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Miramontes-González JP, Cristea AC, Martín MG, González Fernández M, Pérez-Castrillón JL. MEFV gene mutation (c.229G>T) as a cause of fever of unknown origin. Eur J Intern Med 2024; 123:151-152. [PMID: 38320885 DOI: 10.1016/j.ejim.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 01/17/2024] [Accepted: 01/21/2024] [Indexed: 02/08/2024]
Affiliation(s)
- Jose Pablo Miramontes-González
- Department of Medicine, Dermatology and Toxicology, Internal medicine "Rio Hortega" University Hospital, University of Valladolid, Spain; Internal Medicine "Rio Hortega" University Hospital, Spain.
| | | | | | | | - José Luis Pérez-Castrillón
- Department of Medicine, Dermatology and Toxicology, Internal medicine "Rio Hortega" University Hospital, University of Valladolid, Spain
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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.
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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.
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Ozcan G, Cayci S, Celikel Acar B, Basaran O, Aydin F, Elhan AH, Cakar N. Is the performance of the international severity scoring system for familial mediterranean fever in children better than other scoring systems? Int J Clin Pract 2021; 75:e14678. [PMID: 34328662 DOI: 10.1111/ijcp.14678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS Familial Mediterranean fever (FMF) is an autosomal recessive disorder characterised by recurrent episodes of fever and serosal inflammation with elevated acute phase reactants. Assessing the severity of the disease may be useful in identifying colchicine-resistant patients. The aim of this study is to determine the disease severity of FMF patients according to the Pras, Mor, and International Severity Scoring System for Familial Mediterranean Fever (ISSF) scoring systems and to evaluate the consistency of these three systems. METHODS The medical records of patients with FMF were retrospectively reviewed. Demographic features, family history of FMF, clinical characteristics at disease onset, laboratory features, Mediterranean fever genetic mutations, treatment regimens, and disease courses were recorded. RESULTS A total of 205 patients (116 girls) were included in the study. The mean age of the patients was 13.3 ± 4.0 years. The Pras, Mor, and ISSF scores were inconsistent with each other, and there was poor fit between them (generalised Kappa: 0.140 ± 0.029; P < .001). In the receiver operating characteristic (ROC) analysis performed by accepting the clinician's opinion as the gold standard, the ISSF was found to be more sensitive and specific than the other two systems. CONCLUSION Evaluation of disease severity according to the ISSF in paediatric patients is more sensitive and specific than the Pras and Mor scoring systems.
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Affiliation(s)
- Gizem Ozcan
- Department of Pediatric Pulmonology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Semsa Cayci
- Department of Pediatric Nephrology, Ankara City Hospital, Ankara, Turkey
| | - Banu Celikel Acar
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Ozge Basaran
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Fatma Aydin
- Department of Pediatric Rheumatology, Ankara City Hospital, Ankara, Turkey
| | - Atilla Halil Elhan
- Department of Biostatistics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nilgun Cakar
- Department of Pediatric Rheumatology, Ankara University Faculty of Medicine, Ankara, Turkey
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Lainka E, Kallinich T, Wittkowski H. Rekurrierende Fiebersyndrome – Subgruppe der autoinflammatorischen Erkrankungen. Monatsschr Kinderheilkd 2021. [DOI: 10.1007/s00112-021-01149-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chuamanochan M, Weller K, Feist E, Kallinich T, Maurer M, Kümmerle-Deschner J, Krause K. State of care for patients with systemic autoinflammatory diseases - Results of a tertiary care survey. World Allergy Organ J 2019; 12:100019. [PMID: 30937142 PMCID: PMC6439415 DOI: 10.1016/j.waojou.2019.100019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Systemic autoinflammatory diseases (SAIDs) are rare debilitating disorders of which there is limited awareness and a significant delay in diagnosis. There is no uniform approach in the diagnosis and treatment of these disorders and the real life state of SAID patient care is poorly characterized. The aim of this study was to obtain data on the epidemiology, state of care and the perception of physicians who are involved in the care of SAID patients. METHODS We performed a questionnaire-based survey and contacted 134 university departments of dermatology, pediatrics, rheumatology and other SAID departments of tertiary care in German-speaking countries. RESULTS A total of 37 departments participated in the survey. The majority of departments managed both adult and pediatric patients with a variety of monogenic and polygenic/acquired SAIDs. For monogenic SAIDs such as cryopyrin-associated periodic syndromes (CAPS) and familial Mediterranean fever (FMF), the diagnostic and treatment strategies were similar among the departments. The diagnostic work-up included inflammatory markers and genetic testing, the first line treatment interleukin-1 (IL-1) blockers for CAPS and colchicine for FMF. For polygenic/acquired SAIDs, we observed a significant heterogeneity in diagnostic and therapeutic approaches. As a major unmet need, diagnostic delay was identified with a median time to diagnosis of 2 (range 1-5) years. The overall state of care for SAID patients was rated to be excellent or good by only 12% of departments, and to be poor or non-sufficient by 40% of departments. CONCLUSION This study demonstrates a high need to improve the state of care and to harmonize diagnostic and treatment strategies for SAID patients.
