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Yalcin-Mutlu M, Icacan OC, Yildirim F, Temiz SA, Fagni F, Schett G, Tascilar K, Minopoulou I, Burul G, Bes C. IL-1 Inhibitors in the Treatment of Familial Mediterranean Fever: Treatment Indications and Clinical Features in a Large Real-World Cohort. J Clin Med 2024; 13:3375. [PMID: 38929904 PMCID: PMC11203757 DOI: 10.3390/jcm13123375] [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: 05/07/2024] [Revised: 05/26/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
Background: The accruing evidence about the efficacy of anti-IL-1 agents in Familial Mediterranean Fever (FMF) patients led to their widespread off-label use. Therefore, identifying precise indications and clinical characteristics of IL-1i-warranting patients are important. This study investigated the clinical characteristics and treatment indications of patients with FMF requiring interleukin 1 inhibition therapy (IL-1i). Methods: Hospital records of FMF patients attending a tertiary care center at the Department of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital were retrospectively analyzed. Data on symptoms and disease manifestations, age of symptom onset, time to diagnosis, MEFV variants, type of treatment, and their indications were collected. Results: Between June 2020 and March 2023, 312 FMF patients were identified. The mean age at the onset of symptoms was 14.0, and the mean time to diagnosis was 11.9 years. In total, 87.1% of patients were receiving colchicine monotherapy, while the remaining 11.8% warranted IL-1i. Clinical symptoms and flare manifestations did not show a significant difference between the two groups. However, patients receiving IL-1i started having symptoms at younger age (11.5 vs. 14.5, p = 0.042) and time to diagnosis was longer (18.2 vs. 11.0, p < 0.01). M694V homozygosity was more common in patients receiving IL-1i. Indications for patients receiving IL-1i were colchicine resistance (8.0%), secondary amyloidosis (5.1%), and colchicine intolerance (2.2%). Conclusions: This study shows that a subset of FMF patients, particularly those with a more severe phenotype with an earlier disease onset and M694V homozygosity, require IL-1i treatment despite the overall good efficacy and tolerability of colchicine, primarily due to colchicine resistance, intolerance, or complications such as amyloidosis.
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Affiliation(s)
- Melek Yalcin-Mutlu
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
- Department of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Türkiye; (F.Y.); (C.B.)
| | - Ozan Cemal Icacan
- Department of Rheumatology, Yozgat City Hospital, Yozgat 66100, Türkiye;
| | - Fatih Yildirim
- Department of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Türkiye; (F.Y.); (C.B.)
| | - Selahattin Alp Temiz
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
| | - Filippo Fagni
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
| | - Georg Schett
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
- Centre for Rare Diseases Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054 Erlangen, Germany
| | - Koray Tascilar
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Medicine 3—Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany; (S.A.T.); (F.F.); (G.S.); (K.T.); (I.M.)
- Deutsches Zentrum für Immuntherapie (DZI), Friedrich-Alexander-Universität Erlangen-Nürnberg and Uniklinikum Erlangen, 91054 Erlangen, Germany
| | - Gokhan Burul
- Department of Internal Medicine, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul 34203, Türkiye;
| | - Cemal Bes
- Department of Rheumatology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul 34480, Türkiye; (F.Y.); (C.B.)
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Hashim N, Babiker R, Mohammed R, Rehman MM, Chaitanya NC, Gobara B. NLRP3 Inflammasome in Autoinflammatory Diseases and Periodontitis Advance in the Management. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2024; 16:S1110-S1119. [PMID: 38882867 PMCID: PMC11174327 DOI: 10.4103/jpbs.jpbs_1118_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 06/18/2024] Open
Abstract
Inflammatory chemicals are released by the immune system in response to any perceived danger, including irritants and pathogenic organisms. The caspase activation and the response of inflammation are governed by inflammasomes, which are sensors and transmitters of the innate immune system. They have always been linked to swelling and pain. Research has mainly concentrated on the NOD-like protein transmitter 3 (NLRP3) inflammasome. Interleukin (IL)-1 and IL-18 are pro-inflammatory cytokines that are activated by the NOD-like antibody protein receptor 3 (NLRP3), which controls innate immune responses. The NLRP3 inflammasome has been associated with gum disease and other autoimmune inflammatory diseases in several studies. Scientists' discovery of IL-1's central role in the pathophysiology of numerous autoimmune disorders has increased public awareness of these conditions. The first disease to be connected with aberrant inflammasome activation was the autoinflammatory cryopyrin-associated periodic syndrome (CAPS). Targeted therapeutics against IL-1 have been delayed in development because their underlying reasons are poorly understood. The NLRP3 inflammasome has recently been related to higher production and activation in periodontitis. Multiple periodontal cell types are controlled by the NLRP3 inflammasome. To promote osteoclast genesis, the NLRP3 inflammasome either increases receptor-activator of nuclear factor kappa beta ligand (RANKL) synthesis or decreases osteoclast-promoting gene (OPG) levels. By boosting cytokines that promote inflammation in the periodontal ligament fibroblasts and triggering apoptosis in osteoblasts, the NLRP3 inflammasome regulates immune cell activity. These findings support further investigation into the NLRP3 inflammasome as a therapeutic target for the medical treatment of periodontitis. This article provides a short overview of the NLRP3 inflammatory proteins and discusses their role in the onset of autoinflammatory disorders (AIDs) and periodontitis.
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Affiliation(s)
- Nada Hashim
- RAK College of Dental Sciences, RAK Medical and Health Sciences University, Ras al-Khaimah, UAE
| | - Rasha Babiker
- RAK College of Medical Sciences, RAK Medical and Health Sciences University, Ras-al-Khaimah, UAE
| | - Riham Mohammed
- RAK College of Dental Sciences, RAK Medical and Health Sciences University, Ras al-Khaimah, UAE
| | | | - Nallan Csk Chaitanya
- RAK College of Dental Sciences, RAK Medical and Health Sciences University, Ras al-Khaimah, UAE
| | - Bakri Gobara
- Faculty of Dentistry, University of Khartoum, Khartoum, Sudan
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Amaryan G, Sarkisian T, Tadevosyan A, Braegger C. Familial Mediterranean fever in Armenian children with inflammatory bowel disease. Front Pediatr 2024; 11:1288523. [PMID: 38410520 PMCID: PMC10895960 DOI: 10.3389/fped.2023.1288523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/27/2023] [Indexed: 02/28/2024] Open
Abstract
Inflammatory bowel disease (IBD) and familial Mediterranean fever (FMF) are inflammatory diseases with complex interactions among genetic, immune, and environmental factors. FMF is a monogenic autoinflammatory disease, characterized by recurrent febrile attacks and polyserositis, and is manifested mainly in childhood. FMF is widespread in Armenia. There are reports on the concurrent occurrence of FMF and IBD. MEFV gene mutations may have a disease-modifying effect on IBD. We have investigated the frequency of MEFV mutations and FMF in Armenian children with IBD and their influence on the clinical course. A total of 69 untreated IBD patients under 18 years of age were enrolled: 52.1% (36) had ulcerative colitis (UC), 21.7% (15) had Crohn's disease (CD), and 26.0% (18) had unclassified colitis (IBD-U). The frequency of FMF among them was 36.2% (25/69), and MEFV mutations were identified in 53.6% (37/69). The highest rate of MEFV mutations and FMF was in UC patients (61.1% and 41.6% respectively). In all, 56.7% (21/37) of IBD patients with MEFV mutations had M694V mutated alleles, mainly in compound heterozygous and heterozygous states. There were no associations in the group of IBD patients with coexisting FMF (25), either between any MEFV mutation and type of IBD or coexistence of FMF. Overall, 36.0% (9/25) of them developed VEO IBD and carried mainly the M694V mutation. We concluded that the carrier frequency of MEFV mutations among Armenian pediatric IBD patients was rather high (53.6%), especially for UC. It was suggested that the MEFV gene is not necessarily a susceptibility gene but most likely modifies the course of IBD. MEFV genetic testing was recommended for Armenian pediatric IBD patients, especially for VEO UC and IBD-U, atypical IBD course, or resistance to the conventional treatment. They should also be asked for isolated febrile attacks, recurrent arthritis, and family history, even in the absence of FMF typical symptoms, to rule out FMF and its complications.
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Affiliation(s)
- Gayane Amaryan
- National Pediatrics Center for Familial Mediterranean Fever, “Arabkir” Medical Complex-Institute of Child and Adolescent Health, Yerevan, Armenia
- Department of Pediatrics, Yerevan State Medical University, Yerevan, Armenia
| | - Tamara Sarkisian
- Center of Medical Genetics and Primary Health Care, Yerevan, Armenia
- Department of Medical Genetics, Yerevan State Medical University, Yerevan, Armenia
| | - Artashes Tadevosyan
- Department of Public Health and Health Care Organization, Yerevan State Medical University, Yerevan, Armenia
| | - Christian Braegger
- Nutrition Research Unit, Children’s University Hospital in Zürich, Zürich, Switzerland
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Khalil A, Greenhalgh A, Gurung S, Chana H. Acute Myopericarditis as the First Manifestation of Familial Mediterranean Fever: A Case Report. Cureus 2024; 16:e54170. [PMID: 38496144 PMCID: PMC10941304 DOI: 10.7759/cureus.54170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 03/19/2024] Open
Abstract
Familial Mediterranean fever (FMF) is an autoinflammatory disorder, characterized by recurrent episodes of fever and polyserositis, and usually presents during the first two decades of life. Acute pericarditis is a rare manifestation of FMF and typically presents with other symptoms of the inflammatory disorder. A 27-year-old Arabian male presented to our hospital with pleuritic chest pain and shortness of breath while lying flat. His electrocardiogram showed changes suggestive of pericarditis, and his inflammatory markers and troponin were raised. His echocardiogram revealed a moderate-sized pericardial effusion with septa and a normal left ventricular function. He had a strong family history of FMF and consanguinity of the parents. He was treated for acute myopericarditis with colchicine and ibuprofen, and his symptoms improved gradually along with his inflammatory markers and troponin. Six weeks after discharge, he had a cardiac MRI, which revealed a thickened pericardium with profound enhancement (features suggestive of pericarditis) and no signs of myocarditis. He was asymptomatic, and his markers and troponin were within the normal range. His colchicine medication was continued indefinitely, and he was referred to a tertiary care hospital with a specialized periodic fever clinic for follow-up and genotype testing.
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Affiliation(s)
- Abdalla Khalil
- Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
| | - Andrew Greenhalgh
- Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
| | - Shovhit Gurung
- Acute Medicine, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
| | - Harmeet Chana
- Radiology, Nortwick Park Hospital, London North West University Healthcare NHS Trust, London, GBR
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Blank N, Kötter I, Schmalzing M, Rech J, Krause K, Köhler B, Kaudewitz D, Nitschke M, Haas CS, Lorenz HM, Krusche M. Clinical presentation and genetic variants in patients with autoinflammatory diseases: results from the German GARROD registry. Rheumatol Int 2024; 44:263-271. [PMID: 37747561 PMCID: PMC10796580 DOI: 10.1007/s00296-023-05443-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/22/2023] [Indexed: 09/26/2023]
Abstract
To investigate clinical symptoms and genetic variants in patients from the German anti-IL-1 registry for autoinflammatory orphan diseases (GARROD) between 2013 and 2022. Multicentre, retrospective analysis of demographic, clinical and genetic data of patients with autoinflammatory diseases (AID) who received anti-IL-1 targeted therapy. The cohort comprised 152 patients with familial Mediterranean fever (FMF; n = 71), cryopyrin-associated periodic syndromes (CAPS; n = 43), TNF-receptor associated periodic syndrome (TRAPS; n = 19), mevalonate kinase deficiency (MKD; n = 3) and unclassified AID (uAID; n = 16). Inflammatory attacks started in 61.2% of the patients before the age of 18 years. The delay between the first AID attack and anti-IL-1 therapy was 17.8 years. Monogenetic AIDs were diagnosed by clinical symptoms. Genetic analyses confirmed the diagnosis in 87.3% of patients with FMF, 65.2% with CAPS and 94.8% with TRAPS. Among this group, heterozygous MEFV variants and variants of unknown significance (VUS) were detected in 22.5% of patients with FMF, 51.2% with CAPS and 47.4% with TRAPS. Patients with VUS were older at disease onset which is consistent with a milder phenotype. Twenty-four patients had secondary AA amyloidosis (AA) at initiation of anti-IL-1 therapy. The mean age of these patients was 16.4 years at their first attack and 44.9 years at the time of AA diagnosis. Turkish-Armenian ancestry correlated with MEFV variants and higher FMF disease activity compared to German ancestry. Molecular genetic analyses should substantiate the clinical diagnosis of a monogenetic AID. Our data support the concept of variable penetrance of VUS which can be associated with late-onset AID.
