Background. Recurrent aphthous stomatitis (RAS) presents a diagnostic problem in Behçet's disease (BD), particularly when it occurs as the only or earliest feature of the disease. To date, there have been only a few reports studying the differences in characteristics between RAS and BD. Aim. To examine the clinical differences between RAS and BD using a large group of patients. Methods. A retrospective review was carried out, analysing demographic data, the clinical features of the oral ulcer, and the major and minor symptoms of BD of 1643 patients with RAS and 3527 patients with BD presenting from 1995 to 2001. Results. BD had a greater female predominance, and major oral ulcers were significantly more common in BD than in RAS (P < 0.001). Involvement of multiple sites was also more common in BD than in RAS, and the menstrual cycle had more influence on oral ulcers in patients with BD (P < 0.001). Minor symptoms such as articular, neurological and vascular symptoms and epididymitis were also seen more often in BD than in RAS (P < 0.001), and in particularly, patients with BD had a significantly higher frequency of articular symptoms than did patients with RAS (P < 0.001). Conclusion. These findings may provide guidelines for the clinical differentiation between RAS and BD. In addition, patients with multiple major aphthae, particularly with articular symptoms, should be closely followed up for the development of BD, and the possibility of other diseases such as ankylosing spondylitis and Crohn's disease should also be considered.
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