1
|
Sahr T, Kiltz U, Weseloh C, Kallinich T, Braun J. [Results of the systematic literature search as basis for the "Evidence-based treatment recommendations for familial Mediterranean fever patients with insufficient response or intolerability to colchicine" of the Society for Pediatric and Adolescent Rheumatology and the German Society for Rheumatology]. Z Rheumatol 2020; 79:943-951. [PMID: 32997267 PMCID: PMC7647992 DOI: 10.1007/s00393-020-00886-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a genetic disease of childhood and adulthood which is relatively rare in Germany. It is characterized by recurrent febrile attacks, peritonitis, pleuritis and arthritis. The established treatment with colchicine is effective and well-tolerated by most patients; however, some patients do not adequately respond or do not tolerate this treatment. Biologics can be considered for some of these patients. The Society for Pediatric and Adolescent Rheumatology (GKJR) and the German Society for Rheumatology (DGRh) have agreed to develop joint recommendations for this specific clinical situation. AIM Implementation of a systematic literature search (SLR) on the basis of the EULAR recommendations published in 2016 as the foundation for the development of evidence-based treatment recommendations for FMF patients with insufficient response or intolerance to colchicine. METHODS The SLR was performed using references from various databases as an update of the SLR carried out by EULAR up to 2014, whereby all articles must have been published between 1 January 2015 and 31 December 2017. The Rayyan abstract tool for the preselection and the classification of the Oxford Centre for Evidence Based Medicine 2009 were used for the preparation of the evidence tables. RESULTS The search yielded 360 hits and after duplicate matching 263. A total of 88 publications were included (34%) and 102 excluded (39%), a review of the full publication was necessary for a further 73 (28%) and 43 were discussed more intensively. Finally, 64 publications (24%) remained. A total of 4 case-control studies, 31 cohort studies, 8 case series, 7 controlled studies (including 5 abstracts), 10 reviews, 4 meta-analyses and systematic reviews were accepted. DISCUSSION The SLR was carried out in a scientifically accurate and transparent manner according to international standards. The SLR proved to be a good basis for a consensus on the 5 overarching principles and the 10 recommendations, so that the joint activity of the GKJR and DGRh was successfully and even promptly concluded. The recommendations are a solid basis for treating patients of all ages with FMF. The explanations on the problem of colchicine resistance play an important role here.
Collapse
Affiliation(s)
- T Sahr
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - U Kiltz
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland
| | - C Weseloh
- Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - T Kallinich
- Pädiatrie m.S. Pulmonologie und Immunologie, Sozialpädiatrisches Zentrum, Universitätsmedizin Charité Berlin, Berlin, Deutschland
| | - J Braun
- Rheumazentrum Ruhrgebiet, Herne, Ruhr-Universität Bochum, Claudiusstr. 45, 44649, Herne, Deutschland.
| |
Collapse
|
2
|
Celep G, Durmaz ZH, Erdogan Y, Akpinar S, Kaya SA, Guckan R. The Spectrum of MEFV Gene Mutations and Genotypes in the Middle Northern Region of Turkey. Eurasian J Med 2019; 51:252-256. [PMID: 31692716 DOI: 10.5152/eurasianjmed.2019.18396] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Familial Mediterranean fever (FMF) is a common, inherited, autosomal recessive inflammatory disease in children. The diagnosis of FMF is based on clinical features and positive family history supported with genetic testing. This study aimed to determine the frequency and distribution of Mediterranean fever (MEFV) gene alterations of a city in Northern Anatolia. Materials and Methods We evaluated MEFV gene mutations in 374 children preliminary diagnosed as FMF by a commercial kit based on real-time polymerase chain reaction technique in a one-year period, and screened 12 mutations. Results At least one mutation was detected in 213 patients (57%) and 38 genotypes with 11 distinct mutations.A total of 137 (64. 3%) of mutation-positive children were heterozygous, 45 (21. 1%) were compound heterozygous, and 2 (0.9%) were complex heterozygous; and 14 (6.4%) patients were homozygous, 6 (2.8%) were compound homozygous, and 3 (1.4%) were complex homozygous. With a frequency of 50.1%, R202Q was the most common mutation. Also, R202Q/M694V was the most common compound heterozygous genotype. In 43 alleles, R202Q-M694V mutations were found to be in linkage disequilibrium. In our cohort, M694V, E148Q, V726A, and M680I (G/C) were other common mutations; whereas F479L, A744S, K695R, P369S, M694I, and R761H were the rare mutations. None of our patients had M680I (G/A) mutation. Conclusion We determined the most common MEFV alteration prevalence in children of our region for the first time. The high R202Q mutation and linkage disequilibrium (LD) rates were the remarkable results of this study.