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Affiliation(s)
- Norbert Blank
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany.
- Internal Medicine 5, Amyloidosis Center and Division of Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
| | - Ina Kötter
- Department of Rheumatology, University Hospital Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Clinic for Rheumatology and Immunology, Bad Bramstedt, Germany
| | - Marc Schmalzing
- Department of Internal Medicine II, Rheumatology and Clinical Immunology, University of Würzburg, Oberdürrbacherstraße 6, 97080, Würzburg, Germany
| | - Jürgen Rech
- Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3-Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie, Friedrich-Alexander-Universität Erlangen-Nürnberg and Universitätsklinikum Erlangen, 91054, Erlangen, Germany
- Zentrum Für Seltene Erkrankungen Erlangen (ZSE ER), Erlangen, Germany
| | - Karoline Krause
- Department of Dermatology, Charité-Campus Mitte, Luisenstraße 2, 10117, Berlin, Germany
| | - Birgit Köhler
- Städtisches Klinikum Karlsruhe, Department of Internal Medicine I, Nephrology and Rheumatology, Moltkestraße 90, 76133, Karlsruhe, Germany
| | - Dorothee Kaudewitz
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany
| | - Martin Nitschke
- Division of Nephrology, Internal Medicine I, Universityhospital S.-H. Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Christian S Haas
- University of Marburg, Department of Internal Medicine, Nephrology and Intensive Care Medicine, Baldingerstrasse 1, 35033, Marburg, Germany
| | - Hanns-Martin Lorenz
- Department of Internal Medicine V, Division of Rheumatology and Amyloidosis Center, University of Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
- Zentrum Für Seltene Erkrankungen Heidelberg (ZSE HD), Heidelberg, Germany
| | - Martin Krusche
- Department of Rheumatology, University Hospital Eppendorf, Martinistraße 52, 20251, Hamburg, Germany
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Charitéplatz 1, 10117, Berlin, Germany
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Bektas M, Koca N, Oguz E, Sari S, Dagci G, Ince B, Ozer PK, Agargun BF, Yalcinkaya Y, Artim-Esen B, Ocal L, Inanc M, Gul A. Characteristics and course of patients with AA amyloidosis: single centre experience with 174 patients from Turkey. Rheumatology (Oxford) 2024; 63:319-328. [PMID: 37738242 PMCID: PMC10836966 DOI: 10.1093/rheumatology/kead465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/08/2023] [Accepted: 08/13/2023] [Indexed: 09/24/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate the clinical, laboratory and genetic characteristics and outcomes of patients with AA amyloidosis. METHODS Patients followed up in a tertiary referral centre in Turkey with the diagnosis of inflammatory rheumatic diseases and immunohistologically proven AA amyloidosis were included in the study and retrospectively analysed. RESULTS Among 184 patients with the diagnosis of AA amyloidosis, 174 (83 female, 91 male) were included in the analysis. The most common cause of AA amyloidosis was FMF (78.7%), and 91% of FMF-AA amyloidosis patients were carrying the p.M694V variant (74.1% homozygous). AA amyloidosis was identified earlier in patients with homozygous or compound heterozygous MEFV exon 10 variants compared with the heterozygous patients (27, 30 and 41 years, respectively). Patients with an estimated glomerular filtration rate <60 ml/min at admission had a higher frequency of progression to end-stage renal disease (P < 0.001). The overall mortality rate was 15.3% and it increased gradually in association with the amyloid burden (10% in patients with renal, 15% in renal + gastrointestinal and 43% in those with additional cardiac involvement). Renal findings responded completely to treatment in 31% of the patients, a partial response was observed in 4%, a stable course in 23.6% and progression in 38.5%. Amyloid storm was identified in nine patients and was found to be associated with increased mortality within 1 year. CONCLUSION FMF patients still constitute the majority of AA amyloidosis patients in Turkey. The MEFV genotype and associated inflammatory load may affect the age of onset of AA amyloidosis, and earlier diagnosis and stricter follow-up and treatment may delay progression of the disease.
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Affiliation(s)
- Murat Bektas
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Nevzat Koca
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Emin Oguz
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Selma Sari
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Gizem Dagci
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Burak Ince
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Pelin Karaca Ozer
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Besim Fazil Agargun
- Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Yasemin Yalcinkaya
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Bahar Artim-Esen
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Lale Ocal
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul, Turkey
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Kilincalp S, Yuksel I. The Influence of Coexisting Familial Mediterranean Fever on Crohn's Disease: Data From an FMF Endemic Area. J Clin Gastroenterol 2024; 58:71-75. [PMID: 36730654 DOI: 10.1097/mcg.0000000000001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/09/2022] [Indexed: 02/04/2023]
Abstract
GOAL The goal of this study was to evaluate the impact of coexisting familial Mediterranean fever (FMF) on Crohn's disease (CD) patients' phenotype and disease course in an endemic region for FMF. BACKGROUND CD and FMF are inflammatory diseases characterized by recurrent abdominal pain and fever attacks. The impact of coexisting FMF on CD patients' phenotype and disease course is currently unknown. MATERIALS AND METHODS We reviewed the medical records of 210 adult CD patients who were regularly followed up at a tertiary gastroenterology clinic between November 2006 and April 2018. The patients were divided into FMF positive (CD-FMF) and FMF negative (CD-control) groups. The severity of CD was assessed by the rate of hospitalization because of CD, the need for biological therapy, and whether surgery was performed for CD. RESULTS Eight (3.8%) of 210 CD patients have concomitant FMF, which is 35 to 40 times higher than expected in an endemic region for FMF. Baseline demographic parameters, location/behavior of the CD, and initial therapeutic regimens were similar between the 2 groups. The prevalence of peripheral arthritis was significantly higher in CD-FMF group (37.5% vs. 10.4%, respectively, P =0.04). A significantly greater proportion of the CD-FMF patients had received biological therapy (50% vs. 11.9%; P =0.012). Steroid dependence and CD-related hospitalization rates in the CD-FMF group were relatively higher but were not statistically significant (37.5% vs. 15.3 and 62.5% vs. 41.1%). CONCLUSIONS Our findings indicate that the disease course of CD tends to be more severe in patients with coexisting FMF.
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Affiliation(s)
- Serta Kilincalp
- Department of Gastroenterology, Gothenburg University, Ostra Hospital, Gothenburg, Sweden
| | - Ilhami Yuksel
- Department of Gastroenterology, Yildirim Beyazit University School of Medicine, Ankara, Turkey
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Ozdel S, Coşkuner T, Demirkan F, Torun R, Aydın EA, Bağlan E, Yener GO, Öztürk K, Demir F, Karadağ ŞG, Çakan M, Sönmez HE, Makay BB, Ünsal ŞE, Bülbül M, Ayaz NA, Sözeri B. Inflammatory comorbidities ın the largest pediatric Familial Mediterranean fever cohort: a multicenter retrospective study of Pediatric Rheumatology Academy (PeRA)-Research Group (RG). Clin Rheumatol 2024; 43:407-413. [PMID: 37926798 DOI: 10.1007/s10067-023-06802-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023]
Abstract
AIM The aim of this study was to investigate the frequency and type of FMF-associated inflammatory diseases in a large FMF pediatric patients and to compare them to those FMF patients without concomitant inflammatory diseases. MATERIALS AND METHODS Familial Mediterranean fever patients enrolled in the Pediatric Rheumatology Academy (PeRA)-Research Group (RG) were included. The patients were divided into two groups according to concomitant inflammatory disease as FMF patients who had a concomitant inflammatory disease (group 1) and FMF patients who did not have a concomitant inflammatory disease (group 1). The clinical findings and treatments were compared between the two groups. RESULTS The study group comprised 3475 patients with FMF. There were 294 patients (8.5%) in group 1 and 3181 patients (91.5%) in group 2. Juvenile idiopathic arthritis (n = 136) was the most common accompanying inflammatory disease. Arthritis, M694V homozygosity, and the need for biological therapy were more frequently observed in Group 1 (p < 0.05). Fever and abdominal pain were more frequently detected in Group 2 (p < 0.05). FMF patients with concomitant inflammatory diseas more frequently demonstrated colchicine resistance. There were no significant differences in the median attack frequency, chest pain, amyloidosis, erysipelas-like erythema, or family history of FMF between the two patient groups. CONCLUSION To the best of our knowledge, this is the largest pediatric cohort reviewed to date. FMF patients may have different clinical profiles and colchicine responses if they have with concomitant inflammatory diseases. Key points • FMF is associated with some inflammatory comorbidities diseases. • To the best of our knowledge, this is the largest cohort evlauated pediatric FMF associated inflammatory comorbidities diseases reviewed to date.
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Affiliation(s)
- Semanur Ozdel
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey.
- Department of Pediatric Rheumatology, Etlik City Hospital, Ankara, Turkey.
| | - Taner Coşkuner
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Fatmagül Demirkan
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Rüya Torun
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Elif Arslanoglu Aydın
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Esra Bağlan
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Gülçin Otar Yener
- Department of Pediatric Rheumatology, Medicalpark Hospital, Gaziantep, Turkey
| | - Kübra Öztürk
- Department of Pediatric Rheumatology, Istanbul Medeniyet University, Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Ferhat Demir
- Department of Pediatric Rheumatology, Acıbadem Healthcare Group, Istanbul, Turkey
| | - Şerife Gül Karadağ
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Çakan
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
| | - Hafize Emine Sönmez
- Department of Pediatric Rheumatology, Kocaeli University, Faculty of Medicine, Kocaeli, Turkey
| | - Balahan Bora Makay
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Şevket Erbil Ünsal
- Department of Pediatric Rheumatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| | - Mehmet Bülbül
- Department of Pediatric Rheumatology, Dr Sami Ulus Maternity and Child Health and Diseases Training and Research Hospital, Ankara, Turkey
| | - Nuray Aktay Ayaz
- Department of Pediatric Rheumatology, Istanbul University, Faculty of Medicine, Istanbul, Turkey
| | - Betül Sözeri
- Department of Pediatric Rheumatology, University of Health Sciences, Umraniye Research and Training Hospital, Istanbul, Turkey
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9
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Shan S, Mian M. MEFV gene test-Who's ordering them and why? A retrospective study from an Australian referrals center. Int J Rheum Dis 2024; 27:e14994. [PMID: 38061771 DOI: 10.1111/1756-185x.14994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Sam Shan
- Department of General Medicine, Northern Health, Epping, Victoria, Australia
| | - Mueed Mian
- Department of Rheumatology, Northern Health, Epping, Victoria, Australia
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10
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Tuncer Kuru F, Gokcen N, Yazici A, Cefle A. Disease severity and genotype-phenotype correlation in adult patients with familial Mediterranean fever. Mod Rheumatol 2023; 34:214-219. [PMID: 36688581 DOI: 10.1093/mr/road007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/30/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To assess the relationships of disease severity with genotype and phenotype in adult familial Mediterranean fever patients. METHODS Two-hundred seventy-five patients included in the study were divided into four groups according to their mutations: Group 1, M694V homozygous; Group 2, M694V-other; Group 3, other-other; and Group 4, no meaningful gene variants. Disease severity was evaluated using the Pras disease severity score. The association between Pras scores and other possible predictors was assessed by the multiple linear regression analysis. RESULTS In this study, 12.4% of all patients were in Group 1, 55.3% were in Group 2, 26.5% were in Group 3, and 5.8% were in Group 4. Pras scores were higher in Group 1 than in Groups 2, 3, and 4 (post hoc pairwise comparisons; P = .001, P < .001, and P = .001, respectively). Age at disease onset and age at diagnosis were found moderately and strongly correlated with Pras scores. Patients with moderate and severe disease were intensely involved in Group 1. CONCLUSIONS Higher Pras scores, earlier age of symptoms and diagnosis, more frequent arthritis and erysipelas-like erythema, and higher colchicine dose are closely associated with M694V homozygous familial Mediterranean fever patients. These patients also have mostly moderate and severe disease severity.
