THU0241 Behcet’s disease: does lack of knowledge result in underdiagnosis?

Background Prevalence of Behcet’s disease has been estimated at 8–38/10,000 in Turkey and 1–2/30,000 in the USA. Pathergy test positivity is a major criterion for making the diagnosis of Behcet’s disease. Objectives To determine the knowledge among internal medicine (IM) residents from 2 different Mediterranean regions and 2 different regions in the USA regarding general rheumatology (GR), Behcet’s disease, pathergy test and PPD test for tuberculosis. Methods A 26-item questionnaire was developed including both closed and open-ended items, testing knowledge of GR, Behcet’s disease, pathergy test, and PPD test. It was given to IM residents from 4 university centres (St. Louis University Health Sciences Centre (A) and Weill Medical College of Cornell University (B) in the USA, Shaare-Zedak Medical Centre (C) in Israel, and Cerrahpasa Medical Faculty (D) in Turkey). In a single session, residents were asked 10 questions each about GR and Behcet’s disease and 3 questions each about pathergy test and PPD. Rates of correct responses between IM residents from the USA and IM residents from Israel/Turkey were compared using Fischer’s Exact test. Results 69 residents participated in this study (A: 26, B: 13, C: 10, D: 20). The Table 1 shows the proportion of correct answers given for each category of questions. There was a statistically significant difference between the rate of correct responses among IM residents in the USA compared to those in Israel/Turkey with respect to the categories of GR, Behcet’s disease, and pathergy test. This difference was more pronounced in the questions regarding Behcet’s disease and pathergy test. Conclusion Knowledge of Behcet’s disease, and especially pathergy test among IM residents tested is significantly lower in the USA than among those in Israel/Turkey. The difference in the prevalence of Behcet’s disease in these two regions of the world may partly explain this disparity. Contrarily, lack of GR and Behcet’s disease knowledge may contribute to decreased recognition and thus underdiagnosis of Behcet’s disease resulting in the reported low prevalence in the US. Only by improving the education of internists with respect to Behcet’s disease will the true prevalence of this condition be realised.