1
|
Elhani I, Heydacker P, Tavernier AS, Georgin-Lavialle S, Hentgen V. Physical fitness in adolescent patients with familial Mediterranean fever. Rheumatol Int 2024:10.1007/s00296-024-05598-1. [PMID: 38656610 DOI: 10.1007/s00296-024-05598-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 04/12/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is the most frequent monogenic auto-inflammatory disease worldwide responsible for episodes of fever, serositis and musculoskeletal symptoms. Inflammatory attacks are responsible for sedentary behavior and FMF patients may be at increased cardiovascular risk. Cardiorespiratory Fitness (CRF) and physical capacities during adolescence are associated with cardiovascular mortality in adulthood. In this study, we aimed to describe the physical fitness of FMF adolescents. METHODS A monocentric retrospective study at the Versailles Hospital between January 2020 and June 2023. All FMF patients over 14-year-old who had completed a routine physical test were included. Clinical and physical data including results of the 6-minute walking test, timed unipedal stance test, Ruffier-Dickson index, 30-seconds chair-stand test and sit-and-reach test were extracted from medical records. Results were compared with previously published normative reference values and criterion-referenced standards for healthy subjects. RESULTS Eighteen FMF patients (12 girls, 6 boys) were included. The median age was 16 years old [14-18]. Clinical history included joint symptoms (n = 11), chest pleuritis (n = 8), and leg pain (n = 11). Estimated VO2max was below the recommended thresholds in 13 patients, which predicts cardiovascular risk. Cardiovascular adaptation was poor in 11 patients. Low VO2max was associated with CRP > 5 mg/l on test day and history of joint symptoms. CONCLUSION FMF patients displayed altered physical capacities compared to normative values of healthy subjects. History of musculoskeletal pain, systemic inflammation and sedentary behavior may participate in impaired physical abilities and promote cardiovascular diseases in adulthood. Specific exercise programs could benefit patients for disease control and cardiovascular risk reduction.
Collapse
Affiliation(s)
- Inès Elhani
- Department of General Pediatrics, Versailles Hospital, Versailles, France.
- Sorbonne University, Paris, France.
- Department of Internal Medicine, AP-HP, Tenon Hospital, Paris, France.
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Paris, France.
| | - Pascal Heydacker
- Department of General Pediatrics, Versailles Hospital, Versailles, France
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Paris, France
| | - Anne-Sophie Tavernier
- Department of General Pediatrics, Versailles Hospital, Versailles, France
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Paris, France
| | - Sophie Georgin-Lavialle
- Sorbonne University, Paris, France
- Department of Internal Medicine, AP-HP, Tenon Hospital, Paris, France
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Paris, France
| | - Véronique Hentgen
- Department of General Pediatrics, Versailles Hospital, Versailles, France
- National French Reference Centre for Auto-inflammatory Diseases and Inflammatory Amyloidosis (CEREMAIA), Paris, France
| |
Collapse
|
2
|
Di Ciaula A, Iacoviello M, Bonfrate L, Khalil M, Shanmugam H, Lopalco G, Bagnulo R, Garganese A, Iannone F, Resta N, Portincasa P, Stella A. Genetic and clinical features of familial mediterranean fever (FMF) in a homogeneous cohort of patients from South-Eastern Italy. Eur J Intern Med 2023; 115:79-87. [PMID: 37183082 DOI: 10.1016/j.ejim.2023.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/23/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
Familial Mediterranean Fever (FMF) is linked with the MEFV gene and is the commonest among monogenic autoinflammatory diseases, with high prevalence in the Mediterranean basin. Although the clinical presentation of FMF has a major role in diagnosis, genotype/phenotype correlations and the role of "benign" gene variants (as R202Q) appear highly variable and incompletely clear, making difficult to select the most effective strategy in the management of patients. Aim of the present study was to investigate the clinical presentation and the genetic background in a homogenous cohort of patients from Apulia (south eastern Italy). We investigated 217 patients with a clinical suspect of autoinflammatory diseases, who were characterized for the occurrence of specific symptoms and with next generation sequencing by a 4-gene panel including MEFV, MVK, NLRP3 and TNFRSF1A. A genetic change was identified in 122 (53.7%) patients, with 161 different MEFV variants recorded in 100 individuals, 10 variants in NLRP3, and 6 each in TNFRSF1A and MVK. The benign variant R202Q was largely prevalent (41.6% of all MEFV variants). When patients were selected according the number of pathogenic MEFV variants (0, 1, or 2 pathogenic variants), results failed to show significant links between the frequency of symptoms and the number of pathogenic variants. Only family history and Pras score (indicative for severity of disease) predicted the presence of pathogenic variants, as compared with carriers of variants considered of uncertain significance or benign. Fever >38 °C and arthralgias appeared more frequently in R202Q-positive patients than in non-R202Q carriers. These two subgroups showed comparable duration of fever, occurrence of myalgia, abdominal and chest pain, Pras, and IFFS scores. In conclusion, results confirm that FMF manifests in mild form in non-middle eastern patients. This possibility partly affects the reliability of clinical criteria/scores. Furthermore, the presence of the R202Q variant might not be completely neutral in selected groups of patients.