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Affiliation(s)
- Fatma Tuncer Kuru
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Neslihan Gokcen
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayten Yazici
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Ayse Cefle
- Division of Rheumatology, Department of Internal Medicine, School of Medicine, Kocaeli University, Kocaeli, Turkey
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11
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Nacar MC, Yigit S, Ozsoy AZ, Demirturk F, Nursal AF, Karakus N. MEFV gene pathogenic variants: a risk factor for dysmenorrhea in the Turkish population. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2023; 43:643-654. [PMID: 38133485 DOI: 10.1080/15257770.2023.2293074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND/AIM The Mediterranean fever (MEFV) gene codes for protein pyrin, which is among the modulators of inflammasome activity in innate immune cells. It was suggested that there is a relation between MEFV variations and inflammatory diseases. The aim of this study was to investigate MEFV gene variations in the patients with primary dysmenorrhea. METHODS The prevalence of common MEFV gene variations (M694V, M680I, V726A, E148Q and R202Q) was investigated in 145 young women with primary dysmenorrhea and 135 unrelated healthy controls. MEFV gene variations were genotyped using PCR-based RFLP assay. RESULTS Number of childbirth and marriage were significantly lower in the study group than the controls, respectvely (p < 0.001, p = 0.001). Family history was statistically higher in the patient group (p < 0.001). In total, MEFV genotype and allele frequencies were significantly higher in patients than controls, respectively (p = 0.008 and p = 0.005, respectively). It was found that MEFV gene E148Q allele was more common in patient group (p = 0.039). MEFV R202Q A allele was higher in the patients than the controls (p = 0.045). A significant association was observed when the patients were compared with the controls according to R202Q variant AA versus GG+GA genotypes (p=0.020). CONCLUSION Our findings suggest that MEFV variations may be a risk factor for patients with dysmenorrhea in a Turkish cohort.HighlightsThere are very few studies in the literature regarding the relationship between pathological variants of MEFV and dysmenorrhea disease.The common MEFV mutations/variants were evaluated in primary dysmenorrhea patients.Family history was statistically higher in the patient group (p <.001).MEFV gene variations were found 52 (35.9%) in patients and 29 (21.5%2) in controls.MEFV gene allele frequency was significantly higher in-patient group than control (p =.005).
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Affiliation(s)
- Mehmet Can Nacar
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Serbulent Yigit
- Department of Genetics, Faculty of Veterinary, Ondokuz Mayis University, Samsun, Turkey
| | - Asker Zeki Ozsoy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Fazli Demirturk
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - Ayse Feyda Nursal
- Department of Medical Genetic, Faculty of Medicine, Hitit University, Corum, Turkey
| | - Nevin Karakus
- Department of Medical Biology, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
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12
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Ben-Shabat N, Gendelman O, Fisher L, Shani U, Patt YS, Watad A, Skuja V, McGonagle D, Amital H. Increased risk for stroke in patients with familial Mediterranean fever: results from a large population-based study. Rheumatology (Oxford) 2023; 62:3940-3946. [PMID: 37004175 DOI: 10.1093/rheumatology/kead153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 04/03/2023] Open
Abstract
OBJECTIVE The association between chronic inflammatory conditions and cardiovascular disease is well established. Considering FMF, few studies exist investigating the risk of ischaemic heart disease, and none address the risk of stroke. We aimed to evaluate the incidence and risk for stroke in FMF patients compared with the general population. METHODS A retrospective cohort study using the electronic database of Clalit Health Services (CHS), the largest health organization in Israel. All FMF patients diagnosed between 2000 and 2016 were included and matched with control according to age, gender and place of residence. Follow-up continued until the first diagnosis of stroke or death. The incidence of stroke was compared between the groups using univariate and multivariate models adjusting for cardiovascular risk-factors. RESULTS A total of 9769 FMF patients and a similar number of controls were followed up for a median period of 12.5 years. The mean age at the beginning of the follow-up was 25.7 years. In total, 208 FMF patients were diagnosed with stroke compared with 148 controls, resulting in an incidence rate (per 10 000 persons-years) of 19.8 (95% CI 17.2, 22.7) and 13.9 (95% CI 11.8, 16.4), respectively, and a crude HR of 1.42 (95% CI 1.15-1.76; P < 0.001). In a multivariate analysis, FMF patients who developed amyloidosis with related or non-related renal failure demonstrated significant stroke risk (HR = 2.16; 95% CI 1.38, 3.38; P < 0.001), as well as for those who did not develop these complications (HR = 1.32; 95% CI 1.04, 1.67; P < 0.05). CONCLUSION FMF patients are at increased risk for stroke regardless of known complications.
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Affiliation(s)
- Niv Ben-Shabat
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Omer Gendelman
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Lior Fisher
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Uria Shani
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yonatan Shneor Patt
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Abdulla Watad
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Vita Skuja
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Anti-Aging Institute, Health Center 4, Riga, Latvia
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton, Leeds Teaching Hospital Trust, Leeds, UK
| | - Howard Amital
- Department of Internal Medicine B, Sheba Medical Center, Tel-Hashomer, Israel
- Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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13
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Karakas HD, Kuloglu Z, Aydin F, Ozdemir S, Avar-Aydin PO, Tuna Kirsaclioglu C, Cakar N, Ozcakar ZB. Evaluation of Gastrointestinal System Complaints and Comorbidities in Pediatric Familial Mediterranean Fever Patients. J Clin Rheumatol 2023; 29:375-380. [PMID: 37723615 DOI: 10.1097/rhu.0000000000002027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023]
Abstract
OBJECTIVE Familial Mediterranean fever (FMF) is the most prevalent hereditary autoinflammatory disease among children. Abdominal pain and various gastrointestinal system (GIS) manifestations may arise directly from FMF or concomitantly with FMF. This study aimed to evaluate GIS complaints and findings other than classic peritonitis attacks in patients with FMF and to interpret concomitant GIS and hepatic disorders in these patients. METHODS The medical and genetic findings of patients with FMF who attended our clinic between December 2011 and December 2021 were reviewed. Gastrointestinal system symptoms, liver function tests, abdominal images, and endoscopic and histopathological data were extracted from medical records. RESULTS A total of 576 pediatric patients (female, 52.3%) diagnosed with FMF were included. Among them, almost one-fifth displayed GIS complaints, such as abdominal pain, defecation problems, and dyspepsia, distinct from typical FMF attacks. High serum aminotransferase levels were detected in 18.4% of the patients, with viral infections being the most common cause of moderate/severe hypertransaminasemia. In addition, during follow-up, 26.9% of them were referred to the pediatric gastroenterology department. At least 1 gastroenterological and hepatobiliary disorder was detected in 17.5% of the patients because of organic and functional GIS disorders or hepatobiliary disorders, such as gastroesophageal reflux disease, esophagitis, functional dyspepsia, and inflammatory bowel diseases. CONCLUSION Various GIS and hepatic disorders can be encountered in children with FMF. The spectrum of these complaints and pathologies can range from frequently observed health problems to more severe diseases.
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Affiliation(s)
| | - Zarife Kuloglu
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Aydin
- From the Departments of Pediatric Rheumatology
| | - Serpil Ozdemir
- Pediatric Gastroenterology, Ankara University Faculty of Medicine, Ankara, Turkey
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14
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Bildirici AE. Familial Mediterranean fever and microRNAs. Int J Immunogenet 2023; 50:273-280. [PMID: 37794570 DOI: 10.1111/iji.12640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 07/24/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023]
Abstract
Familial Mediterranean fever (FMF) is an inherited disorder caused by the gain of function mutations in MEFV (MEditerranean FeVer) gene loci. FMF affects more than 100,000 people worldwide and generally seen in the eastern Mediterranean region and causes the lifelong diseases which have a significant effect on the patient's life quality and health systems. The identification of low penetrant or heterozygous MEFV gene mutations in clinically diagnosed FMF patients was considered that epigenetic or environmental factors may display a role in FMF pathogenesis. Epigenetics might be defined as heritable changes that affect gene expression without any changes in the genome. MicroRNAs (miRNAs) are the main group of small noncoding RNAs, and an important element of epigenetic mechanisms and their discoveries revolutionized our knowledge about biological processes, such as malignant, infectious and autoimmune mechanisms, and contributed to the development of the epigenetic areas. In this review, the studies focusing on the roles of miRNAs in FMF pathogenesis in the last decades were examined and the importance of miRNAs as therapeutic agents which are promising for diagnosis and treatment was discussed.
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15
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Wolff L, Horisberger A, Moi L, Karampetsou MP, Comte D. Polyarteritis Nodosa: Old Disease, New Etiologies. Int J Mol Sci 2023; 24:16668. [PMID: 38068989 PMCID: PMC10706353 DOI: 10.3390/ijms242316668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 11/11/2023] [Accepted: 11/17/2023] [Indexed: 12/18/2023] Open
Abstract
Polyarteritis nodosa (PAN), also known as panarteritis nodosa, represents a form of necrotizing vasculitis that predominantly affects medium-sized vessels, although it is not restricted to them and can also involve smaller vessels. The clinical presentation is heterogeneous and characterized by a significant number of patients exhibiting general symptoms, including asthenia, fever, and unintended weight loss. Although PAN can involve virtually any organ, it preferentially affects the skin, nervous system, and the gastrointestinal tract. Orchitis is a rare but specific manifestation of PAN. The absence of granulomas, glomerulonephritis, and anti-neutrophil cytoplasmic antibodies serves to distinguish PAN from other types of vasculitis. Major complications consist of hemorrhagic and thrombotic events occurring in mesenteric, cardiac, cerebral, and renal systems. Historically, PAN was frequently linked to hepatitis B virus (HBV) infection, but this association has dramatically changed in recent years due to declining HBV prevalence. Current epidemiological research often identifies a connection between PAN and genetic syndromes as well as neoplasia. This article provides a comprehensive review of PAN, specifically focusing on the progression of its clinical manifestations over time.
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Affiliation(s)
- Louis Wolff
- Department of Internal Medicine, Hôpital Universitaire de Bruxelles (H.U.B.), Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium;
| | - Alice Horisberger
- Department of Medicine, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Department of Medicine, Division of Immunology and Allergy, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Laura Moi
- Immunology and Allergology, Institut Central des Hôpitaux, Valais Hospital, 1951 Sion, Switzerland;
| | | | - Denis Comte
- Department of Medicine, Division of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1005 Lausanne, Switzerland
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Ersan N, Özel B. Evaluation of mandibular cortical and trabecular radiomorphometry in familial Mediterranean fever patients. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:640-648. [PMID: 37422403 DOI: 10.1016/j.oooo.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/12/2023] [Accepted: 05/29/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to evaluate the mandibular cortical and trabecular morphology and microarchitecture of patients with familial Mediterranean fever (FMF) and compare them to those of healthy individuals by examining radiomorphometric indices on panoramic radiographs. STUDY DESIGN We examined a group of 56 FMF patients aged 5 to 71 years and an age- and sex-matched control group of individuals with no systemic diseases. We classified the FMF and control groups according to age and sex and the FMF group according to colchicine use. We evaluated the quantitative radiomorphometic indices of gonial index, antegonial index, molar cortical thickness, mental index, panoramic mandibular index, and lacunarity, and the qualitative mandibular cortical index on all panoramic radiographs and performed between and within group analysis. RESULTS Mean gonial index, antegonial index, and molar cortical thickness values of the FMF group were significantly smaller than those of the control group. Significantly fewer patients in the FMF group were classified as mandibular cortical index type 1 compared to the control group. There were no significant differences in quantitative index values according to colchicine use in the FMF group or regarding the categorical parameters of age, sex, and mandibular cortical index classification. CONCLUSIONS Radiomorphometric values of the mandibular basal cortex posterior to the mental foramen differ significantly in FMF patients compared to healthy counterparts. Dentists should note mandibular morphologic changes indicative of low bone density when examining panoramic images of patients with this disease.
