Keywords
Psychological burden
Depression
Anxiety
Uveitis
Arthritis
Categories
How to Cite
Abstract
Background: Behçet disease is a chronic, relapsing, multisystem inflammatory vasculitis in which mucocutaneous, articular, and ocular manifestations may coexist with substantial psychological burden.
Methods: This narrative review synthesized English-language literature identified through structured searches of PubMed/MEDLINE, Scopus, and Google Scholar, supplemented by reference-list screening. Searches were updated through 31 January 2026 and focused on depression, anxiety, stress, fatigue, sleep disturbance, and quality-of-life outcomes in non-neuro-Behçet contexts.
Results: The available literature suggests that depression and anxiety are frequent in Behçet disease and are associated with disease activity, pain, fatigue, sleep disturbance, and reduced quality of life. Mucocutaneous symptoms may contribute through pain, visible lesions, embarrassment, and impaired self-image; articular involvement through pain, stiffness, fatigue, and reduced mobility; and ocular disease through visual threat, repeated treatment, and impaired visual function. Sleep disturbance, fatigue, and reduced quality of life are closely interrelated and appear to amplify overall psychosocial burden.
Conclusions: Psychological burden is an important dimension of Behçet disease. Although direct evidence for a rigorously defined combined mucocutaneous-articular-ocular phenotype remains limited, the current literature supports a converging burden model across these domains.
References
1. Alpsoy E. Behcet's disease: A comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocutaneous lesions. J Dermatol. 2016: 620 [PMID: 27075942 10.1111/1346-8138.13381]
2. Bettiol A, Prisco D, Emmi G. Behcet: the syndrome. Rheumatology (Oxford). 2020: iii101 [PMID: 32348523 10.1093/rheumatology/kez626]
3. Nakamura K, Tsunemi Y, Kaneko F, Alpsoy E. Mucocutaneous Manifestations of Behcet's Disease. Front Med (Lausanne). 2020: 613432 [PMID: 33598466 10.3389/fmed.2020.613432]
4. Eser-Ozturk H, Yeter V, Karabekiroglu A, Sullu Y. The Effect of Vision-Related Quality of Life on Depression and Anxiety in Patients with Behcet Uveitis. Turk J Ophthalmol. 2021: 358 [PMID: 34963263 10.4274/tjo.galenos.2020.06791]
5. Zulfiqar MH, Shamdas M, Bashir A, Douglas S, Murray PI. Longitudinal Study Investigating the Relationship between Disease Activity and Psychological Status of Patients with Behcet's Disease. Ocul Immunol Inflamm. 2020: 613 [PMID: 31393210 10.1080/09273948.2019.1616770]
6. Can Sandikci S, Colak S, Omma A, Enecik ME. An evaluation of depression, anxiety and fatigue in patients with Behcet's disease. Int J Rheum Dis. 2019: 974 [PMID: 30398004 10.1111/1756-185X.13411]
7. El Hasbani G, Uthman I, Jawad S, Jawad ASM. The psychological impact of Behcet's disease. Musculoskeletal Care. 2022: 742 [PMID: 35384265 10.1002/msc.1632]
8. Atay IM, Erturan I. The impact of coping strategies in behcet's disease: A case-control study. Niger J Clin Pract. 2020: 680 [PMID: 32367876 10.4103/njcp.njcp_84_19]
9. Teixeira CEG, Reis F, Dos Santos MPS, Simoes MF, Del Rio APT, Coimbra IB, Pugliesi A, de Paiva Magalhaes E, Sachetto Z. The burden of mental health issues in Behcet's disease: implications for patient quality of life. Expert Rev Clin Immunol. 2025: 103 [PMID: 39373908 10.1080/1744666X.2024.2412771]
10. Ramadan MM, Abdalla RA, Qoran RK, Daoud RA, Al-Nakawah GF, Al-Khatib RA, Alheet LH, Alayyaf AE, Mahdi O, Al-Hariri MS. Behcet's Disease and the Burden of Chronicity: Interplay Between Physical Symptoms, Mental Health, and Quality of Life. Cureus. 2025: e84660 [PMID: 40546633 10.7759/cureus.84660]