Collapse
Affiliation(s)
- Agostino Di Ciaula
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Matteo Iacoviello
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Leonilde Bonfrate
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Mohamad Khalil
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Harshitha Shanmugam
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Rosanna Bagnulo
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | | | - Florenzo Iannone
- Rheumatology Unit, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Nicoletta Resta
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy; Laboratory of Medical Genetics, AOU Hospital Policlinico, Bari, Italy
| | - Piero Portincasa
- Clinica Medica "A. Murri", Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Alessandro Stella
- Laboratory of Medical Genetics, Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE-J), Università degli Studi di Bari Aldo Moro, Bari, Italy; Laboratory of Medical Genetics, AOU Hospital Policlinico, Bari, Italy.
| |
Collapse
|
3
|
Aiello A, Mariano EE, Prada M, Cioni L, Teruzzi C, Manna R. Budget impact analysis of anakinra in the treatment of familial Mediterranean fever in Italy. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2176091. [PMID: 36819891 PMCID: PMC9930828 DOI: 10.1080/20016689.2023.2176091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 01/27/2023] [Indexed: 06/18/2023]
Abstract
INTRODUCTION Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disease that significantly reduces occupational productivity and quality-of-life in affected patients. Italy has an estimated FMF prevalence of 1 in 60,000 people. While colchicine is the primary treatment for FMF, biologics are administered to intolerant and non-responder patients. Anakinra and canakinumab are the only biologics approved and reimbursed for FMF in Italy. Both medicines have demonstrated efficacy in FMF patients yet differ in treatment costs. This study aimed to perform a budget impact analysis (BIA) following anakinra's reimbursement for FMF treatment, considering pharmaceutical costs from the Italian National Healthcare Service (NHS) perspective. METHODS A 'Reference scenario' (all patients treated with canakinumab) was compared to an 'Alternative scenario', with increased anakinra market shares. The target population was estimated based on the Italian population, epidemiological and market research data. Drugs costs were estimated based on Summary of Product Characteristics and net ex-factory prices. Sensitivity analyses were implemented to test results' robustness. RESULTS The base case analysis showed an overall cumulative expenditure of €30,586,628 for 'Reference scenario' and € 16,465,548 for 'Alternative scenario'. A cumulative savings of €14,121,080 (46.2%) was calculated over 3 years as a result of the reimbursement and increasing uptake of anakinra. The sensitivity analyses, even considering a discount of 50% for canakinumab, confirmed the base case results. CONCLUSIONS Anakinra's introduction, in FMF treatment, provides a financially sustainable option for Italian patients, with savings increasing according to greater use of anakinra.
Collapse
Affiliation(s)
- A Aiello
- Intexo Società Benefit S.r.l, Milan, Italy
| | - EE Mariano
- Intexo Società Benefit S.r.l, Milan, Italy
| | - M Prada
- Intexo Società Benefit S.r.l, Milan, Italy
| | - L Cioni
- Swedish Orphan Biovitrum, Milan, Italy
| | - C Teruzzi
- Swedish Orphan Biovitrum, Milan, Italy
| | - R Manna
- Periodic Fevers Research Centre, Catholic University of the Sacred Heart, Rome, Italy
| |
Collapse
|
4
|
Ozen S, Kuemmerle‐Deschner JB, Cimaz R, Livneh A, Quartier P, Kone‐Paut I, Zeft A, Spalding S, Gul A, Hentgen V, Savic S, Foeldvari I, Frenkel J, Cantarini L, Patel D, Weiss J, Marinsek N, Degun R, Lomax KG, Lachmann HJ. International Retrospective Chart Review of Treatment Patterns in Severe Familial Mediterranean Fever, Tumor Necrosis Factor Receptor–Associated Periodic Syndrome, and Mevalonate Kinase Deficiency/Hyperimmunoglobulinemia D Syndrome. Arthritis Care Res (Hoboken) 2017; 69:578-586. [DOI: 10.1002/acr.23120] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 08/31/2016] [Accepted: 10/04/2016] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Avi Livneh
- Sackler School of Medicine, Tel Aviv UniversityTel Aviv Israel
| | - Pierre Quartier
- Hôpital Necker, Assistance Publique Hopitaux de Paris, IMAGINE Institute, and Paris‐Descartes UniversityParis France
| | | | | | | | - Ahmet Gul
- Istanbul School of Medicine, University of IstanbulIstanbul Turkey
| | - Veronique Hentgen
- Centre Hospitalier Universitaire de Bicêtre, APHP, University of Paris SUDParis France
| | | | - Ivan Foeldvari
- Hamburger Zentrum für Kinder‐ und JugendrheumatologieHamburg Germany
| | | | | | | | | | | | | | | | | |
Collapse
|