Behçet's disease is one of the rheumatologic disorders related to vasculitis which affects most commonly young adults.1 It is more prevalent in Mediterranean countries such as Turkey, Greece, Israel; Middle Eastern countries such as Iraq and Iran as well as Far Eastern countries such as Japan, Korea, and China.2,3 Common symptoms include oral and genital ulcers, skin lesions and arthritis, which might be accompanied by ocular and vascular involvements.4 These symptoms not only have negative effect on physical and mental health of patients, but they also diminish their quality of life (QoL) by causing several physical impairments.5

The QoL becomes as an important outcome variable in patients with chronic diseases. Measurement of Health-Related Quality of Life (HRQoL) plays an important role in treatment decisions and assessing the course of the disease. QoL is a concept that includes being able to satisfy one's own basic needs, being satisfied with life, showing enough social interaction, allocating time to fun, feeling good emotionally and physically, being good at interpersonal relationships, having self-esteem as well as previous experiences. Therefore, it could be defined as perception of people about life, values, goals, standards, and interests. Recent studies indicated that QoL in patients with Behçet disease was negatively affected by the disease.6–13 According to previous investigations, there is a stress factor in most patients with BD before the initial onset or relapse of the disease.14–16 Furthermore, it has been reported that subjects with BD have higher anxiety and depression levels14,15 and lower quality of life (QoL) than healthy controls.7,12

QoL evaluation could help in developing more detailed care plans that ensure a better understanding of the behaviors and the psychological reactions of the patients as well as the difficulties they experience with adjusting to the disease and developing effective coping mechanisms.17 Since BD is a chronic disease having a relapsing course therefore, complaints associated with BD have adverse effects on physical and mental health and attenuates QoL by generating certain physical problems.6

Short-Form-36 (SF-36) is the most commonly used international scale and is considered a valid instrument for measuring physical functioning and comparing different aspects of health related QoL in patients with rheumatologic diseases.18 To the best of our knowledge, there is no study evaluating QoL in Iranian Azeri Behçet patients using SF-36, therefore this study aimed to assess the QoL in this population as well as evaluating the association between QoL and disease characteristics including disease activity and clinical symptoms.

Table 1 presents baseline characteristics of BD patients and controls. The mean±SD age of BD patients and control group was 38.19±10.99 (Min–Max: 15–62) and 33.65±7.29 (Min–Max: 17–58) years, respectively. Sixty-one percent of patients and 69.1% of control group were males. Mean duration of disease in BD patients was 11.82±8.39 years and the median (Min–Max) of BDCAF, IBDDAM and VDI were 1 (0–4), 0.3 (0–6) and 0 (0–6), respectively. There was significant difference in mean age and education level between the two groups (P<0.05); whilst no significant difference was observed in gender and marital status between the two groups (P>0.05).

As indicated in Table 2, the Physical Health score as well as most of SF-36 domains including Role Physical, Bodily Pain, General Health, Vitality, and Mental Health were significantly lower in BD patients compared with the control group (P<0.05).

Table 3 depicts correlation between SF-36 scores with disease activity and VDI in patients with Behçet's disease. According to Table 3, there was significant correlation between the Physical and Mental Health scores and most of SF-36 domains with disease activity (P<0.05); whilst significant correlation was only observed between VDI and Bodily Pain domain (P<0.05).

Table 4 presents correlation between SF-36 scores and clinical symptoms in patients with Behçet's disease. As indicated in Table 4, there was significant correlation between the Physical and Mental Health scores and some SF-36 domains with genital ulcers, ophthalmic and central nervous system (CNS) involvement (P<0.05). No significant correlation was observed between the Physical and Mental Health scores and some SF-36 domains with oral aphthous ulcer, skin lesions, arthritis, gastrointestinal and vascular involvement as well as pathergy test (P>0.05).

Taking into account that BD is a chronic immunoinflammatory disease with periods of exacerbation and remission, the quality of life can be affected negatively. To the best of our knowledge, this is the first study to examine the QoL in Iranian Azeri Behçet patients. According to our study, the Physical Health score as well as most of SF-36 domains were significantly lower in BD patients, compared with the control group. Furthermore, significant correlation was observed between the Physical and Mental Health score and most of SF-36 domains with disease activity. Our findings were in agreement with the results of previous studies which showed the impaired quality of life in BD patients (6–13). Ertam et al.8 demonstrated that overall SF-36 scores as well as their domains were significantly lower in BD patients, compared with the control group. In another study, Mumcu et al.11 found that all SF-36 domains were significantly worse in BD patients than in controls. They also found that impairment in quality of life was related with disease activity in BD.11 Furthermore, Bodur et al.7 investigated the relationship between the quality of life, life satisfaction and disease activity in BD patients and compared with controls. They found that life satisfaction index scores were significantly lower and Nottingham health profile scores were significantly worse in all dimensions in BD patients. So they concluded that life satisfaction and quality were impaired in BD patients.7 Also, Canpolat et al.21 found that QoL scores in patients with Behçet's disease were low and were affected by gender, age, work status, education status as well as complaints of oral and genital ulcerations, arthritis, skin lesions and bodily pain. In another study, Tanriverdi et al.12 showed that BD patients were more susceptible to mood and anxiety disorders, and their QoL was lower than that of their healthy counterparts. They also reported that chronic diseases like BD might be related to mood disorders, which might have a negative effect on patient's daily life.

Our study also indicated significant correlation between the Physical and Mental Health scores and some SF-36 domains with genital ulcers, ophthalmic and CNS involvement. No significant correlation was observed between the Physical and Mental Health scores and some SF-36 domains with oral aphthous ulcer, skin lesions, arthritis, gastrointestinal and vascular involvement as well as pathergy test. Our findings were consistent with Tanriverdi et al.12 study which reported mental status might have triggered the development of ocular attacks in BD and that BD patients with ocular involvement had significantly more susceptibility to anxiety and depression. Similarly, Ertam et al.8 found significantly lower scores in “Mental Health” domain of SF-36 scale in BD patients with eye involvement. Moreover, the negative effect of the genital ulcers on the quality of life in BD was shown by Blackford et al.26 In other previous study, Bodur et al.7 reported that arthritis, fatigue and genital ulcer scores of BDCAF were the most important factors impairing the quality of life in BD. In contrast with present study, Gur et al.9 reported that arthritis had a negative effect on the quality of life in BD patients. Taner et al.27 used Beck depression and Beck anxiety inventory in BD patients and psoriasis patients. Although the psoriatic skin lesions might be expected to deteriorate the quality of life considerably, they reported that the quality of life of BD patients were even worse than that of the psoriasis patients. Furthermore, Ertam et al.8 indicated that presence of vascular involvement, eye involvement and arthritis contributed considerably to impaired quality of life in BD. However, they could not show that genital ulcers impaired the quality of life in BD. According to Kilinç et al.,28 patients with oral ulcer, genital ulcer, lesions that looks like erythema nodosum and gastrointestinal ulcer had lower emotional life, daily activity, symptom and sexual life scores. This discrepancy between our results with previous studies might be due to differences in studied population.

In conclusion, based on evaluation of SF-36 scores, quality of life is impaired in BD, and this impairment is related with disease severity. Presence of arthritis, eye involvement and vascular involvement seem to contribute the impairment of quality of life in BD. These results highlight the importance of nursing interventions in managing the symptoms experienced by patients effectively so that the limited effects of the symptoms which decrease QoL can be eliminated.

This study was supported by Connective Tissue Diseases Research Center of Tabriz University of Medical Sciences, Tabriz, Iran.

The authors declare that there is no conflict of interests.