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Key Words
- AOSD, Adult-onset Still's disease
- ARC2, Autoinflammation Reference Center Charité
- Autoinflammatory disease
- BD, Behçet's disease
- CAPS, Cryopyrin-associated periodic syndrome
- CBC, Complete blood count
- CRMO, Chronic recurrent osteomyelitis
- CRP, C-reactive protein
- FMF, Familial Mediterranean fever
- HIDS, Hyper IgD syndrome
- IL-1β, Interleukin-1β
- MKD, Mevalonate kinase deficiency
- MWS, Muckle-Wells syndrome
- NSAIDs, Nonsteroidal anti-inflammatory drugs
- PAPA, Pyogenic arthritis pyoderma gangrenosum and acne syndrome
- PG, Pyoderma gangrenosum
- PRAAS, Proteasome-associated autoinflammatory syndrome
- SAA, Serum amyloid A
- SAIDs, Systemic autoinflammatory diseases
- SJIA, Systemic juvenile idiopathic arthritis
- SchS, Schnitzler's syndrome
- State of care
- Survey
- TNF, Tumor necrosis factor
- TRAPS, TNF-receptor-associated periodic syndrome
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Affiliation(s)
- Mati Chuamanochan
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
- Division of Dermatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Karsten Weller
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
- Autoinflammation Reference Center Charité, Charité (ARC) – Universitätsmedizin Berlin, Germany
| | - Eugen Feist
- Autoinflammation Reference Center Charité, Charité (ARC) – Universitätsmedizin Berlin, Germany
- Department of Rheumatology and Clinical Immunology, Charité – Universitätsmedizin Berlin, Germany
| | - Tilmann Kallinich
- Autoinflammation Reference Center Charité, Charité (ARC) – Universitätsmedizin Berlin, Germany
- Department of Pediatric Pneumology and Immunology, Center for Chronically Sick Children, Charité – Universitätsmedizin Berlin, Germany
| | - Marcus Maurer
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
- Autoinflammation Reference Center Charité, Charité (ARC) – Universitätsmedizin Berlin, Germany
| | - Jasmin Kümmerle-Deschner
- Division of Pediatric Rheumatology, Department of Pediatrics and Autoinflammation Reference Center Tübingen, University Hospital, Tübingen, Germany
| | - Karoline Krause
- Department of Dermatology and Allergy, Charité – Universitätsmedizin Berlin, Germany
- Autoinflammation Reference Center Charité, Charité (ARC) – Universitätsmedizin Berlin, Germany
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Knieper AM, Klotsche J, Lainka E, Berger T, Dressler F, Jansson AF, Rietschel C, Oommen PT, Berendes R, Niehues T, Neudorf U, Foell D, Wittkowski H, Kallinich T. Familial Mediterranean fever in children and adolescents: factors for colchicine dosage and predicting parameters for dose increase. Rheumatology (Oxford) 2017; 56:1597-1606. [PMID: 28859329 DOI: 10.1093/rheumatology/kex222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/13/2022] Open
Abstract
Objectives The aim was to analyse factors influencing the individual colchicine dose in children with FMF, to evaluate the impact of dose adjustment on the clinical course and inflammation and to identify clinical parameters and biomarkers that predict dose increase in the near future. Methods Data from 409 paediatric FMF patients (4566 visits) derived from the national auto-inflammatory diseases registry were analysed. Serum concentrations of S100 molecules were determined by ELISA. Results The age-dependent colchicine dose is influenced by the present genotype. The body surface area is the anthropometric parameter that correlates best with the applied dosages. Colchicine introduction and dose increase lead to significant reduction of clinical symptoms and inflammation. During established colchicine therapy, an increase of one single biomarker increases the likelihood of a dose increment in the next 12 months with a factor of 1.62-1.94. A combination of biomarkers including S100 molecules increases this odds ratio up to 4.66 when analysing all patients and up to 7.27 when analysing patients with a high risk of severe disease. Conclusion Colchicine therapy is currently guided mainly by the occurrence of clinical symptoms and serological inflammation. Other factors, such as the genotype, the body surface area and biomarkers, will help to manage colchicine therapy in a more individualized fashion. The additional analysis of S100 molecules as sensitive biomarkers will help to identify patients at risk for dose increases in the near future.