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Affiliation(s)
- Nilüfer Ersan
- Department of Dentomaxillofacial Radiology, Yeditepe University Faculty of Dentistry, Istanbul, Turkey.
| | - Beliz Özel
- Department of Endodontics, Academic Centre for Dentistry Amsterdam, Amsterdam, Netherlands
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Khalaji A, Jafarpour M. A case of familial Mediterranean fever presenting with ankylosing spondylitis: A rare case-report. Clin Case Rep 2023; 11:e8197. [PMID: 38028036 PMCID: PMC10645605 DOI: 10.1002/ccr3.8197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/12/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Message The association of familial Mediterranean fever and ankylosing spondylitis is rare, but it is essential to consider this diagnosis in patients with a history of FMF who develop symptoms of back pain or other rheumatologic conditions. Abstract Familial Mediterranean fever (FMF) is an inherited inflammatory disorder characterized by recurrent fever episodes, abdominal pain, and arthralgia. Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects the spine's joints. The association of FMF and AS is rare. We report the case of a 22-year-old male patient with a history of FMF and a positive family history of FMF in his father, who presented with inflammatory back pain. The patient was found to have sacroiliitis on MRI, which is a characteristic feature of AS. The patient was negative for HLA-B27, a genetic marker often associated with AS. This case report highlights the importance of considering AS in patients with a history of FMF who develop back pain symptoms or other rheumatologic conditions.
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Affiliation(s)
- Amirreza Khalaji
- Immunology Research CenterTabriz University of Medical SciencesTabrizIran
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
| | - Mehdi Jafarpour
- Connective Tissue Diseases Research CenterTabriz University of Medical SciencesTabrizIran
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18
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Öner N, Çelikel E, Güngörer V, Ekici Tekin Z, Coşkun S, Karagöl C, Sezer M, Tekgöz N, Kaplan MM, Polat MC, Çelikel Acar B. The Effect of Clinical and Genetic Variables of Familial Mediterranean Fever Patients: Real Life Data. J Clin Rheumatol 2023; 29:326-331. [PMID: 37496121 DOI: 10.1097/rhu.0000000000002002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
BACKGROUND The Eurofever/the Pediatric Rheumatology International Trials Organization (PRINTO) classification criteria for familial Mediterranean fever (FMF) include a combination of clinical symptoms and genotype. The pathogenicity of gene variants associated with FMF is categorized by the International Study Group for Systemic Autoinflammatory Diseases (INSAID) classification criteria. OBJECTIVE The aim of this study was to evaluate the real-life impact and usefulness of the Eurofever/PRINTO classification criteria and the INSAID classification criteria in patients with FMF and their impact on treatment management. METHODS In this medical records review study, the files of FMF patients who met the Eurofever/PRINTO classification criteria were reviewed. The MEFV (MEditerranean FeVer) variants were grouped according to the INSAID classification criteria. RESULTS Of the 1062 patients, the female-to-male ratio was 1:1.01. In group 1, there were 150 patients (14.1%) who met the clinical criteria. Group 2 consisted of 912 patients (85.9%) who met the criteria according to genetic variants. The mean ages at symptom onset in groups 1 and 2 were 5.6 ± 3.8 and 1.5 ± 1.2 years, respectively ( p = 0.024). Whereas the mean annual attack frequency was 2.7 ± 3.1/year in group 1, it was 4.1 ± 2.3/year in group 2 ( p = 0.04). The pathogenic variant was higher in the colchicine-resistant group compared with the responders ( p = 0.12). CONCLUSIONS The Eurofever/PRINTO classification criteria may provide a new perspective on the diagnosis and clinical follow-up of FMF patients. Patients with a pathogenic variant who meet the Eurofever/PRINTO classification criteria including genetic variables have earlier onset of disease and more frequent attacks than those who meet the criteria including clinical variables. These patients need regular and closer follow-ups in terms of attack frequency, colchicine dose adjustment, and colchicine resistance.
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Affiliation(s)
- Nimet Öner
- From the Division of Pediatric Rheumatology, Department of Pediatrics, University of Health Sciences, Ankara City Hospital, Ankara, Turkey
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Sönmez HE, Bayındır Y, Batu ED. Cardiovascular manifestations of monogenic periodic fever syndromes. Clin Rheumatol 2023; 42:2717-2732. [PMID: 36622520 DOI: 10.1007/s10067-023-06504-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 12/23/2022] [Accepted: 01/02/2023] [Indexed: 01/10/2023]
Abstract
Periodic fever syndromes (PFS) are a group of autoinflammatory diseases characterized by repeated febrile episodes and systemic inflammation. The most common monogenic periodic fever syndromes are familial Mediterranean fever, mevalonate kinase deficiency/hyper immunoglobulin D syndrome, cryopyrin-associated periodic syndrome, and tumor necrosis factor receptor-associated periodic syndrome. Although fever is the predominant feature of PFS, other systems, including the cardiovascular system, may be involved in the disease process. This review focuses on cardiovascular risks and issues in monogenic PFS. Cardiovascular involvement may occur as a disease manifestation, association, or result of complications or a drug's adverse effects in monogenic PFS. Pericarditis seems to be a feature of PFS. Patients with recurrent pericarditis or pericarditis resistant to conventional treatment should be evaluated for PFS. Amyloidosis is the most severe complication of PFS, increasing the risk of cardiac morbidity. Furthermore, ongoing inflammation may result in early atherosclerosis. Therefore, assessing cardiovascular risks in PFS patients should be considered a part of routine care. Key points • Pericarditis is the most common cardiac involvement of monogenic periodic fever syndromes (PFS), while some forms may present with myocarditis. • Amyloidosis, the most significant complication of PFS, may lead to deterioration in cardiac functions. • Ongoing inflammation in PFS may result in endothelial dysfunction and atherosclerosis. • Effective control of inflammation and reducing concomitant risk factors such as obesity, diabetes mellitus, and hypertension could improve cardiovascular outcomes in PFS patients.
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Affiliation(s)
- Hafize Emine Sönmez
- Division of Pediatric Rheumatology, Department of Pediatrics, Kocaeli University Faculty of Medicine, Izmit, Kocaeli, Turkey
| | - Yağmur Bayındır
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey
| | - Ezgi Deniz Batu
- Division of Pediatric Rheumatology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
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20
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Çapraz M, Düz ME. R202Q prevalence in clinically diagnosed Familial Mediterranean Fever patients: 9 years of data analysis from 1570 patients living Central Black Sea region, Turkey. Ir J Med Sci 2023; 192:2273-2278. [PMID: 36441449 DOI: 10.1007/s11845-022-03233-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent self-limiting fever, peritonitis, arthritis, and erysipelas-like-erythema, common among ethnic groups such as Turkish, Armenian, Arab, and Jewish. The disease is caused by mutations in the MEFV gene encoding the Pyrin. This study examines the genotypes of FMF patients from Amasya, Turkey. METHOD According to the Tel Hashomer criteria, one thousand five hundred seventy patients (871 female, 699 male, mean age 21.2 ± 15.5 years) living in Amasya Province and the surroundings were screened for sequence variants in the entire MEFV gene. Besides, mutation types and alleles were evaluated with clinical findings. RESULTS MEFV mutations and polymorphisms were found in 1413 of the 1570 patients (90%). Among these patients, 5 (0.3%) were double homozygous, 152 (9.7%) were homozygous, 373 (23.8%) were double heterozygous, and 882 (56.2%) were heterozygous. The most frequent genotype was R202Q (960, 43.5%) followed by M694V (n = 412, 18.7%), E148Q (n = 321, 14.6%), and M680I (n = 200, 9.1%). The most common clinical symptoms were abdominal pain (96.4%) and fever (91.3%). CONCLUSIONS The fact that the R202Q genotype, which is compatible with the known FMF clinic, is frequently seen shows that it should be included in routine molecular screenings of the patients. Functional studies of the R202Q variant pyrin protein should be performed to understand FMF better. Finally, it is unclear whether the R202Q genotype might be regarded as a mutation while being approved as a polymorphism in the inFevers database.
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Affiliation(s)
- Mustafa Çapraz
- Sabuncuoğlu Şerefeddin Training and Research Hospital, Internal Medicine, Amasya University, Amasya, Turkey
| | - Muhammed Emin Düz
- Sabuncuoğlu Şerefeddin Training and Research Hospital, Medical Biochemistry, Amasya University, Amasya, Turkey.
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de Moraes MPM, do Nascimento RRNR, Abrantes FF, Pedroso JL, Perazzio SF, Barsottini OGP. What General Neurologists Should Know about Autoinflammatory Syndromes? Brain Sci 2023; 13:1351. [PMID: 37759952 PMCID: PMC10526530 DOI: 10.3390/brainsci13091351] [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: 08/09/2023] [Revised: 09/12/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Autoinflammatory disorders encompass a wide range of conditions with systemic and neurological symptoms, which can be acquired or inherited. These diseases are characterized by an abnormal response of the innate immune system, leading to an excessive inflammatory reaction. On the other hand, autoimmune diseases result from dysregulation of the adaptive immune response. Disease flares are characterized by systemic inflammation affecting the skin, muscles, joints, serosa, and eyes, accompanied by unexplained fever and elevated acute phase reactants. Autoinflammatory syndromes can present with various neurological manifestations, such as aseptic meningitis, meningoencephalitis, sensorineural hearing loss, and others. Early recognition of these manifestations by general neurologists can have a significant impact on the prognosis of patients. Timely and targeted therapy can prevent long-term disability by reducing chronic inflammation. This review provides an overview of recently reported neuroinflammatory phenotypes, with a specific focus on genetic factors, clinical manifestations, and treatment options. General neurologists should have a good understanding of these important diseases.
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Affiliation(s)
| | | | - Fabiano Ferreira Abrantes
- Department of Neurology, Universidade Federal de São Paulo, São Paulo 04039-002, Brazil; (M.P.M.d.M.); (F.F.A.); (J.L.P.)
| | - José Luiz Pedroso
- Department of Neurology, Universidade Federal de São Paulo, São Paulo 04039-002, Brazil; (M.P.M.d.M.); (F.F.A.); (J.L.P.)
| | - Sandro Félix Perazzio
- Departament of Rheumatology, Universidade Federal de São Paulo, São Paulo 04039-050, Brazil; (R.R.N.R.d.N.); (S.F.P.)
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22
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Aktı S, Albayrak E. Evaluation of Liver and Spleen With Shear Wave Elastography in Adult Patients With Familial Mediterranean Fever. Ultrasound Q 2023; 39:165-170. [PMID: 36165616 DOI: 10.1097/ruq.0000000000000628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
ABSTRACT Familial Mediterranean fever (FMF) is an autoinflammatory disease and an important health problem in countries bordering the eastern Mediterranean, including Turkey. In this study, we aimed to evaluate possible tissue stiffness changes that may develop in the liver and spleen in adult FMF patients with shear wave elastography (SWE), and its usability as an auxiliary imaging method that will be able to provide additional advantage in clinical follow-up. Seventy-five adult FMF patients and 73 adult volunteer were included in the study. Examination was performed through an intercostal space where the liver and spleen were clearly visible. The parenchymal stiffness degrees of the liver and spleen were quantified by shear modulus values in kilopascals. Differences in stiffness values of the liver and spleen between the 2 groups were examined. Liver stiffness value (LSV) was found to be statistically significantly higher in the FMF group. Although the spleen stiffness value (SSV) was found higher in the FMF group, the difference between the groups was not statistically significant. Increased LSVs in patients with FMF can be quantitatively demonstrated by the 2-dimensional SWE method, and SWE may be useful as an auxiliary imaging method in the follow-up of patients with FMF for this purpose. The LSV and SSV obtained in this study may be useful as reference stiffness values for both healthy individuals and those with FMF.