Collapse
Affiliation(s)
- Gokce Celep
- Department of Paediatrics, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Zeynep Hulya Durmaz
- Department Biochemistry, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Yalciner Erdogan
- Department of Paediatrics, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Seviye Akpinar
- Department of Paediatrics, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Saban Abdullah Kaya
- Department of Paediatric Surgery, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| | - Rıdvan Guckan
- Department of Microbiology, Amasya University School of Medicine, Sabuncuoğlu Şerefeddin Training and Research Hospital, Amasya, Turkey
| |
Collapse
|
3
|
YAŞAR BİLGE NŞ, SARI İ, SOLMAZ D, ŞENEL S, EMMUNGİL H, KILIÇ L, YILMAZ ÖNER S, YILDIZ F, YILMAZ S, ERSÖZLU BOZKIRLI D, AYDIN TUFAN M, YILMAZ S, YAZISIZ V, PEHLİVAN Y, BES C, YILDIRIM ÇETİN G, ERTEN Ş, GÖNÜLLÜ E, ŞAHİN F, AKAR S, AKSU K, KALYONCU U, DİRESKENELİ H, ERKEN E, KISACIK B, SAYARLIOGLU M, ÇINAR M, KAŞİFOĞLU T. The distribution of MEFV mutations in Turkish FMF patients:
multicenter study representing results of Anatolia. Turk J Med Sci 2019; 49:472-477. [PMID: 30887796 PMCID: PMC7018361 DOI: 10.3906/sag-1809-100] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background/aim The distribution of Mediterranean fever (MEFV) gene mutations in Turkish familial Mediterranean fever (FMF)
patients varies according to geographic area of Turkey. There is a need for highly representative data for Turkish FMF patients. The aim
of our study was to investigate the distribution of the common MEFV mutations in Turkish FMF patients in a nationwide, multicenter
study. Materials and methods Data of the 2246 FMF patients, from 15 adult rheumatology clinics located in different parts of the country,
were evaluated retrospectively. The following mutations have been tested in all patients: M694V, M680I, M694I, V726A, and E148Q. Results There were 1719 FMF patients with available genetic testing. According to the genotyping, homozygous M694V, present in
413 patients (24%), was the most common mutation . One hundred and fifty-four (9%) of patients had no detectable mutations. Allele
frequencies of common mutations were: M694V (n = 1529, 44.5%), M680I (n = 423, 12.3%), V726A (n = 315, 9.2%), E148Q (n = 214,
1%), and M694I (n = 12, <1%). Conclusion In this large-scale multicenter study, we provided information about the frequencies of common MEFV gene mutations
obtained from adult Turkish FMF patients. Nearly half of the patients were carrying at least one M694V mutations in their alleles.
Collapse
Affiliation(s)
- N. Şule YAŞAR BİLGE
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, EskişehirTurkey
- * To whom correspondence should be addressed. E-mail:
| | - İsmail SARI
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University, İzmirTurkey
| | - Dilek SOLMAZ
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University, İzmirTurkey
| | - Soner ŞENEL
- Division of Rheumatology, Department of Internal Medicine, Erciyes University, KayseriTurkey
| | - Hakan EMMUNGİL
- Division of Rheumatology, Department of Internal Medicine, Ege University, İzmirTurkey
| | - Levent KILIÇ
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, AnkaraTurkey
| | - Sibel YILMAZ ÖNER
- Division of Rheumatology, Department of Internal Medicine, Marmara University, İstanbulTurkey
| | - Fatih YILDIZ
- Division of Rheumatology, Department of Internal Medicine, Çukurova University, AdanaTurkey
| | - Sedat YILMAZ
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences,Gülhane Faculty of Medicine, AnkaraTurkey
| | - Duygu ERSÖZLU BOZKIRLI
- Division of Rheumatology, Department of Internal Medicine, Adana Numune Education and Research Hospital, AdanaTurkey
| | - Müge AYDIN TUFAN
- Division of Rheumatology, Department of Internal Medicine, Adana Numune Education and Research Hospital, AdanaTurkey
| | - Sema YILMAZ
- Division of Rheumatology, Department of Internal Medicine, Selçuk University, KonyaTurkey
| | - Veli YAZISIZ
- Division of Rheumatology, Department of Internal Medicine, Şişli Etfal Education and Research Hospital, İstanbulTurkey
| | - Yavuz PEHLİVAN
- Division of Rheumatology, Department of Internal Medicine, Gaziantep University, GaziantepTurkey
| | - Cemal BES
- Division of Rheumatology, Department of Internal Medicine, Abant İzzet Baysal University, BoluTurkey
| | - Gözde YILDIRIM ÇETİN
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University, KahramanmaraşTurkey