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Affiliation(s)
| | - Jens Klotsche
- German Rheumatism Research Centre Berlin, Leibniz Institute.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Medicine Berlin, Berlin
| | - Elke Lainka
- Pediatric Rheumatology, Department of Paediatrics, University of Duisburg-Essen, Essen
| | - Thomas Berger
- Pediatric Neurology, Vestische Kinderklinik Datteln, Datteln
| | - Frank Dressler
- Centre for Paediatrics and Adolescent Medicine, Hannover Medical School, Hannover
| | - Annette F Jansson
- Department of Rheumatology and Immunology, Hauner Children's Hospital, Ludwig Maximilians University, Munich
| | - Christoph Rietschel
- Clementine Kinderhospital, Verein Frankfurter Stiftungskrankenhäuser, Frankfurt
| | - Prasad T Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, Center of Child and Adolescent Health, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf
| | - Rainer Berendes
- Pediatric Rheumatology, Children's Hospital St Marien, Landshut
| | - Tim Niehues
- Zentrum für Kinder- und Jugendmedizin, HELIOS Klinikum Krefeld, Krefeld
| | - Ulrich Neudorf
- Pediatric Rheumatology, Department of Paediatrics, University of Duisburg-Essen, Essen
| | - Dirk Foell
- Department of Paediatric Rheumatology and Immunology, University of Münster, Münster
| | - Helmut Wittkowski
- Department of Paediatric Rheumatology and Immunology, University of Münster, Münster
| | - Tilmann Kallinich
- Pediatric Pneumology and Immunology, Charité University Medicine Berlin.,Social Pediatric Center, Charité University Medicine Berlin, Berlin, Germany
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Gohar F, Orak B, Kallinich T, Jeske M, Lieber M, von Bernuth H, Giese A, Weissbarth-Riedel E, Haas JP, Dressler F, Holzinger D, Lohse P, Neudorf U, Lainka E, Hinze C, Masjosthusmann K, Kessel C, Weinhage T, Foell D, Wittkowski H. Correlation of Secretory Activity of Neutrophils With Genotype in Patients With Familial Mediterranean Fever. Arthritis Rheumatol 2017; 68:3010-3022. [PMID: 27333294 DOI: 10.1002/art.39784] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 06/02/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is an autoinflammatory disorder caused by pyrin-encoding MEFV mutations. Patients present with recurrent but self-limiting episodes of acute inflammation and often have persistent subclinical inflammation. The pathophysiology is only partially understood, but neutrophil overactivation is a hallmark of the disease. S100A12 is a neutrophil-derived proinflammatory danger signal that is strongly elevated in active FMF. This study was undertaken to characterize the secretory activity of neutrophils in vitro and investigate the association of S100A12 with disease activity and genotype in patients with FMF. METHODS Neutrophils from FMF patients carrying the p.M694V mutation (1 compound heterozygous and 5 homozygous) and neutrophils from 4 healthy control subjects were purified and stimulated in vitro. Neutrophil secretion of S100A12, interleukin-18 (IL-18), IL-1β, and caspase 1 was determined. Based on these in vitro analyses, serum concentrations of S100A12, IL-18, and IL-1β were also analyzed in 128 clinically and genetically characterized patients with FMF. RESULTS In vitro, unstimulated neutrophils from p.M694V-positive patients spontaneously secreted