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Affiliation(s)
- Serdar Aktı
- Department of Radiology, Erbaa State Hospital
| | - Eda Albayrak
- Department of Radiology, Medical Faculty, Tokat Gaziosmanpasa University, Tokat, Turkey
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23
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Gullu UU, Balaban İ, Kara SS, Yaralı O, Türkyılmaz A, İpek S, Güllü ŞD, Çalışkan OF. Frequency of Familial Mediterranean Fever Gene Mutation in Patients Presenting With Joint Pain and Diagnosed With Acute Rheumatic Fever. Cureus 2023; 15:e43001. [PMID: 37671203 PMCID: PMC10476970 DOI: 10.7759/cureus.43001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
Introduction Acute rheumatic fever (ARF) is a non-suppurative systemic inflammatory disease that manifests 1-5 weeks following a Group A beta-hemolytic streptococcal infection. On the other hand, familial Mediterranean fever (FMF) is a hereditary autoinflammatory disease characterized as an autosomal recessive disease, with affected individuals having pathogenic mutations in the Mediterranean fever gene (MEFV) gene located on the short arm of chromosome 16. FMF and ARF have overlapping symptoms and signs, and both disorders are common in Turkey. In ARF, the target organ is the heart, while in FMF, the target organ is the kidney; both organs can benefit from prophylactic measures. Our study aims to determine the frequency of the FMF gene mutation in patients with ARF in Turkey and detect any overlapping conditions. Method Patients who were diagnosed with a first-attack ARF between May 2015 and May 2018 were retrospectively screened. Patients who underwent MEFV gene analysis considering FMF in the differential diagnosis were included in the study. Results In this study, no statistical difference was found between the presence of MEFV gene mutations, carditis, high anti-streptolysin-O antibody (ASO) levels, and the groups with monoarthritis, polyarthritis, and polyarthralgia (p >0.05). Conclusions In conclusion, patients with ARF should be evaluated for FMF to avoid irreversible complications.
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Affiliation(s)
- Ufuk U Gullu
- Pediatric Cardiology, Hatay Mustafa Kemal University, Hatay, TUR
| | - İsmail Balaban
- Pediatric Cardiology, Yeni Yuzyıl University, Istanbul, TUR
| | - Soner Sertan Kara
- Pediatric Infectious Diseases, Adnan Menderes University, Aydın, TUR
| | - Oğuzhan Yaralı
- Medical Genetics, Erzurum Regional Training and Research Hospital, Erzurum, TUR
| | - Ayberk Türkyılmaz
- Medical Genetics, Erzurum Regional Training and Research Hospital, Erzurum, TUR
| | - Sevcan İpek
- Pediatrics, Hatay Mustafa Kemal University, Hatay, TUR
| | - Şeyma D Güllü
- Pediatrics, Hatay Mustafa Kemal University, Hatay, TUR
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24
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Reddy P, Kane GC, Oh JK, Luis SA. The Evolving Etiologic and Epidemiologic Portrait of Pericardial Disease. Can J Cardiol 2023; 39:1047-1058. [PMID: 37217161 DOI: 10.1016/j.cjca.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/17/2023] [Accepted: 05/17/2023] [Indexed: 05/24/2023] Open
Abstract
Pericardial disease includes a variety of conditions, including inflammatory pericarditis, pericardial effusions, constrictive pericarditis, pericardial cysts, and primary and secondary pericardial neoplasms. The true incidence of this varied condition is not well established, and the causes vary greatly across the world. This review aims to describe the changing pattern of epidemiology of pericardial disease and to provide an overview of causative etiologies. Idiopathic pericarditis (assumed most often to be viral) remains the most common etiology for pericardial disease globally, with tuberculous pericarditis being most common in developing countries. Other important etiologies include fungal, autoimmune, autoinflammatory, neoplastic (both benign and malignant), immunotherapy-related, radiation therapy-induced, metabolic, postcardiac injury, postoperative, and postprocedural causes. Improved understanding of the immune pathophysiological pathways has led to identification and reclassification of some idiopathic pericarditis cases into autoinflammatory etiologies, including immunoglobulin G (IgG)4-related pericarditis, tumour necrosis factor receptor-associated periodic syndrome (TRAPS), and familial Mediterranean fever in the current era. Contemporary advances in percutaneous cardiac interventions and the recent COVID-19 pandemic have also resulted in changes in the epidemiology of pericardial diseases. Further research is needed to improve our understanding of the etiologies of pericarditis, using the assistance of contemporary advanced imaging techniques and laboratory testing. Careful consideration of the range of potential causes and local epidemiologic patterns of causality are important for the optimization of diagnostic and therapeutic approaches.
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Affiliation(s)
- Prajwal Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sushil Allen Luis
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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25
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Aydın F, Özçakar ZB, Avar Aydın PÖ, Mekik Akar E, Çakar N. Exertional leg pain represents a severe disease phenotype in childhood familial Mediterranean fever. Postgrad Med 2023; 135:588-592. [PMID: 37309906 DOI: 10.1080/00325481.2023.2224649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 06/09/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease. Recurrent fever, serositis, and arthritis are common findings of the disease. In addition, musculoskeletal complaints such as exertional leg pain can be overlooked, although they are common and affect patients' quality of life. The aim of this study was to evaluate the frequency of exertional leg pain in pediatric FMF patients and to analyze the association of this finding with other characteristics of FMF. METHODS The files of FMF patients were retrospectively evaluated. The clinical characteristics and disease severity of the patients with exertional leg pain were compared with the patients without exertional leg pain. International severity scoring system for FMF (ISSF) and Mor severity score were used for assessment. RESULTS The study included 541 FMF patients (287 females), 149 (27.5%) with exertional leg pain. The median colchicine dosage was significantly higher in patients with exertional leg pain (p = 0.02), arthritis (p = 0.001) and arthralgia (p˂0.001) were encountered more frequently in the attacks of these patients. The median disease severity scores calculated by both Mor severity scale and ISSF were significantly higher in patients with exertional leg pain compared to those without (p˂0.001). In the group of patients with exertional leg pain, the M694V mutation, either in one allele or in two alleles, was found to be significantly more common (p = 0.006 and p˂0.001, respectively). CONCLUSIONS Exertional leg pain in pediatric FMF patients is the component of moderate-to-severe disease course, and this may be considerably associated with the presence of M694V mutation.
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Affiliation(s)
- Fatma Aydın
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Zeynep Birsin Özçakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology and Nephrology, Ankara, Turkey
| | - Pınar Özge Avar Aydın
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
| | - Ece Mekik Akar
- Ankara University School of Medicine, Department of Pediatrics, Ankara, Turkey
| | - Nilgün Çakar
- Ankara University School of Medicine, Department of Pediatrics, Division of Pediatric Rheumatology, Ankara, Turkey
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Cebeci SO, Yildiz M, Gunalp A, Cebi MN, Kilinc B, Pinar E, Konte EK, Aslan E, Haslak F, Adrovic A, Sahin S, Barut K, Kasapcopur O. The efficacy of a single-dose anakinra injection during disease attack in pediatric familial Mediterranean fever. Rheumatol Int 2023:10.1007/s00296-023-05351-0. [PMID: 37277620 DOI: 10.1007/s00296-023-05351-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
The aim of this retrospective study is to evaluate the efficacy of a single-dose anakinra during familial Mediterranean fever (FMF) attacks and its effect on the duration, severity, and frequency of attacks. The patients with FMF who had disease episode and received a single-dose anakinra during disease episode between December 2020 and May 2022 were included. Demographic characteristics, MEFV gene variants detected, concomitant medical conditions, demographics of recent and previous episodes, laboratory findings and length of hospital stay were recorded. A retrospective analysis of medical records revealed 79 attacks from 68 patients who met inclusion criteria. The patients had a median age of 13 (2.5-25) years. All patients reported that the average duration of their previous episodes lasted longer than 24 h. When the recovery time of attacks after subcutaneous anakinra application at the disease attack was examined, it was observed that 4 attacks (5.1%) ended in 10 min; 10 attacks (12.7%) in 10-30 min; 29 attacks (36.7%) in 30-60 min; 28 attacks (35.4%) in 1-4 h; 4 attacks (5.1%) in 24 h; and 4 attacks (5.1%) ended in more than 24 h. There was no patient who did not recover from their attack after a single dose of anakinra. Although the efficacy of a single-dose anakinra administration during FMF attacks in children needs to be confirmed by prospective studies, our results suggest that use of a single-dose anakinra during FMF attacks is effective in reduction of severity and duration of disease attacks.
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Affiliation(s)
- Sinem Oral Cebeci
- Department of Pediatric Emergency, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Yildiz
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Aybuke Gunalp
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Memnune Nur Cebi
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Berivan Kilinc
- Department of Pediatric Emergency, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Eymen Pinar
- Department of Pediatric Emergency, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Elif Kilic Konte
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Esma Aslan
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Fatih Haslak
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezgin Sahin
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ozgur Kasapcopur
- Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.
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27
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Kisaoglu H, Baba O, Kalyoncu M. Genotype-Phenotype Associations of Children With Familial Mediterranean Fever in a Cohort Consisting of M694V Mutation and Implications for Colchicine-Resistant Disease. J Clin Rheumatol 2023; 29:207-213. [PMID: 36870084 DOI: 10.1097/rhu.0000000000001953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
OBJECTIVES The aim of this study was to investigate the clinical associations of the second allele mutations and the effect of genotype and presenting features on colchicine resistance in children with familial Mediterranean fever (FMF), carrying at least one M694V variant. METHODS The medical records of the patients diagnosed with FMF, in whom at least one allele M694V mutation was detected, were reviewed. Patients were grouped according to the genotype as M694V homozygotes, compound heterozygote M694V with an exon 10 mutation, compound heterozygote M694V with a variant of unknown significance (VUS), and M694V heterozygotes. Disease severity was assessed with the International Severity Scoring System for FMF. RESULTS Among the 141 patients included, homozygote M694V (43.3%) was the most frequent MEFV genotype. Clinical manifestations of FMF at diagnosis were not significantly different according to genotypic alterations except homozygote M694V. Besides, homozygous M694V was associated with a more severe disease, with more frequent comorbidities and colchicine-resistant disease. A lower disease severity score was observed in compound heterozygotes with VUS than in M694V heterozygotes (median 1 vs 2, p = 0.006). Regression analysis revealed that homozygous M694V, arthritis, and frequency of attacks were associated with an increased risk of colchicine-resistant disease. CONCLUSIONS Clinical manifestations of FMF at diagnosis with a M694V allele were predominantly influenced by the M694V rather than the second allele mutations. Although homozygous M694V was associated with the most severe form, the presence of compound heterozygosity with a VUS did not affect disease severity or clinical features. Homozygous M694V confers the highest risk of colchicine-resistant disease.
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Affiliation(s)
- Hakan Kisaoglu
- From the Division of Pediatric Rheumatology, Department of Pediatrics, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
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28
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Seyahi E, Ugurlu S, Amikishiyev S, Gul A. Behçet disease, familial Mediterranean fever and MEFV variations: More than just an association. Clin Immunol 2023; 251:109630. [PMID: 37216220 DOI: 10.1016/j.clim.2023.109630] [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: 04/13/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/24/2023]
Abstract
Behçet disease (BD) and familial Mediterranean fever (FMF) are two inflammatory disorders that share many features including historical background, ethnical distribution and inflammatory characteristics. Several studies suggested that BD and FMF might occur in the same individual more commonly than expected. Additionally, the pathogenic MEFV gene variants, especially p.Met694Val, activating the inflammasome complex have been shown to increase the risk for BD in regions where both FMF and BD are prevalent. Whether these variants are associated with certain disease subtypes and whether they may help in the planning of treatment need to be explored. This review provides a recent overview of the plausible association between FMF and BD and the role of MEFV variants in the pathogenesis of BD.
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Affiliation(s)
- Emire Seyahi
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey.