| | - Şükran ERTEN
- Division of Rheumatology, Department of Internal Medicine, Yıldırım Beyazıt University, AnkaraTurkey
| | - Emel GÖNÜLLÜ
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, EskişehirTurkey
| | - Fezan ŞAHİN
- Department of Biostatistics, Eskişehir Osmangazi University, EskişehirTurkey
| | - Servet AKAR
- Division of Rheumatology, Department of Internal Medicine, Dokuz Eylül University, İzmirTurkey
| | - Kenan AKSU
- Division of Rheumatology, Department of Internal Medicine, Ege University, İzmirTurkey
| | - Umut KALYONCU
- Division of Rheumatology, Department of Internal Medicine, Hacettepe University, AnkaraTurkey
| | - Haner DİRESKENELİ
- Division of Rheumatology, Department of Internal Medicine, Marmara University, İstanbulTurkey
| | - Eren ERKEN
- Division of Rheumatology, Department of Internal Medicine, Çukurova University, AdanaTurkey
| | - Bünyamin KISACIK
- Division of Rheumatology, Department of Internal Medicine, Medical Park, GaziantepTurkey
| | - Mehmet SAYARLIOGLU
- Division of Rheumatology, Department of Internal Medicine, Kahramanmaraş Sütçü İmam University, KahramanmaraşTurkey
| | - Muhammed ÇINAR
- Division of Rheumatology, Department of Internal Medicine, University of Health Sciences,Gülhane Faculty of Medicine, AnkaraTurkey
| | - Timuçin KAŞİFOĞLU
- Division of Rheumatology, Department of Internal Medicine, Eskişehir Osmangazi University, EskişehirTurkey
| |
Collapse
|
4
|
Ou-Yang LJ, Tang KT. A case of adult onset Still's disease with mutations of the MEFV gene who is partially responsive to colchicine. Medicine (Baltimore) 2018; 97:e0333. [PMID: 29642170 PMCID: PMC5908639 DOI: 10.1097/md.0000000000010333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
RATIONALE Familial Mediterranean fever (FMF) and adult onset Still's disease (AOSD) have overlapping features, and are categorized as being on the spectrum of autoinflammatory diseases (AIDs). FMF is more prevalent in the Mediterranean region but rarely, described in the Chinese population. PATIENT CONCERNS We present an interesting case of a Han Chinese AOSD patient with episodic fever, wheals, and polyarthritis for 2 years. DIAGNOSIS Sequencing analysis found exon 2 mutations of the MEFV gene (c.329T>C [L110P], and c.442G>C [E148Q]). INTERVENTION Her arthritis was well-controlled with colchicine treatment, but fever, and rashes were not. OUTCOMES She eventually received tocilizumab, in addition to colchicine, and her symptoms completely disappeared. LESSONS MEFV mutations may exist in AOSD patients, and treatment with colchicine might be helpful in such patients.
Collapse
Affiliation(s)
| | - Kuo-Tung Tang
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital, Taichung, R.O.C
| |
Collapse
|
5
|
Bd C, A K, E S, O B, E C. Increased Frequency of MEFV Genes in Patients with Epigastric Pain Syndrome. Balkan J Med Genet 2017; 20:51-58. [PMID: 29876233 PMCID: PMC5972503 DOI: 10.1515/bjmg-2017-0020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Atypical clinical forms of familial Mediterranean fever (FMF) can be misdiagnosed as therapy-resistant epigastric pain syndrome (EPS) for they share many of the same clinical features, such as abdominal pain. Thus, we aimed to determined the frequency of FMF in patients who were followed with a diagnosis of therapy-resistant EPS. Seventy-five patients with therapy-resistant EPS and 20 controls were involved in the study. To detect the FMF in patients with therapy-resistant EPS, Tel-Hashomer criteria, family history of FMF were researched and recorded. We performed performed MEFV gene analysis on all patients. Forty-three patients with EPS (57.3%) had MEFV gene mutations and the carrier rate was 30.0%. The most common MEFV gene alteration was R202Q (55.8%), followed by E148Q (16.2%), R761H (16.2%), V726A (9.3%), M680I (9.3%) and M694V (4.6%). Rarely seen mutations in the Turkish population were also identified: K695R (2.3%), L110P (2.3%) and G304R (2.3%). Eight patients with EPS were diagnosed with FMF and started on colchicine therapy. Three patients with compound heterozygosities for three mutations, two patients with compound heterozygosities for two mutations (K695R/ V726A and R202Q/ R761H), one patient with homozygous R202Q, one patient with heterozygous R202Q mutation and one patient with non- R202Q heterozygous mutation (G304R/-) had clinical FMF symptoms and were started on colchicine therapy. Patients who have therapy-resistant EPS should also be questioned about FMF, especially in high risk populations.