more S100A12, IL-18, and caspase 1 compared to neutrophils from healthy controls. Serum concentrations of S100A12 correlated with disease activity and genotype, with the levels being highest in homozygous patients and with compound heterozygotes displaying higher levels than heterozygotes. Compared to individuals negative for the p.M694V mutation, heterozygous, compound heterozygous, or homozygous p.M694V-positive patients had higher serum levels of S100A12 and IL-18 during inactive and subclinical disease. CONCLUSION The FMF phenotype is known to be more severe in patients carrying the p.M694V mutation. This report describes 2 molecules secreted by unconventional secretory pathways, S100A12 and IL-18, whose concentrations correlated with clinical disease activity and genotype in patients with FMF. In this clinically and genetically heterogeneous disease, management of these surrogate markers might help to improve patient care and outcomes.
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Affiliation(s)
- Faekah Gohar
- University Children's Hospital, Muenster, Germany
| | - Banu Orak
- Charité University Medicine, Berlin, Germany
| | | | | | | | - Horst von Bernuth
- Labor Berlin-Charité Vivantes GmbH and Charité University Medicine, Berlin, Germany
| | - Arnd Giese
- St. Josef-Hospital, Ruhr University, Bochum, Germany
| | | | - Johannes-Peter Haas
- German Centre for Child and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | | | | | - Peter Lohse
- Center for Genomics and Transcriptomics, Tuebingen, Germany
| | | | - Elke Lainka
- University of Duisburg-Essen, Essen, Germany
| | - Claas Hinze
- University Children's Hospital, Muenster, Germany
| | | | | | | | - Dirk Foell
- University Children's Hospital, Muenster, Germany
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Demirkaya E, Acikel C, Hashkes P, Gattorno M, Gul A, Ozdogan H, Turker T, Karadag O, Livneh A, Ben-Chetrit E, Ozen S. Development and initial validation of international severity scoring system for familial Mediterranean fever (ISSF). Ann Rheum Dis 2016; 75:1051-6. [PMID: 26823530 DOI: 10.1136/annrheumdis-2015-208671] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 01/10/2016] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To develop widely accepted international severity score for children and adult patients with familial Mediterranean fever (FMF) that can be easily applied, in research and clinical practice. METHODS Candidate severity criteria were suggested by several FMF expert physicians. After three rounds of Delphi survey, the candidate criteria, defined by the survey, were discussed by experts in a consensus meeting. Each expert brought data of clinical manifestations, laboratory findings and physician's global assessments (PGAs) of minimum 20 patients from their centres. We used the PGAs for disease severity as a gold standard. Logistic regression analysis was used to evaluate the predicting value of each item, and receiver operating characteristic curve analysis was performed to demonstrate the success of the criteria set. RESULTS A total of 281 patients consist of 162 children and 119 adults with FMF were enrolled and available for validity analysis: Nine domains were included in the final core set of variables for the evaluation of disease severity in FMF. The International Severity Score for FMF (ISSF) may reach a maximum of 10 if all items are maximally scored. The threshold values to determine: severe disease ≥6, intermediate disease 3-5, mild disease ≤2. Area under the curve was calculated as 0.825 for this set in the whole group. CONCLUSIONS The initial validity of ISSF both in children and adult with FMF was demonstrated. We anticipate that it will provide a robust tool to objectively define disease severity for clinical trials, future research as well as for therapeutic decisions in managing patients with FMF.
