Behçet's syndrome: one year in review 2026

This critical review aims to highlight the publications on Behçet's syndrome (BS) during 2025. Recent studies have further elucidated the immunopathogenesis of BS, highlighting the interplay between innate and adaptive immune responses. Neutrophil hyperactivation, macrophage heterogeneity, and T cell imbalance emerge as central mechanisms, with growing evidence supporting the role of intercellular crosstalk and epigenetic regulation. Monocytes and non-coding RNAs emerge as areas of interest, while confirming the already established role of Th1/Th17 immune activation. These findings contribute to a more integrated understanding of disease mechanisms and may inform future targeted therapeutic strategies. While most studies are limited by small patient numbers and lack of validation in independent cohorts, the overall direction of research is encouraging. BS remains a diagnostically challenging systemic vasculitis. A meaningful proportion of patients develop significant organ damage without satisfying formal classification criteria. There is growing interest in the diagnostic utility of multimodal imaging for Behçet's uveitis. Phenotypic clustering offers a promising modality for understanding disease mechanisms, but there are substantial methodological inconsistencies across cohorts. Roflumilast and dusquetide might be promising agents for severe oral ulcers.Vascular involvement appears to be the most frequent de novo manifestation during treatment with monoclonal TNF inhibitors. High CRP level and large aneurysm diameter are associated with the need of surgery in patients with arterial involvement.