الفهرس 
Recurrent aphthous stomatitis (RAS)Only 14 pages are availabe for public view
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Abstract
Behçet’s disease is a chronic inflammatory disorder of unknown etiology. There are no specific tests to confirm the diagnosis of Behcet’s Disease. The diagnosis is based on clinical criteria. It may take several months or years for all the common symptoms of the disease to appear, often making it difficult to obtain a definitive diagnosis.
The usefulness of a positive skin pathergy test as disgnostic test for behcet disease is controversial as there is gradual decline of pathergy test (PT) positivity in several countries over the past period of time; moreover it differs according to gender and among different countries.
New trials for finding a more accurate test for behcet diagnosis using self-saliva with a simple skin prick technique can be a valuable in vivo diagnostic approach for differentiating BD from other mimicking mucocutaneous diseases, assuming that the saliva of behcet patients contains S. sangunis antigens and may in part address the underlying immunopathology in BD.
Our study aimed to determine the reliability and accuracy of skin prick test using self-saliva as diagnostic tests for Behçet’s disease in comparison to pathergy test the study was conducted on Behçet patients, patients with recurrent oral ulcer who did not met the criteria of Behçet’s disease and healthy controls. The test was done before and after filtration of saliva and repeated after sterilization of forearm to detect the role of skin normal flora in test positivity.
Our study showed that there was statistical significance between the studied groups regarding gender where Behçet’s disease was more common among males.
The clinical manifestations observed in Behçet’s disease patients were recurrent oral ulcers, followed by mucocutaneous manifestations (including: genital ulcers, erythema nodosum, pustules in the scalp and folliculitis), ocular manifestations (including: uveitis, retinal hemorrhage and retinal detachment), vascular problems, neurological manifestations and arthritis.
There was raised total leucocytic count and ESR among Behçet’s disease patients.
Slit lamp/ fundus examination revealed high percentage of uveitis affecting Behçet’s disease patients, followed by retinal hemorrhage and retinal detachment.
There was statistical significance between Behçet’s diseases and both recurrent oral ulcers and healthy controls regarding the number of patients positively reacted to pathergy test, skin prick test with neat self-saliva and skin prick test with filtered self-saliva.
As regard the diagnostic accuracy of pathergy in discriminating Behçet and non-Behçet patients using the AUC showed fair accuracy (0.709), 95% confidence interval was (0.604 to 0.800), Youden index was 0.417, Sensitivity was 50%, Specificity was 91.7%, correct classification was 78%, Positive predictive value (PPV) was 75% and Negative predictive value (NPV) was 79%.
On the other hand, the diagnostic accuracy of skin prick test with neat self-saliva in discriminating Behçet and non-Behçet patients using the AUC showed excellent accuracy (0.907), 95% confidence interval was (0.827 to 0.958), Youden index was 0.800, Sensitivity was 80%, Specificity was 100%, Correct classification was 80%, Positive predictive value (PPV) was 66% and Negative predictive value (NPV) was 90%.
By comparing the results of the study, we can say that the skin prick test with neat self-saliva is superior to pathergy test diagnosis and so it can be used as a new diagnostic test for Behçet’s disease.
Limitations of the study:
The number of enrolled patients in the study were relatively small, as the study was conducted on 30 patients for each group, it might be due to the study`s inclusion criteria that stated the patients enrolled in the study should not receive immunosuppressive drugs 2 weeks earlier. So in order to evaluate the test properly it is advised to have more patients enrolled in the study.
The study did not involve more investigations for S. sangunis as specific cultures from the saliva or histopathological investigations, but we can explain that as our study focused on the efficacy and accuracy of skin prick test with saliva as a diagnostic test for Behçet patients more than investigating directly the role of S. sangunis in Behçet’s disease pathogenesis, but it is recommended that in future studies adding both cultures and histopathology to the skin prick test with saliva may increase the sensitivity and the accuracy of the skin prick test.
The study did not evaluate the relationship between the skin prick test with saliva and Behçet’s disease activity, as patients enrolled in the study were not in active disease, so in order to evaluate the correlation between the skin prick test with saliva and the activity of Behçet’s disease, patients with active Behçet’s disease to be included in future studies.