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Istanbul University-Cerrahpasa, School of Medicine, Istanbul, Turkey
| | - Shirkhan Amikishiyev
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Gul
- Division of Rheumatology, Department of Internal Medicine, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
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29
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Helvaci O, Yasar E. Familial Mediterranean Fever-Related Amyloidosis in Turkey: A Need for a Familial Mediterranean Fever Registry. EXP CLIN TRANSPLANT 2023; 21:101-104. [PMID: 37496356 DOI: 10.6002/ect.iahncongress.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Amyloidosis has been well known since Rudolph Virchow named the condition in the 19th century. Most physicians were aware of the association between amyloidosis to chronic suppurative conditions and multiple myeloma. However, familial Mediterranean fever, although probably as ancient as the Galenic era, was appropriately identified only in the 21st century. The nomenclature was variable throughout history, but the name "FMF" has been universally adopted since the report from Heller and colleagues in 1958. In 1967, Sokmen and Ozdemir of Ankara University published a report on 194 patients, of whom 64 had amyloidosis. Familial Mediterranean fever constituted the cause in half of the cases. Goldfinger and Ozkan demonstrated efficacy of colchicine for treatment of familial Mediterranean fever in 1972, and further studies revealed that colchicine is also efficient for prevention of amyloidosis. However, since then, several single-center and multicenter amyloid A amyloidosis studies from Turkey have been published. Almost invariably, familial Mediterranean fever is the most common cause of systemic amyloidosis. No downward trends in percentages have been observed. Recent studies have shown that cases of amyloidosis in patients with familial Mediterranean fever are decreasing. Also, cases of amyloidosis in conjunction with suppurative conditions are on the decrease worldwide. However, according to registry data from the Turkish Society of Nephrology, the percentage of incident hemodialysis patients with amyloidosis is not decreasing. The question arises: Why is a complication that is 98% preventable still causing end-stage renal disease? We believe the lack of a stable and comprehensive registry for familial Mediterranean fever, including associated cases of amyloidosis, is the reason we cannot properly answer this question. In this work, we use a historical approach to present why a familial Mediterranean fever registry is direly needed.
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Affiliation(s)
- Ozant Helvaci
- From the Department of Nephrology, Gazi University, Ankara, Turkey
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30
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Lancieri M, Bustaffa M, Palmeri S, Prigione I, Penco F, Papa R, Volpi S, Caorsi R, Gattorno M. An Update on Familial Mediterranean Fever. Int J Mol Sci 2023; 24:ijms24119584. [PMID: 37298536 DOI: 10.3390/ijms24119584] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 05/18/2023] [Accepted: 05/20/2023] [Indexed: 06/12/2023] Open
Abstract
(1) Background: Familial Mediterranean Fever (FMF) is the prototypal autoinflammatory disease, characterized by recurrent bursts of neutrophilic inflammation. (2) Methods: In this study we look at the most recent literature on this condition and integrate it with novel information on treatment resistance and compliance. (3) Results: The canonical clinical presentation of FMF is in children with self-limited episodes of fever and polyserositis, associated with severe long-term complications, such as renal amyloidosis. It has been described anecdotally since ancient times, however only recently it has been characterized more accurately. We propose an updated overview on the main aspects of pathophysiology, genetics, diagnosis and treatment of this intriguing disease. (4) Conclusions: Overall, this review presents the all the main aspects, including real life outcome of the latest recommendation on treatment resistance of FMF, a disease, that not only helped understanding the pathophysiology of the auto inflammatory process but also the functioning of the innate immune system itself.
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Affiliation(s)
- Maddalena Lancieri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marta Bustaffa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Serena Palmeri
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Ignazia Prigione
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Federica Penco
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Riccardo Papa
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Stefano Volpi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Roberta Caorsi
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Marco Gattorno
- UOC Malattie Autoinfiammatorie e Immunodeficenze, IRCCS Istituto Giannina Gaslini, 16147 Genova, Italy
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31
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La Bella S, Di Ludovico A, Di Donato G, Scorrano G, Chiarelli F, Vivarelli M, Breda L. Renal involvement in monogenic autoinflammatory diseases: A narrative review. Nephrology (Carlton) 2023. [PMID: 37142240 DOI: 10.1111/nep.14166] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 04/18/2023] [Accepted: 04/20/2023] [Indexed: 05/06/2023]
Abstract
Autoinflammatory diseases (AIDs) are mostly caused by dysfunctions in single genes encoding for proteins with a prominent role in the regulation of innate immunity, such as complement factors, inflammasome components, tumour necrosis factor (TNF)-α, and proteins belonging to type I-interferon (IFN) signalling pathways. Due to the deposition of amyloid A (AA) fibrils in the glomeruli, unprovoked inflammation in AIDs frequently affects renal health. In fact, secondary AA amyloidosis is the most common form of amyloidosis in children. It is caused by the extracellular deposition of fibrillar low-molecular weight protein subunits resulting from the degradation and accumulation of serum amyloid A (SAA) in numerous tissues and organs, primarily the kidneys. The molecular mechanisms underlying AA amyloidosis in AIDs are the elevated levels of SAA, produced by the liver in response to pro-inflammatory cytokines, and a genetic predisposition due to specific SAA isoforms. Despite the prevalence of amyloid kidney disease, non-amyloid kidney diseases may also be responsible for chronic renal damage in children with AIDs, albeit with distinct characteristics. Glomerular damage can result in various forms of glomerulonephritis with distinct histologic characteristics and a different underlying pathophysiology. This review aims to describe the potential renal implications in patients with inflammasomopathies, type-I interferonopathies, and other rare AIDs in an effort to improve the clinical course and quality of life in paediatric patients with renal involvement.
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Affiliation(s)
- Saverio La Bella
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | - Armando Di Ludovico
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | - Giulia Di Donato
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | - Giovanna Scorrano
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
| | - Marina Vivarelli
- Division of Nephrology, Laboratory of Nephrology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luciana Breda
- Department of Pediatrics, University of Chieti-Pescara "G. d'Annunzio", Chieti, Italy
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32
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Urfali M, Yilmaz G, Özkul B, Urfali FE. Indirect evaluation of amyloid deposition by ultrasonography and its relationship with MEFV gene mutation in FMF patients. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:715-722. [PMID: 36449313 DOI: 10.1002/jcu.23409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/06/2022] [Accepted: 10/02/2022] [Indexed: 05/03/2023]
Abstract
OBJECTIVE The most significant complication in familial mediterranean fever (FMF) patients is dysfunction and organ failure developing depending on amyloid deposition in organs. The golden standard for showing amyloid deposition is the biopsy; however, tissue stiffness was examined by shear wave elastography as a non-invasive method in a restricted number of studies conducted, and it is considered that amyloid deposition can be shown indirectly. In our study, we aimed to indirectly evaluate amyloid deposition in organs with Shear wave and Doppler ultrasonography and to reveal its relationship with MEFV gene mutation analysis. METHOD 42 FMF patients with normal thyroid and renal function tests and 35 participants with no FMF symptoms were included in our study. FMF patients were grouped depending on their MEFV mutation analyses. Thyroid, salivary glands, and renal parenchymal tissue stiffness were evaluated by shear wave elastography. Thyroidal artery and both renal artery resistances were evaluated by Doppler ultrasonography. RESULTS Both parotis gland, thyroid and renal parenchymal stiffness and arterial vascular resistances in the patient group were found higher than the control group. A significant difference was not found in any parameters in classification based on gender. Tissue stiffness and vascular resistance values in the patient group with M694V homozygote mutation were found statistically significantly higher than the other mutation groups (p < 0.001). CONCLUSION Our study shows that identifying genetic mutation type in FMF patients will help determine possibly amyloidosis risk. Imaging of tissue stiffness by shear wave elastography and evaluation of vascular resistance by Doppler can be useful for routine screening of those patients.
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Affiliation(s)
- Mine Urfali
- Department of Medical Genetic, Kütahya Health Science University, Kütahya, Turkey
| | - Gürkan Yilmaz
- Liv Hospital Bahçeşehir, Department of Rheumatology, İstinye University, Istanbul, Turkey
| | - Bahattin Özkul
- Department of Radiology, Atlas University, Istanbul, Turkey
| | - Furkan Ertürk Urfali
- Department of Interventional Radiology, Kütahya Health Science University, Kütahya, Turkey
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Kaçan H, Kaş Alay G, Yildiz E. The effect of education given to Turkish adolescents with Familial Mediterranean fever on anxiety, depression, and quality of life. Eur J Pediatr 2023:10.1007/s00431-023-04975-5. [PMID: 37069356 DOI: 10.1007/s00431-023-04975-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/19/2023]
Abstract
To examine the effects of individual education given to Turkish adolescents with Familial Mediterranean fever (FMF) on anxiety, depression, and quality of life. The randomized controlled experimental study was performed on 70 adolescents aged 12-18 years who were diagnosed as having FMF between October 2021 and April 2022 in Turkey. The disease management education was offered individually to adolescents in the intervention group with a booklet entitled "FMF is under my control;" no intervention was applied to adolescents in the control group. The training booklet was prepared by the researchers in a multidisciplinary team and was finalized by taking expert opinions. In the data collection process, a personal information form, the State-Trait Anxiety Inventory for Children (STAI-CH), the children's depression inventory (CDI), and the Pediatric Quality of Life Inventory (PedsQL) were used. After applying the scales specified in the pretest, individual training was given and the posttest was performed 2 months later using the same scales. After the education, there was a statistically significant decrease in the mean CDI score of the intervention group (p < 0.05), whereas there were statistically significant increases in mean scores obtained on PedsQL and its sub-scales (p < 0.05). However, the decrease in the mean STAI-CH score of the intervention group was not statistically significant (p > 0.05). There was no statistically significant difference in the mean STAI-CH, CDI, and PedsQL scores of the control group after the education (p > 0.05). Conclusion: The effectiveness of the individual education program for adolescents with FMF in improving quality of life and reducing levels of depression within the scope of disease management has been confirmed. It is recommended that all health professionals working with children with FMF regularly provide individual or group-planned education programs. What is Known: • The unpredictability of FMF attacks has a very negative effect on adolescents. • Individual education programs on FMF focus on children with a holistic approach. What is New: • To the best of our knowledge, this study is the first study to evaluate disease management education given to adolescents with FMF. • This is a pioneering study of the use of nurses in the education of adolescents with FMF and in fulfilling their educational roles.
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Affiliation(s)
- Havva Kaçan
- Department of Mental Health and Psychiatric Nursing, Department of Nursing, Faculty of Health Sciences, Kastamonu University, Kastamonu, Turkey
| | - Gamze Kaş Alay
- Department of Child Health and Diseases Nursing, Department of Nursing, Faculty of Health Sciences, Kastamonu University, Kastamonu, Turkey
| | - Eren Yildiz
- Department of Pediatrics, Faculty of Medicine, Kastamonu University, Kastamonu, Turkey.
- Kuzeykent Merkez Kampüsü, Kuzeykent Mah. Org. Atilla Ateş Paşa Cad, 37150, Kastamonu, Turkey.
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Gallego E, Arias-Merino G, Sánchez-Díaz G, Villaverde-Hueso A, Posada de la Paz M, Alonso-Ferreira V. Familial Mediterranean Fever in Spain: Time Trend and Spatial Distribution of the Hospitalizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4374. [PMID: 36901385 PMCID: PMC10002354 DOI: 10.3390/ijerph20054374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 06/18/2023]
Abstract
Familial Mediterranean Fever (FMF) is a rare, hereditary, auto-inflammatory disease. The aims of this study were to explore the time trend and geographical distribution of hospitalizations in Spain from 2008 to 2015. We identified hospitalizations of FMF from the Spanish Minimum Basic Data Set at hospital discharge, using ICD-9-CM code 277.31. Age-specific and age-adjusted hospitalization rates were calculated. The time trend and the average percentage change were analyzed using Joinpoint regression. Standardized morbidity ratios were calculated and mapped by province. A total of 960 FMF-related hospitalizations (52% men) were identified across the period 2008-2015, with an increase in hospitalizations of 4.9% per year being detected (p < 0.05). The risk of hospitalization was higher than expected for the national total (SMR > 1) in 13 provinces (5 in the Mediterranean area), and lower (SMR < 1) in 14 provinces (3 in the Mediterranean area). There was an increase in hospitalizations of patients with FMF in Spain throughout the study period, with a risk of hospitalization that was higher, though not exclusively so, in provinces along the Mediterranean coast. These findings contribute to the visibility of FMF and provide useful information for health planning. Further research should take into account new population-based information, in order to continue monitoring this disease.