Collapse
Affiliation(s)
- Coskun Bd
- Department of Gastroenterology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Kiraz A
- Department of Genetics, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Sevinc E
- Department of Gastroenterology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Baspinar O
- Department of Internal Medicine, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Cakmak E
- Department of Gastroenterology, Cumhuriyet University, Faculty of Medicine, Sivas, Turkey
| |
Collapse
|
6
|
Cekin N, Akyurek ME, Pinarbasi E, Ozen F. MEFV mutations and their relation to major clinical symptoms of Familial Mediterranean Fever. Gene 2017; 626:9-13. [PMID: 28483595 DOI: 10.1016/j.gene.2017.05.013] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 04/28/2017] [Accepted: 05/04/2017] [Indexed: 10/19/2022]
Abstract
Familial Mediterranean fever is a common hereditary disease in Turkey. To date, different mutational spectrum of MEFV gene was observed in studies carried out in different regions of Turkey but in most of these studies association of clinical symptoms of FMF to mutant genotypes have not been investigated in details. Here we report the MEFV gene variations in exons 2, 3, 5 and 10 and their relations to major clinical symptoms of FMF in 514 unrelated (245 males and 269 females) Turkish patients. MEFV mutations were found in 45% (n=230) of patients and 55% (n=284) of patients did not have any mutations. One hundred and thirty-seven (60%) patients were heterozygous, 57 (24.7%) patients were compound heterozygous, 33 (14%) patients were homozygous and 3 (1.3%) patients were having a complex genotype. Allele frequencies of MEFV mutations were M694V (48%), E148Q (18%), M680I (15%), V726A (12.5%), P369S (3.3%), R761H (0.9), K695R (0.9), E148V (0.9) and A744S (0.5%). Abdominal pain (76%) and fever (58%) were two most seen complications among patients followed by arthritis (28%) and chest pain (19%). Almost all major clinical symptoms of FMF were higher in patients with one or more M694V or M680I mutant allele. In contrast, patients having E148Q or V726A mutant allele showed fewer clinical FMF symptoms. Patients with P369S have higher abdominal pain, chest pain and fever than expected. Arthritis was high in K695R heterozygous genotype. One hundred and eighteen patients were carrying more than one polymorphic allele. The most common polymorphism was R202Q (13%). In addition, a novel heterozygous polymorphism at 564th nucleotide (C>T) of exon2 were found in 2 patients.
Collapse
Affiliation(s)
- Nilgun Cekin
- Department of Medical Biology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | | | - Ergun Pinarbasi
- Department of Medical Biology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey.
| | - Filiz Ozen
- Medeniyet University, Ministry of Health, Goztepe Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Sandhya P, Vellarikkal SK, Nair A, Ravi R, Mathew J, Jayarajan R, Kumar A, Verma A, Sivadas A, Danda D, Sivasubbu S, Scaria V. Egyptian tale from India: application of whole-exome sequencing in diagnosis of atypical familial Mediterranean fever. Int J Rheum Dis 2017; 20:1770-1775. [DOI: 10.1111/1756-185x.13042] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Pulukool Sandhya
- Department of Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Shamsudheen Karuthedath Vellarikkal
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
- Academy of Scientific and Innovative Research (AcSIR); Delhi India
| | - Aswin Nair
- Department of Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Rowmika Ravi
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| | - John Mathew
- Department of Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Rijith Jayarajan
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| | - Anoop Kumar
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| | - Ankit Verma
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| | - Ambily Sivadas
- Academy of Scientific and Innovative Research (AcSIR); Delhi India
- GN Ramachandran Knowledge Center for Genome Informatics; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| | - Debashish Danda
- Department of Rheumatology; Christian Medical College and Hospital; Vellore India
| | - Sridhar Sivasubbu
- Genomics and Molecular Medicine; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
- Academy of Scientific and Innovative Research (AcSIR); Delhi India
| | - Vinod Scaria
- Academy of Scientific and Innovative Research (AcSIR); Delhi India
- GN Ramachandran Knowledge Center for Genome Informatics; CSIR Institute of Genomics and Integrative Biology (CSIR-IGIB); Delhi India
| |
Collapse
|