Clinical Rheumatology

, Volume 30, Issue 9, pp 1151–1155 | Cite as

Diagnostic value of pathergy test in Behcet’s disease according to the change of incidence over the time

  • Fereydoun Davatchi
  • Cheyda Chams-Davatchi
  • Zahra Ghodsi
  • Farhad Shahram
  • Abdolhadi Nadji
  • Hormoz Shams
  • Massoomeh Akhlaghi
  • Roghieh Larimi
  • Bahar Sadeghi-Abdolahi
Original Article


Pathergy test (PT) is used for the diagnosis of Behcet’s disease (BD). It is a criterion in many classification/diagnosis criteria. PT is mainly seen in BD but can be seen in other conditions too. PT has been reported with high frequency from most countries along the Silk Road. The sensitivity of pathergy phenomenon (PP) is declining over the time. The aim of this study was to look for the diagnostic value of PT in the past and at the present time. The BD registry (Rheumatology Research Center, Tehran University of Medical Sciences) has the data of 6,607 BD and 4,292 control patients. Patients and controls were divided in four groups of 1,650 BD and 1,073 controls. Sensitivity, specificity, positive and negative predictive value (PPV-NPV), positive and negative likelihood ratio (PLR-NLR), diagnostic odds ratio (DOR), and Youden’s index (YI) were calculated for each group. The first and the fourth quartiles were compared. Sensitivity of PT decreased from 64.2% (first quartile) to 35.8% (fourth quartile). Specificity improved from 86.6% to 98.4%. PPV improved from 82.7% to 95.7%. NPV decreased from 82.7% to 60.5%. PLR improved from 4.8 to 22.4, while NLR deteriorated from 0.41 to 0.65. DOR improved from 11.6 to 34.3. Yuden’s index worsened from 0.5 to 0.34. Although sensitivity of PP decreased, the increase of specificity is a plus value for diagnosis. As a result, PPV, PLR, and DOR improved, while NPR, NLR, and YI deteriorated. Although the pathergy test lost its sensitivity during the past 35 years, it has not lost its value as a diagnostic test, improving many of its characteristics. In a practical view, the chances of getting a positive test have decreased over the time. However, a positive test is rather the synonym of Behcet’s disease, with a probability of 98.4%.


Behcet’s disease Classification/diagnosis criteria Pathergy phenomenon Pathergy test 