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Affiliation(s)
- Erkan Demirkaya
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey FMF Arthritis Vasculitis and Orphan disease Research in pediatric rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey
| | - Cengizhan Acikel
- FMF Arthritis Vasculitis and Orphan disease Research in pediatric rheumatology (FAVOR), Gulhane Military Medical Faculty, Ankara, Turkey Department of Biostatistics, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Philip Hashkes
- Pediatric Rheumatology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Marco Gattorno
- Department of Pediatric Rheumatology, Istituto Giannina Gaslini, Genoa, Italy
| | - Ahmet Gul
- Department of Rheumatology, Istanbul University Medical Faculty, Istanbul, Turkey
| | - Huri Ozdogan
- Department of Rheumatology, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Turker Turker
- Department of Epidemiology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Omer Karadag
- Department of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Avi Livneh
- Department of Medicine, Sheba Medical Centre, Tel-Hashomer, and Ramat-Gan and Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | | | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Heterozygote Formen des familiären Mittelmeerfiebers können beim Erwachsenen als myofasziales Schmerzsyndrom imponieren. Z Rheumatol 2015; 74:533-9. [DOI: 10.1007/s00393-014-1518-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Anwar WA, Khyatti M, Hemminki K. Consanguinity and genetic diseases in North Africa and immigrants to Europe. Eur J Public Health 2015; 24 Suppl 1:57-63. [PMID: 25107999 DOI: 10.1093/eurpub/cku104] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Endemic diseases are caused by environmental and genetic factors. While in this special issue several chapters deal with environmental factors, including infections, the present focus is on genetic causes of disease clustering due to inbreeding and recessive disease mechanisms. Consanguinity is implying sharing of genetic heritage because of marriage between close relatives originating from a common ancestor. With limited natural selection, recessive genes may become more frequent in an inbred compared with an outbred population. Consanguinity is common in North Africa (NA), and the estimates range from 40 to 49% of all marriages in Tunisia and 29-33% in Morocco. As a consequence, recessive disorders are common in the NA region, and we give some examples. Thalassaemia and sickle cell disease/anaemia constitute the most common inherited recessive disorders globally and they are common in NA, but with immigration they have spread to Europe and to other parts of the world. Another example is familial Mediterranean fever, which is common in the Eastern Mediterranean area. With immigrantion from that area to Sweden, it has become the most common hereditary autoinflammatory disease in that country, and there is no evidence that any native Swede would have been diagnosed with this disease. The examples discussed in this chapter show that the historic movement of populations and current immigration are influencing the concept of 'endemic' disease.
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Affiliation(s)
- Wagida A Anwar
- 1 Community Medicine Department, Ain Shams University, Cairo, Egypt
| | | | - Kari Hemminki
- 3 Division of Molecular Genetic Epidemiology, German Cancer Research Centre (DKFZ), Heidelberg, Germany4 Center for Primary Health Care Research, Lund University, 205 02, Malmö, Sweden
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Ben-Zvi I, Herskovizh C, Kukuy O, Kassel Y, Grossman C, Livneh A. Familial Mediterranean fever without MEFV mutations: a case-control study. Orphanet J Rare Dis 2015; 10:34. [PMID: 25887307 PMCID: PMC4377009 DOI: 10.1186/s13023-015-0252-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 03/10/2015] [Indexed: 12/20/2022] Open
Abstract
Background Although familial Mediterranean fever (FMF) was originally defined as an autosomal recessive disorder, approximately 10–20% of FMF patients do not carry any FMF gene (MEFV) mutations. Fine phenotype characterization may facilitate the elucidation of the genetic background of the so called “FMF without MEFV mutations”. In this study we clinically and demographically characterize this subset. Methods MEFV mutation-negative FMF and control patients were recruited randomly from a cohort followed in a dedicated FMF clinic. The control subjects comprised 2 groups: 1. typical population of FMF, consisting of genetically heterogeneous patients manifesting the classical spectrum of FMF phenotype and 2. a severe phenotype of FMF, consisting of FMF patients homozygous for the p.M694V mutation. Results Forty-seven genetic-negative, 60 genetically heterogeneous and 57 p.M694V homozygous FMF patients were enrolled to the study. MEFV-mutation negative FMF patients showed a phenotype closely resembling that of the other 2 populations. It differed however from the p.M694V homozygous subset by its milder severity (using Mor et al. scoring method), as determined by the lower proportion of patients with chest and erysipelas like attacks, lower frequency of some of the chronic manifestations, lower colchicine dose and older age of disease onset. Conclusions MEFV mutation-negative FMF by virtue of its classical FMF phenotype is probably associated with a genetic defect upstream or downstream to MEFV related metabolic pathway.
