Recommendations for the Management of Neuro-Behçet's Disease by the Japanese National Research Committee for Behçet's Disease

  • Hirohata Shunsei
    Department of Rheumatology, Nobuhara Hospital, Japan Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Japan Department of Internal Medicine, Teikyo University School of Medicine, Japan
  • Kikuchi Hirotoshi
    Department of Internal Medicine, Teikyo University School of Medicine, Japan
  • Sawada Tetsuji
    Department of Rheumatology, Tokyo Medical University, Japan
  • Okada Masato
    Immuno-Rheumatology Center, St. Luke's International Hospital, Japan
  • Takeno Mitsuhiro
    Department of Allergy and Rheumatology, Nippon Medical University Musashi-Kosugi Hospital, Japan
  • Kuwana Masataka
    Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Japan
  • Kawachi Izumi
    Comprehensive Medical Education Center, Niigata University School of Medicine, Japan Department of Neurology, Brain Research Institute, Niigata University, Japan
  • Mochizuki Hideki
    Department of Neurology, Osaka University Graduate School of Medicine, Japan
  • Kusunoki Susumu
    Department of Neurology, Kindai University School of Medicine, Japan
  • Ishigatsubo Yoshiaki
    Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, Japan

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<p>Objective Brain parenchymal involvement in Behçet's disease (BD) (neuro-Behçet's disease, NB) can be classified into acute type (ANB) and chronic progressive type (CPNB) based on differences in the clinical course and responses to corticosteroid treatment. The present study developed evidence-based recommendations for the management of NB.</p><p>Methods The task force of the research subcommittee consisted of seven board-certified rheumatologists (one was also a board-certified neurologist) and three board-certified neurologists. First, several clinical questions (CQs) were established. A systematic literature search was performed by The Japan Medical Library Association in order to develop recommendations. The final recommendations for each CQ developed from three blind Delphi rounds, for which the rate of agreement scores [range 1 (strongly disagree)-5(strongly agree)] was determined through voting by the task force.</p><p>Results A flow chart of the algorithm was established for the management of ANB and CPNB. Thirteen recommendations were developed for NB (general 1, ANB 7, CPNB 5). The strength of each recommendation was established based on the evidence level as well as the rate of agreement.</p><p>Conclusion The recommendations generated in this study are based on the results of uncontrolled evidence from open trials, retrospective cohort studies and expert opinions, due to the lack of randomized clinical trials. Nevertheless, these recommendations can be used for international studies, although verification by further properly designed controlled clinical trials is required.</p>

収録刊行物

  • Internal Medicine

    Internal Medicine 59 (19), 2359-2367, 2020-10-01

    一般社団法人 日本内科学会

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