  1. 1.
    Davatchi F (2009) Behcet’s disease. In: Syngle A, Deodhar SD (eds) Rheumatology principles and practice. Jaypee Brothers, New Delhi, pp 249–268Google Scholar
  2. 2.
    Davatchi F, Shahram F, Chams-Davatchi C et al (2010) Behcet’s disease: from East to West. Clin Rheumatol. doi:10.1007/s10067-010-1430-6 Google Scholar
  3. 3.
    Davatchi F, Shahram F, Chams-Davatchi C et al (2010) How to deal with Behcet’s disease in the daily practice. Int J Rheum Dis 13:105–116PubMedCrossRefGoogle Scholar
  4. 4.
    Katzenellenbogen I, Feuerman EJ (1965) Beitrag zum Morbus Behçet Die Bedeutung der spezifschen. Hauthyperraktivität Behçetin Reaktion Hautarzt 16:13–18Google Scholar
  5. 5.
    Aral O, Dilsen N, Konice M (1986) Positive skin pathergy reactivity as a genetic marker of Behçet’s disease. In: Lehner T, Barnes CG (eds) Recent advances in Behçet’s disease. Royal Society of Medical Services, London, pp 173–175Google Scholar
  6. 6.
    Davatchi F (1998) Behcet’s Disease. In: Howe HS, Feng PH (eds) Textbook of clinical rheumatology. National Arthritis Foundation, Singapore, pp 298–315Google Scholar
  7. 7.
    Al-Otaibi LM, Porter SR, Poate TWJ (2005) Behcet’s disease: a review. J Dent Res 84:209–222PubMedCrossRefGoogle Scholar
  8. 8.
    Calamia KT, Kaklamanis PG (2008) Behcet’s disease: recent advances in early diagnosis and effective treatment. Curr Rheumatol Rep 10:349–359PubMedCrossRefGoogle Scholar
  9. 9.
    Blobner F (1937) Zur rezidivierenden hypopyoniritis. Z Augenheilkunde 91:129–139Google Scholar
  10. 10.
    Davatchi F, Sadeghi Abdollahi B, Shahram F et al (2010) Validation of the international criteria for Behçet’s disease (ICBD) in Iran. Int J Rheum Dis 13:55–60PubMedCrossRefGoogle Scholar
  11. 11.
    Alekberova Z, Madanat W, Prokaeva T, Yermakova N, Poljanskaja I (1993) Clinical and genetic features of 35 patients with Behcet’s disease from commonwealth independent states. In: Godeau P, Wechsler B (eds) Behcet’s disease. Elsevier Science, Amsterdam, pp 171–174Google Scholar
  12. 12.
    Benamour S, Zeroual B, Bennis R, Amraoui A, Bettal S (1990) Maladie de Behçet. 316 cas. Press Med 19:1485–1489Google Scholar
  13. 13.
    Al-Rawi ZS, Sharqui KE, Al-Hadithi FM, Munir JJ (1986) Behcet’s disease in Iraqi patients. Ann Rheum Dis 45:987–990PubMedCrossRefGoogle Scholar
  14. 14.
    Dong Yi, Ming Qiu Xiao, Zhang Nai Zheng, Li Cui Hai, Wu Qi Yan (1991) Testing different diagnostic criteria of Behcet’s syndrome in Chinese patients. In: O’Duffy JD, Kokmen E (eds) Behcet’s disease basic and clinical aspects. Marcel Decker, New York, pp 55–59Google Scholar
  15. 15.
    Assad-Khalil SH (1991) Clinical, genetic, immunological, and biochemical features of 180 Egyptian patients with Behcet’s disease. In: O’Duffy JD, Kokmen E (eds) Behcet’s disease basic and clinical aspects. Marcel Decker Inc, New York, pp 269–277Google Scholar
  16. 16.
    Davatchi F, Shahram F, Akbarian M et al (1997) Behcet’s disease—analysis of 3443 cases. APLAR Journal of Rheumatology 1:2–5Google Scholar
  17. 17.
    Zouboulis Ch C, Djawari D, Kirch W, Keitel W, Ochsendorf F, Orfanos CE (1993) Adamantiades-Behcet’s disease in Germany. In: Godeau P, Wechsler B (eds) Behcet’s disease. Elsevier Science Publishers B.V, Amsterdam, pp 193–200Google Scholar
  18. 18.
    Nakae K, Masaki F, Hashimoto T, Inaba G, Moshizuki M, Sakane T (1993) Recent epidemiological features of Behcet’s Disease in Japan. In: Godeau P, Wechsler B (eds) Behcet’s disease. Elsevier Science, Amsterdam, pp 145–151Google Scholar
  19. 19.
    al-Dalaan AN, al-Balaa SR, el Ramahi K et al (1994) Behcet’s disease in Saudi Arabia. J Rheumatol 21:658–661PubMedGoogle Scholar
  20. 20.
    Benamour S, Naji T, Echchilali K et al (2006) Study of 1034 cases of Behcet’s disease. Clin Exp Rheumatol 24(suppl 42):S13Google Scholar
  21. 21.
    Davatchi F, Shahram F, Chams-Davatchi et al (2010) Behcet’s disease in Iran. Analysis of 6500 cases. Int J Rheum Dis 13:367–373PubMedCrossRefGoogle Scholar
  22. 22.
    Crespo G, Vaz Patto J, Proenca R (2003) Epidemiology of Behcet’s syndrome in Portugal. BD News 4:1Google Scholar
  23. 23.
    Altenburg A, Papoutsis N, Orawa H et al (2006) Epidemiologie und Klinik des Morbus Adamantiades-Behçet in Deutschland—Aktuelle pathogenetische Konzepte und therapeutische Möglichkeiten. J Dtsch Dermatol Ges 4:49–66PubMedCrossRefGoogle Scholar
  24. 24.
    Davatchi F, Chams-Davatchi C, Shahram F et al (2007) Pathergy test in Behcet’s disease: change in incidence over the time. APLAR J Rheumatol 10:333–335CrossRefGoogle Scholar
  25. 25.
    Kirshwood BR, Sterne JAC (2003) Essential medical statistics, Secondth edn. Blackwell Science, MaldenGoogle Scholar
  26. 26.
    Kraemer HC (2004) Reconsidering the odds ratio as a measure of 2 × 2 association in a population. Stat Med 23:257–270PubMedCrossRefGoogle Scholar
  27. 27.
    Glas AS, Lijmer JG, Prins MH, Bonsel GJ, Bossuyt PM (2003) The diagnostic odds ratio: a single indicator of test performance. J Clin Epidemiol 56:1129–1135PubMedCrossRefGoogle Scholar
  28. 28.
    Youden WJ (1950) Index for rating diagnostic tests. Cancer 3:32–35PubMedCrossRefGoogle Scholar
  29. 29.
    Dilsen N, Koniçe M, Aral O, Ocal L, Inanç M, Gül A (1993) Comparative study of the skin pathergy test with blunt and sharp needles in Behcet’s disease: confirmed specificity but decreased sensitivity with sharp needles. Ann Rheum Dis 52:823–825PubMedCrossRefGoogle Scholar

Copyright information

© Clinical Rheumatology 2011

Authors and Affiliations

  • Fereydoun Davatchi
    • 1
  • Cheyda Chams-Davatchi
    • 1
  • Zahra Ghodsi
    • 1
  • Farhad Shahram
    • 1
  • Abdolhadi Nadji
    • 1
  • Hormoz Shams
    • 1
  • Massoomeh Akhlaghi
    • 1
  • Roghieh Larimi
    • 1
  • Bahar Sadeghi-Abdolahi
    • 1
  1. 1.Rheumatology Research Center, Shariati HospitalTehran University of Medical SciencesTehranIran

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