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Affiliation(s)
- Elisa Gallego
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Escuela Internacional de Doctorado, Universidad Nacional de Educación a Distancia (UNED), Calle Bravo Murillo, 38, 28015 Madrid, Spain
| | - Greta Arias-Merino
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Germán Sánchez-Díaz
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Ana Villaverde-Hueso
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
| | - Manuel Posada de la Paz
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Verónica Alonso-Ferreira
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), 28029 Madrid, Spain
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Bekis Bozkurt H, Yıldırım S, Ergüven M. Renal involvement, presence of amyloidosis, and genotype-phenotype relationship in pediatric patients with Familial Mediterranean fever: a single center study. Eur J Pediatr 2023; 182:1911-1919. [PMID: 36807513 DOI: 10.1007/s00431-023-04855-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
The aim of the study is to investigate how renal involvement is correlated with frequency of amyloidosis, risk factors, and demographic and clinical characteristics in pediatric patients with Familial Mediterranean fever (FMF). Demographic and clinical characteristics and laboratory data of the pediatric patients diagnosed with FMF between 1990 and 2018 were recorded from their files. The diagnosis of patients with amyloidosis (AA) was proven by renal biopsy, and as for patients with non-amyloidosis renal involvement (RI wo AA), amyloidosis could not be detected but they were followed up with the diagnosis of proteinuria and/or hematuria. A total of 1929 FMF pediatric patients were included in the study. About 962 (49.9%) participants were male. There were 134 (6.9%) patients with RI wo AA and 23 (1.2%) patients with AA diagnosed by biopsy. The most common M694V heterozygous/homozygous(het/hom) (31%) mutation was observed. Delay in diagnosis and presence of colchicine resistance were more in patients with RI wo AA and AA (p < 0.05). M694V het/hom mutation was high in both RI wo AA and AA, while the presence of compound heterozygous with M694V mutation was high in RI wo AA (p < 0.01, p = 0.02, p = 0.048, respectively). There was a positive correlation between M694V mutation and monoarthritis/polyarthritis, between compound heterozygous with M694V mutations and presence of chest pain, and between V726A mutation and constipation. Also a negative correlation was found between E148Q and chest pain and between R202Q mutation and monoarthritis/polyarthritis. While M694V mutation increased the risk 2.6 times for AA and 1.7 times for RI wo AA, colchicine resistance increased the risk 33 times for AA and 25 times for RI wo AA. Concluson: It was concluded in the present study that M694V mutation and colchicine resistance were two important risk factors for RI wo AA (6.9%) and amyloidosis (1.2%) in FMF patients. It should be kept in mind that compound heterozygous with M694V mutations may be associated with chest pain and R202Q mutation may be negatively correlated with arthritis, unlike M694V. The genetic results and clinical findings of the patients should be evaluated together and followed up closely. What is Known: • M694V mutation and colchicine resistance were two important risk factors for RI wo AA and amyloidosis in FMF patients. What is New: • Compound heterozygous with M694V mutations were associated with chest pain and may be more serious than thought. • Another point is that while R202Q mutations were negatively correlated with arthritis, M694V mutations were positively correlated.
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Affiliation(s)
- Hayrunnisa Bekis Bozkurt
- Department of Pediatric Allergy and Immunology, Göztepe Prof. Dr. Süleyman, Yalçın City Hospital, İstanbul Medeniyet University, Istanbul, Turkey.
| | - Sema Yıldırım
- Department of Pediatrics, İstanbul Göztepe Prof. Dr. Süleyman Yalçın City Hospital, Istanbul, Turkey
| | - Müferet Ergüven
- Department of Pediatric Rheumatology, Düzce University Faculty of Medicine, Düzce, Turkey
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Brenner DM, Brandt LJ, Fenster M, Hamilton MJ, Kamboj AK, Oxentenko AS, Wang B, Chey WD. Rare, Overlooked, or Underappreciated Causes of Recurrent Abdominal Pain: A Primer for Gastroenterologists. Clin Gastroenterol Hepatol 2023; 21:264-279. [PMID: 36180010 DOI: 10.1016/j.cgh.2022.09.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/08/2022] [Indexed: 01/28/2023]
Abstract
Recurrent abdominal pain is a common reason for repeated visits to outpatient clinics and emergency departments, reflecting a substantial unmet need for timely and accurate diagnosis. A lack of awareness of some of the rarer causes of recurrent abdominal pain may impede diagnosis and delay effective management. This article identifies some of the key rare but diagnosable causes that are frequently missed by gastroenterologists and provides expert recommendations to support recognition, diagnosis, and management with the ultimate aim of improving patient outcomes.
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Affiliation(s)
- Darren M Brenner
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Lawrence J Brandt
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Marc Fenster
- Division of Gastroenterology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Matthew J Hamilton
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, Boston, Massachusetts
| | - Amrit K Kamboj
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Amy S Oxentenko
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona
| | - Bruce Wang
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - William D Chey
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan
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Şen N, Acer Kasman S, Baysal T, Dizman R, Yılmaz-Öner S, Tezcan ME. Apical fibrosis was the most common incidental pulmonary finding in a familial Mediterranean fever cohort. Clin Rheumatol 2023; 42:1363-1370. [PMID: 36725780 PMCID: PMC9891658 DOI: 10.1007/s10067-023-06526-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF) is one of the common autoinflammatory diseases with multisystemic manifestation. Pleuritis is the only known pulmonary involvement of FMF; however, as far as we know, thoracic involvements in pleural, parenchymal, bronchial, and vascular structures have not been evaluated yet. METHOD We included 243 consecutive FMF patients who applied to our clinic within the last 5 years and were requested to have a thorax CT for any reason and 122 trauma patients without any comorbidity. An experienced radiologist evaluated the thorax CT images blindly according to the relevant guidelines. We then presented the common incidental pulmonary and mediastinal findings on the thorax CT. Additionally, we compared patients with and without lung involvement according to demographic and disease-related parameters. RESULTS In our study, 167 of 243 patients (68.7%) had at least one of the pulmonary findings on their thorax CT. The most common pulmonary findings were apical fibrosis in 96 (39.5%) patients, parenchymal fibrotic changes in 48 (19.8%) patients, and a solitary parenchymal nodule smaller than 4 mm in 33 (13.6%) patients. All demographic, genetic, and disease-related characteristics, including the frequency of spondyloarthropathy, were similar in patients with and without pulmonary findings. CONCLUSIONS We showed that the most common incidental pulmonary finding in our FMF cohort was apical fibrosis on thoracic CT. Our data did not show causality between FMF and apical fibrosis; therefore, more studies are needed to evaluate the frequency and clinical significance of apical fibrosis in FMF. Key Points • More than two-thirds of familial Mediterranean fever (FMF) patients in our study group who underwent a thoracic scan for any reason had pulmonary and mediastinal findings on thorax computed tomography (CT). • In our FMF cohort, the most common incidental pulmonary finding on their thorax CT was apical fibrosis. • All demographic and disease-related characteristics, including the frequency of spondyloarthritis, were similar between patients with and without pulmonary and mediastinal findings.
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Affiliation(s)
- Nesrin Şen
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Sevtap Acer Kasman
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey.
| | - Tamer Baysal
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Rıdvan Dizman
- Department of Radiology, Kartal Dr. Lutfi Kirdar City Hospital, Istanbul, Turkey
| | - Sibel Yılmaz-Öner
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
| | - Mehmet Engin Tezcan
- Department of Rheumatology, Kartal Dr. Lutfi Kirdar City Hospital, Kartal, 34680, Istanbul, Turkey
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Erkilet HK, Gezgin Yildirim D, Esmeray P, Söylemezoğlu O. Efficacy and safety of anti-interleukin-1 in children with colchicine-resistant familial Mediterranean fever. Pediatr Int 2023; 65:e15588. [PMID: 37658625 DOI: 10.1111/ped.15588] [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: 10/09/2022] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the efficacy and safety of anti-interleukin-1 (IL-1) therapies in colchicine-resistant pediatric patients with familial Mediterranean fever (FMF). METHODS In this study, we retrospectively evaluated 656 children with FMF and 27 patients who had been treated with anti-IL-1 therapies (anakinra/canakinumab) . Clinical and laboratory features, MEFV gene mutations, treatment responses were investigated. RESULTS Twenty of the patients were treated with anakinra (the treatment of 6 patients who initially used anakinra was switched to canakinumab in the follow-up period), and 13 patients were treated with canakinumab. Clinical symptom and severity scores decreased in all patients A decrease in acute phase reactants was also observed in patients. A total of 18 (66%) patients had a M694V homozygous mutation, while 24 (89%) patients had a M694V mutation, at least in one allele. CONCLUSIONS FMF patients with colchicine resistance may progress to amyloidosis. IL-1 antagonist treatment could be used safely with a favorable outcome in pediatric patients with FMF resistance to colchicine therapy and/or who have renal amyloidosis.
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Affiliation(s)
| | - Deniz Gezgin Yildirim
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Pelin Esmeray
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Oğuz Söylemezoğlu
- Department of Pediatric Rheumatology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Kirkiz S, Kaya Z, Gönen S, Yağcı M, Koçak Ü. Occurrence of familial Mediterranean fever in haemophilia patients. Haemophilia 2023; 29:165-171. [PMID: 36409293 DOI: 10.1111/hae.14698] [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: 07/17/2022] [Revised: 11/06/2022] [Accepted: 11/06/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION This is the first study of simultaneous occurrences of Familial Mediterranean Fever (FMF) in patients with haemophilia. AIM The aim was to investigate the frequency and clinical characteristics of FMF in patients with severe haemophilia. METHODS Our study included 30 patients with severe haemophilia (26 haemophilia A and four haemophilia B). All 30 patients are screened for MEFV genotypes in FMF according to the new Eurofever/PRINTO diagnostic criteria. All cohorts were genetically tested for FMF and thrombophilia. RESULTS Eight (26%) of 30 haemophilic patients were diagnosed with FMF. Six different heterozygous FMF mutations including M694V (n = 2), E148Q (n = 2), V726A(n = 1), P369S (n = 1), E148Q/K695R (n = 1) and E148Q/M694I (n = 1) were identified. Seven had haemophilia A and only one had haemophilia B. Four (50%) patients had a positive family history and three of them had extraarticular findings specific to FMF. Only one haemophilia B patient received colchicine. Target joints in the knee, ankle, and elbow were identified in three FMF patients. The number of target joints in eight patients with FMF was significantly lower than in twenty-two patients without FMF (p < .05). The annual number of suspected joint bleedings in FMF patients admitted to the hospital was 40; however, 15 (37.5%) were documented bleedings in ultrasounds. Hereditary thrombophilia was detected in seven of eight patients. CONCLUSION Our data indicate that screening for FMF may be useful in patients with haemophilia who develop arthritis without prominent bleeding and have a positive family history in many Mediterranean countries, including Turkey.
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Affiliation(s)
- Serap Kirkiz
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Zühre Kaya
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Sevim Gönen
- Tissue-Typing Laboratory, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Münci Yağcı
- Department of Adult Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ülker Koçak
- Department of Pediatric Hematology, Faculty of Medicine, Gazi University, Ankara, Turkey
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Parmaksız G, Noyan ZA. Can RDW be used as a screening test for subclinical inflammation in children with FMF? Is RDW related to MEFV gene mutations? Clin Rheumatol 2023; 42:197-202. [PMID: 36103024 DOI: 10.1007/s10067-022-06358-x] [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: 06/30/2022] [Revised: 08/09/2022] [Accepted: 08/21/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Subclinical inflammation, an insidious feature of familial Mediterranean fever (FMF), can lead to life-threatening amyloidosis. We aimed to investigate acute phase reactants and complete blood count parameters to identify a useful marker for subclinical inflammation in children with FMF. A secondary aim was to identify an association between subclinical inflammation and specific Mediterranean fever (MEFV) gene mutations. METHODS This study included 420 pediatric patients with FMF. Laboratory parameters of patients during the attack-free period and MEFV gene mutation analyses were recorded. RESULTS Of the 420 patients, 88 (21%) had subclinical inflammation. Of those with subclinical inflammation, 48 (55%) had mutations in exon 10, 36 (41%) had M694V mutation, and 10 (11%) had M694V homozygous mutation. Red cell distribution width (RDW) value was higher in exon 10, M694V, and M694V homozygous mutations compared to other mutations. RDW was positively correlated with serum amyloid A (SAA) (r = 0.390, p = 0.0001). Analysis of a receiver-operating characteristic curve of RDW revealed that its optimal cut-off value for subclinical inflammation was 12.69%, its sensitivity was 64.10%, and its specificity was 50.90%. The area under the curve was 0.616 (p = 0.004, 95% confidence interval = 0.538-0.695). CONCLUSION We suggest that RDW can be used as a screening test as a marker of subclinical inflammation. A high RDW value should alert the clinician about subclinical inflammation in FMF children's patients with M694V (heterozygous, homozygous, compound heterozygous) mutation. Key Points • Subclinical inflammation in FMF patients can lead to amyloidosis. • RDW can be a predictor of subclinical inflammation. • RDW can be used as a screening test for subclinical inflammation in FMF patients with M694V mutation.