11. Emmi G, Bettiol A, Hatemi G, Prisco D. Behcet's syndrome. Lancet. 2024: 1093 [PMID: 38402885 10.1016/S0140-6736(23)02629-6]
12. Alpsoy E, Bozca BC, Bilgic A. Behcet Disease: An Update for Dermatologists. Am J Clin Dermatol. 2021: 477 [PMID: 34061323 10.1007/s40257-021-00609-4]
13. Kotter I, Lotscher F. Behcet's Syndrome Apart From the Triple Symptom Complex: Vascular, Neurologic, Gastrointestinal, and Musculoskeletal Manifestations. A Mini Review. Front Med (Lausanne). 2021: 639758 [PMID: 33898481 10.3389/fmed.2021.639758]
14. Guan Y, Li F, Li N, Yang P. Decoding Behcet's Uveitis: an In-depth review of pathogenesis and therapeutic advances. J Neuroinflammation. 2024: 133 [PMID: 38778397 10.1186/s12974-024-03123-6]
15. Senusi A, Higgins S, Fortune F. The influence of oral health and psycho-social well-being on clinical outcomes in Behcet's disease. Rheumatol Int. 2018: 1873 [PMID: 30151720 10.1007/s00296-018-4117-y]
16. Ali S, Nagieb CS, Fayed HL. Effect of Behcet's disease-associated oral ulcers on oral health related quality of life. Spec Care Dentist. 2023: 435 [PMID: 36127751 10.1111/scd.12782]
17. Altingoz EN, Yenisoy Y, Kapusuz A, Abacar K, Sisman-Kitapci N, Yay M, Karacayli U, Alibaz-Oner F, Inanc N, Ergun T, Fortune F, Direskeneli H, Mumcu G. The mediator role of treatment response on oral health related quality of life in Behcet's syndrome. Med Oral Patol Oral Cir Bucal. 2024: e350 [PMID: 38150605 10.4317/medoral.26319]
18. Karacan Y, Akkus Y, Kasap K, Unlu K. Relationship between dermatological quality of life, disease activity, depression, and anxiety levels in Behcet's syndrome: a structural equation modelling approach. Psychol Health Med. 2025: 1 [PMID: 41004688 10.1080/13548506.2025.2565518]
19. Sweeting F, Arden-Close E. The impact of Behcet's disease on intimate relationships in women: A qualitative study. Chronic Illn. 2022: 255 [PMID: 32722917 10.1177/1742395320945210]
20. Yankouskaya A, Boughey A, McCagh J, Neal A, de Bezenac C, Davies SJ. Illness Perception Mediates the Relationship Between the Severity of Symptoms and Perceived Health Status in Patients With Behcet Disease. J Clin Rheumatol. 2019: 319 [PMID: 31764491 10.1097/RHU.0000000000000872]
21. Canpolat O, Yurtsever S. The Quality of Life in Patients With Behcet's Disease. Asian Nurs Res (Korean Soc Nurs Sci). 2011: 229 [PMID: 25030525 10.1016/j.anr.2011.12.003]
22. Gorial FI, Jabbar MA. Impact of disease activity on health related quality of life in patients with Behcet's disease: A cross-sectional study. Ann Med Surg (Lond). 2020: 43 [PMID: 32368339 10.1016/j.amsu.2020.03.010]
23. Bernabe E, Marcenes W, Mather J, Phillips C, Fortune F. Impact of Behcet's syndrome on health-related quality of life: influence of the type and number of symptoms. Rheumatology (Oxford). 2010: 2165 [PMID: 20675710 10.1093/rheumatology/keq251]
24. Masoumi M, Tabaraii R, Shakiba S, Shakeri M, Smiley A. Association of lifestyle elements with self-rated wellness and health status in patients with Behcet's disease. BMC Rheumatol. 2020: 49 [PMID: 32999993 10.1186/s41927-020-00148-1]
25. Senusi AA, Mather J, Ola D, Bergmeier LA, Gokani B, Fortune F. The impact of multifactorial factors on the Quality of Life of Behcet's patients over 10 years. Front Med (Lausanne). 2022: 996571 [PMID: 36544503 10.3389/fmed.2022.996571]
26. Senusi AA, Ola D, Mather J, Mather J, Fortune F. Behcet's syndrome and health-related quality of life: influence of symptoms, lifestyle and employment status. Clin Exp Rheumatol. 2017: 43 [PMID: 28598773
27. Ben Hassine I, Naija S, Baya W, Anoun J, Adaily N, Boudriga H, Mzabi A, Rezgui A, Ben Fredj F. Quality of Life and Sexual Health in Patients with Behçet’s Disease: A Cross-Sectional Study in a Tunisian Cohort. F1000Research. 2025: 10.12688/f1000research.169865.1]
