is aprost (4-phosphodiesterase inhibitor), which has been proved to be effective in treating oral ulcer of Behcet's disease by phase 3 clinical studies (relief).at the EULAR, Professor hatemi first introduced the curative effect of APR on oral ulcer pain in patients with active Behcet's disease.in this 12 week clinical study, 207 patients with active Behcet's disease were randomly treated with apr30mgbid orally or placebo in a 1:1 manner. The VAS score was used to evaluate the oral ulcer pain of the patients, and the improvement ≥ 10mm was defined as the clinically significant minimal improvement (MCID), while ≥ 30mm and 50mm were 3 times and 5 times MCID respectively.after 12 weeks of follow-up, the proportion of patients with MCID in the APR group was significantly higher than that in the placebo group, and the proportion of patients with 3-fold and 5-fold MCID in the APR group was also higher (Figure 1).this study shows that oral administration of apr30mgbid has a positive clinical effect on the treatment of oral ulcer of Behcet's disease.Figure 1 the proportion of patients with pain improved in the APR and placebo groups at 12 weeks. In another multicenter clinical study from Spain, A.H. Morant et al. Evaluated the efficacy of APR on refractory oral / vulvar ulcer of Behcet's disease.this study included 51 patients with Behcet's disease who had not been treated with drugs before. They were treated with APR 30mgbid alone (31 cases) or APR combined with other drugs (16 cases of immunosuppressive agents and 4 cases of biological agents).after an average follow-up of 6 months, most of the patients in the two groups improved their mucosal ulcer (89.8% of the patients improved at 2 weeks), and there was no significant difference between the two groups (Table 1 below).this result indicates that APR can rapidly and continuously improve the refractory mucosal ulcer of Behcet's disease, and it seems that there is no difference in the efficacy of single and combined treatment of Apr.Table 1 outcome of the treatment of refractory Behcet's disease with oral / vulvar ulcer 02 new use of old drugs, these treatment methods are worth exploring! A study from Turkey t. Bozkurt et al. Suggests that early use of immunosuppressants may prevent major organ damage in Behcet's disease.This retrospective study compared the incidence of new organ damage in Behcet's disease patients treated with and without immunosuppressants.a total of 640 patients with Behcet's disease were included in the study and were followed up for at least half a year.among them, 348 patients were treated with immunosuppressive agents for various reasons. Of these patients, only 38 (11%) developed new organ damage, while 91 (28%) had recurrence of original organ damage (Table 2).Table 2: comparison of the use of immunosuppressants in the prevention of major organ damage in Behcet's disease. Another interesting study on the treatment of oral ulcer in Behcet's disease is from s.a.a.tabra et al. this study evaluated the efficacy of topical colchicine and glucocorticoids in the treatment of oral ulcers in Behcet's disease. a total of 44 patients with Behcet's disease were included in this study. They were randomly divided into two groups. Group 1 used lidocaine gel and mixed powder 5mg prednisone +0.6mg colchicine, group 2 used lidocaine gel to mix 5mg powder prednisone. local application of two groups of drugs three times a day until healing. at the 24 week follow-up, the oral ulcer severity score (ouss), Behcet's disease quality of life score (bd-qol) and SF-36 scale in the two groups were significantly improved compared with the baseline (P < 0.05), and the improvement of group 1 was better than that of group 2 (P < 0.05). this study revealed the potential efficacy of topical colchicine + hormone + anesthetics in the treatment of oral ulcer in Behcet's disease. 03 latest experience, the voice of China in the field of Behcet's disease! Finally, Prof. Zheng Wenjie of Peking Union Medical College Hospital brought the latest Chinese experience in the treatment of severe and refractory Behcet's disease with JAK inhibitor tolfatib. a total of 13 patients with Behcet's disease with vascular and gastrointestinal involvement were enrolled in the study. On the basis of the original hormone and immunosuppressant treatment, the oral treatment of tolfatib 5mg bid was added. the activity score of Behcet's disease (bdcaf) was significantly improved compared with baseline (Fig. 2). in terms of safety, two patients developed herpes zoster due to the combined use of multiple immunosuppressants and tolfatib. this study initially suggests the possible efficacy of tolfatib in the treatment of Behcet's disease, but it needs to be confirmed in a larger scale. Meanwhile, the risk of infection in immunosuppressed patients should be vigilant. Figure 2: the bdcaf score of Behcet's disease is significantly improved compared with the baseline. More and more research reports on Behcet's disease are reported in EULAR, which fully indicates that Behcet's disease, a rare disease, has been paid more and more attention by the academic community. We also hope that there will be more voices about Behcet's disease from China in the future international conferences.