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Affiliation(s)
- Ilan Ben-Zvi
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,The Rheumatology unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Heller Institute of Medical research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. .,The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel.
| | - Corinne Herskovizh
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Olga Kukuy
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Yonatan Kassel
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel.
| | - Chagai Grossman
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,The Rheumatology unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Avi Livneh
- Department of Medicine F, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,The Rheumatology unit, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Heller Institute of Medical research, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Ornek A, Kurucay M, Henning BF, Pagonas N, Schlottmann R, Schmidt WE, Giese A. Sonographic assessment of spleen size in Turkish migrants with Familial Mediterranean fever in Germany. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:1991-1997. [PMID: 25336487 DOI: 10.7863/ultra.33.11.1991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) can be associated with splenomegaly. Prospective quantitative data are lacking. We performed a sonographic assessment of spleen size in patients with FMF and healthy control participants to assess its diagnostic value. METHODS Patients with FMF according to the criteria of Livneh et al (Arthritis Rheum 1997; 40:1879-1885) who were in an asymptomatic interval and control participants were prospectively included in this study in Germany and underwent sonographic measurement of the spleen as well as a structured interview and a physical examination. Patients and controls were Turkish migrants. RESULTS Thirty-six patients and 27 controls were included. Patients and controls did not differ significantly in age (mean ± SD, 34.8 ± 9.7 versus 33.3 ± 10.0 years, respectively; P = .56), sex, height, weight, or body mass index (26.7 ± 4.7 versus 26.1 ± 4.3 kg/m(2); P = .63). Spleen size was greater in patients than controls in width (4.3 ± 1.0 versus 3.7 ± 0.7 cm; P = .008) and also length (12.1 ± 1.9 versus 10.5 ± 1.4 cm; P = .001). Twenty-six of 36 patients (72.2%) had a history of appendectomy compared to 3 of 27 controls (11.1%; P < .001). The combination of an enlarged spleen (length >11 cm and/or width >4 cm) gave specificity of 100% (95% confidence interval, 87%-100%) and a positive predictive value of 100% (95% confidence interval, 78%-100%) for the diagnosis of FMF in our study. CONCLUSIONS Spleen size as evaluated by sonography is larger in patients with FMF compared to healthy controls. Most patients with FMF included in this study had undergone appendectomy. Familial Mediterranean fever should be considered as a differential diagnosis in Turkish migrants in Germany if the spleen is enlarged and a history of appendectomy is reported.
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Affiliation(s)
- Ahmet Ornek
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Mustafa Kurucay
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Bernhard F Henning
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Nikolaos Pagonas
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Renate Schlottmann
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Wolfgang E Schmidt
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.)
| | - Arnd Giese
- Department of Internal Medicine I, Marienhospital Herne, Medical Center of Ruhr University Bochum, Herne, Germany (A.Ö., M.K., B.F.H., N.P., A.G.); Institute for Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Bergmannsheil, Ruhr University Bochum, Bochum, Germany (A.Ö.); and Department of Internal Medicine I, St Josef-Hospital, Medical Center of Ruhr University Bochum, Bochum, Germany (R.S., W.S., A.G.).
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