28. Tharwat S, Abdalla I, Elhefnawi MAF, Abutaleb AMM, Zein DM, Abdelmaksoud AAI, Elmetwalli RS, Elkilany HM, Abdelaziz RMM, Nassar MK. A Comprehensive Patient-Centric Analysis of Disease Burden, Treatment Challenges, and Unmet Needs in Behcet's Disease: Insights from a Large Cohort Study. Medicina (Kaunas). 2026: [PMID: 41597506 10.3390/medicina62010220]
29. Koca I, Savas E, Ozturk ZA, Tutoglu A, Boyaci A, Alkan S, Kisacik B, Onat AM. The relationship between disease activity and depression and sleep quality in Behcet's disease patients. Clin Rheumatol. 2015: 1259 [PMID: 24816545 10.1007/s10067-014-2632-0]
30. Ilhan B, Can M, Alibaz-Oner F, Yilmaz-Oner S, Polat-Korkmaz O, Ozen G, Mumcu G, Maradit Kremers H, Direskeneli H. Fatigue in patients with Behcet's syndrome: relationship with quality of life, depression, anxiety, disability and disease activity. Int J Rheum Dis. 2018: 2139 [PMID: 26913703 10.1111/1756-185X.12839]
31. Kabul EG, Yenil S, Ulutas F, Calik BB, Cobankara V. Investigation of Biopsychosocial Status, Fatigue, Sleep Quality, Alexithymia, Cognitive Functions, and Quality of Life in Behcet's Disease. Mediterr J Rheumatol. 2023: 436 [PMID: 38282923 10.31138/mjr.290823.ib]
32. Fawzy RM, Abd-Elmaksoud SF, Elolemy GG. Depression in Behçet’s disease patients: Relationship with disease pattern, activity and quality of life. The Egyptian Rheumatologist. 2021: 325 10.1016/j.ejr.2020.11.001]
33. Koruyucu ŞaC, Özlem. The Relationship Between Perceived Stress Level, Disease Activity, and Sleep Quality in Patients with Behçet’s Disease. Journal of Education and Research in Nursing. 2024: 288 10.14744/jern.2024.27003]
34. Karlidag R, Unal S, Evereklioglu C, Sipahi B, Er H, Yologlu S. Stressful life events, anxiety, depression and coping mechanisms in patients with Behcet's disease. J Eur Acad Dermatol Venereol. 2003: 670 [PMID: 14761134 10.1046/j.1468-3083.2003.00760.x]
35. Talarico R, Palagini L, d'Ascanio A, et al. Behçet's syndrome and psychiatric involvement: is it a primary or secondary feature? Clinical and Experimental Rheumatology. 2018: 125
36. Urbain F, Hardy-Leger I, Adebs-Nasser G, de Menthon M, Pivert C, Mausoleo A, Laparra A, Lerolle N, Domnariu PA, Lambotte O, Denier C, Goujard C, Castro-Gordon A, Noel N. Psychiatric Symptoms and Cognitive Disorders in Behcet's Disease: A Single-Center, Cross-Sectional Study. J Clin Med. 2023: [PMID: 37176589 10.3390/jcm12093149]
37. Shaddad AM, Hussein AARM, Safwat SM, Talaat EA, Farrag S, Gamal NM, Khaleel WGE. Assessment of sleep quality, anxiety, depression, and quality of life in Behçet’s disease. The Egyptian Journal of Bronchology. 2023: 10.1186/s43168-023-00200-x]
38. Italiano N, Di Cianni F, Marinello D, Elefante E, Mosca M, Talarico R. Sleep quality in Behcet's disease: a systematic literature review. Rheumatol Int. 2023: 1 [PMID: 36194239 10.1007/s00296-022-05218-w]
39. Mastrolia MV, Marinello D, Di Cianni F, Talarico R, Simonini G. Assessing quality of life in Behcet's disease: a systematic review. Clin Exp Rheumatol. 2022: 1560 [PMID: 36106544 10.55563/clinexprheumatol/sian1b]
40. Sahin N, Bayrak YE, Sonmez HE, Sozeri B. The relationship between Behcet's disease and the quality of life for pediatric patients and their parents. Mod Rheumatol. 2024: 1226 [PMID: 38590079 10.1093/mr/roae031]
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2026 Ahmed Ismael, Ahmed Mabrouk, Mahmoud Zeinhom Ramadan, Hussein Eldamery, Assem Amer, Mohamed Fouad M Ragab, Sherif Helal, Elsadek Helal E. Mahdi, Sherin A Ghaith, Mahmoud M Saber Abdelwahed, Mohammad M. Badran, Ashraf E.M. Ebaid