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Affiliation(s)
- Gönül Parmaksız
- Pediatric Nephrology Department, Başkent University School of Medicine, Adana Dr. Turgut Noyan Training and Research Center, Seyhan, Adana, Turkey.
| | - Z Aytül Noyan
- Pediatric Nephrology Department, Başkent University School of Medicine, Adana Dr. Turgut Noyan Training and Research Center, Seyhan, Adana, Turkey
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Monfort JB, Deshayes S, Dusser P, Bourguiba R, Savey L, Vinit C, Koné-Paut I, Amaryan G, Theodoropoulou K, Guedri R, Pachlopnik J, Belot A, Melki I, Perveen Maldar N, Hentgen V, Georgin-Lavialle S. Cutaneous manifestations of monogenic auto-inflammatory diseases: An international cohort study from the Juvenile Inflammatory Rheumatism cohort. J Am Acad Dermatol 2022; 87:1391-1394. [PMID: 35970384 DOI: 10.1016/j.jaad.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/04/2022] [Accepted: 08/06/2022] [Indexed: 10/15/2022]
Affiliation(s)
- J B Monfort
- Department of Dermatology, Tenon Hospital, Sorbonne Université, Faculté de Médecine Sorbonne Université, AP-HP, Paris, France.
| | - S Deshayes
- Department of Internal Medicine, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France
| | - P Dusser
- Department of Pediatric Rheumatology, CEREMAIA, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
| | - R Bourguiba
- Department of Internal Medicine, Sorbonne Université, AP-HP, Tenon Hospital, National Reference Centre for Auto-inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Paris, France; Hôpital des Forces de sécurités de l'intérieur, La Marsa, Tunisia
| | - L Savey
- Department of Internal Medicine, Sorbonne Université, AP-HP, Tenon Hospital, National Reference Centre for Auto-inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Paris, France
| | - C Vinit
- Department of General Pediatrics, André Mignot Hospital, Versailles, CEREMAIA, Paris, France
| | - I Koné-Paut
- Department of Pediatric Rheumatology, CEREMAIA, Assistance Publique-Hôpitaux de Paris (AP-HP), University of Paris Sud Saclay, Le Kremlin-Bicêtre, France
| | - G Amaryan
- National Pediatric Centre for Familial Mediterranean Fever, Arabkir Medical Complex, Institute of Child and Adolescent Health, Yerevan State Medical University, Yerevan, Armenia
| | - K Theodoropoulou
- Romandy Multisite Centre for Pediatric Immunology and Rheumatology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - R Guedri
- Department of Pediatrics (PUC), Children Hospital Béchir Hamza, University Tunis El Manar, Tunis, Tunisia
| | - J Pachlopnik
- Division of Immunology, University Children's Hospital Zurich, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - A Belot
- Department of Pediatric Nephrology, Rheumatology, Dermatology, Mère-Enfant Hospital, Hospices Civils de Lyon, Université Claude Bernard-Lyon 1, Bron, France
| | - I Melki
- Infectious Disease and Internal Medicine Department, General Pediatrics, Robert-Debré Hospital, APHP, Paris, France
| | | | | | - V Hentgen
- Department of General Pediatrics, André Mignot Hospital, Versailles, CEREMAIA, Paris, France
| | - S Georgin-Lavialle
- Department of Internal Medicine, Sorbonne Université, AP-HP, Tenon Hospital, National Reference Centre for Auto-inflammatory Diseases and Amyloidosis of Inflammatory Origin (CEREMAIA), Paris, France
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Egyptian evidence-based consensus on clinical practice recommendations for the management of familial Mediterranean fever. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00132-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
We aimed to provide a consensus, evidence-based recommendations for the diagnosis, evaluation, and treat-to-target management of children living with FMF.
This study was carried out to achieve an expert consensus on a treat-to-target management strategy for FMF using the Delphi technique. The preliminary scientific committee identified a total of 17 key clinical questions according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) approach. An evidence-based, systematic, literature review was conducted to compile evidence for the benefits and harms associated with JIA treatments. The core leadership team identified researchers and clinicians with expertise in FMF management. Delphi process was implemented (2 rounds) to reach a consensus on the management recommendations of FMF patients.
Results
Twenty-one expert panel participated in the 2 rounds with a response rate of 100%. A total of 12 recommendations, categorized into 2 sections (4 in the diagnosis section and 8 in management), were obtained. The agreement with the recommendations (rank 7–9) ranged from 85.7 to 100%. The consensus was reached (i.e., ≥75% of respondents strongly agreed or agreed) on all the clinical standards. Algorithms for management have been also developed.
Conclusion
A wide and representative panel of experts established a consensus regarding the management of FMF. The developed guidelines provide a comprehensive treat-to-target approach to the management of FMF for all healthcare professionals who are involved in its management.
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Bas B, Sayarlioglu H, Yarar Z, Dilek M, Arik N, Sayarlioglu M. Investigation of the relationship between disease severity and development of amyloidosis and genetic mutation in FMF disease. Ir J Med Sci 2022:10.1007/s11845-022-03108-5. [PMID: 35972675 DOI: 10.1007/s11845-022-03108-5] [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: 07/04/2022] [Accepted: 07/19/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is an autosomal recessive genetic disease. Amyloidosis is the most important complication of FMF that determines the prognosis of the disease. AIMS In our study, we have investigated the relationship between the genetic mutations with the disease severity and the frequency of development of amyloidosis inpatients with FMF. METHODS A total of 148 patients with FMF were included this study. The relationship between disease activity score, clinical findings, response to treatment, and presence of amyloid and genetic mutations were evaluated. RESULTS One hundred forty-eight patients (80 women (54%), 68 men (46%)) were enrolled over 18 years of age. The mean age of the patients was 30.98 ± 11.18 (18-67) years. In our study, the most frequently seen mutations are M694V, M680I, R202Q, and E148Q, respectively. The most common genotype is M694V/M694V mutation and this mutation has been found in 37 patients (25%). In 25 patients, M694V heterozygous have been found (16.8%). The third frequent mutationis M694V/M680I/R202Q has been found in13 patients (8.7%). In 23 patients, amyloidosis has been developed. Ten patients with amyloidosis have M694V homozygous mutations (27%) and 5 patients with amyloidosis M694V heterozygous (20%) mutations. The both of the two patients who carry the homozygous E148Q mutations have developed amyloidosis. CONCLUSIONS In our study, the distribution of the frequency of mutations is consistent with other similar studies performed in Turkey. We found that patients with M694V mutation had a significantly higher rate of exacerbation, higher drug doses for treatment, and a close relationship with amyloidosis, as compared to patients with other mutations.
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Affiliation(s)
- Berk Bas
- Department of Internal Medicine, Ondokuz Mayis University, Samsun, Turkey
| | | | - Zeliha Yarar
- Department of Internal Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - Melda Dilek
- Department of Nephrology Ondokuz, Mayis University, Samsun, Turkey
| | - Nurol Arik
- Department of Nephrology Ondokuz, Mayis University, Samsun, Turkey
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Ahmad T. Mapping of global research on familial Mediterranean fever: a SCI-Expanded-based bibliometric analysis. Rheumatol Int 2022; 42:2231-2239. [PMID: 35920892 DOI: 10.1007/s00296-022-05179-0] [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: 07/03/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is a disease of the innate immune system. The disease is prevalent in the Mediterranean region. A comprehensive bibliometric analysis of the published literature on FMF indexed in the SCI-Expanded is lacking. OBJECTIVE To review the global research trend, developments, leading authors, journals, institutions, and countries, and visualization mapping of the published scientific literature on FMF. METHODS The data were obtained from SCI-Expanded of the WoSCC database. The obtained data were analyzed using Bibliometrix: An R-tool and an online Bibliometric tool. P-value less than 0.05 was considered statistically significant. RESULTS In this study, a total of 1665 publications (research article, 92% and review, 8%) on FMF were analyzed and characterized. These publications were authored by 5630 authors, and published in 465 journals. The scientific production in FMF research has been increasing over time (p < 0.0001), with scientific annual growth of 3.96%. The most frequent year of publications was 2021 (n = 98), while the most attractive and published journal in FMF research was Rheumatology International (n = 116). The leading institution was Hacettepe University. The top ranked and most cited country in FMF research was Turkey. In total, the authors' collaboration index was 3.47. CONCLUSION Generally, FMF scientific research production has increased over the last two decades. The most studied research areas in FMF were rheumatology, general internal medicine and genetics heredity. The most studied recent trend topics in FMF research were validity, reliability, endothelial dysfunction, management, and recommendations. Moreover, regional collaboration between less active countries should be extended in order to expand FMF-related research and thus prevent and control the disease in the near future.
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Affiliation(s)
- Tauseef Ahmad
- Vanke School of Public Health, Tsinghua University, Beijing, 100084, China.
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Aydin O, Egeli BH, Ozdogan H, Ugurlu S. Late-onset familial mediterranean fever: single-center experience and literature review. Intern Emerg Med 2022; 17:1301-1306. [PMID: 35061158 DOI: 10.1007/s11739-021-02912-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022]
Abstract
Familial Mediterranean fever (FMF) is a hereditary, autoinflammatory disease characterized by recurrent fever and serositis attacks. The disease onset occurs before 20 years of age in 90% of patients and rarely after the 4th decade. The aim of this study is to screen our FMF patient pool for patients with disease onset after age of 40 and to compare them to patients with early onset with regard to clinical and genetic features. The charts of 2020 patients registered in our FMF center in the years 2008-2017 were screened with regard to age of disease onset. Patients with disease onset after the age of 40 were considered as late-onset group (Group 1). The control group (Group 2) consisted of patients with a disease onset before the age of 20 who were randomly selected from the patient pool with twice the number of probands. Demographic, clinical and genetic data were recorded. Out of 2020 patients, the attacks of FMF had started after the fourth decade in 41 patients (2.02%), (Group 1). The male to female ratio was 1:1.7 in both groups. The delay of diagnosis was 5.6 ± 5.75 years in group 1, 10.7 ± 12.3 years in group 2. The only significant difference with regard to clinical features between two groups was the frequency of fever, which was present in 26 (63.4%) patients in group 1 and 67 (81.7%) in group 2 (p = 0.026). M694V mutation was more prevalent among early-onset group whereas exon 2 variants were more frequent in patients with late onset. The mean colchicine dose in the last 6 months was 1.38 ± 0.64 mg in group 1, and 1.61 ± 0.47 mg in group 2. FMF may start after 40 years of age in approximately 2% of the patients. Lower frequency of fever, lower daily colchicine dose and lower prevalence of exon 10 mutations point out that FMF patients with a disease onset after 40 years of age experience a milder disease compared to those with an onset before the second decade of life.
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Affiliation(s)
- Okan Aydin
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Bugra Han Egeli
- Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Huri Ozdogan
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey
| | - Serdal Ugurlu
- Division of Rheumatology, Department of Internal Medicine, Cerrahpasa Medical Faculty, University of Istanbul-Cerrahpasa, Istanbul, Turkey.
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Wekell P, Wester T. Familial Mediterranean fever may mimic acute appendicitis in children. Pediatr Surg Int 2022; 38:1099-1104. [PMID: 35737103 PMCID: PMC9259538 DOI: 10.1007/s00383-022-05153-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/30/2022]
Abstract
Acute appendicitis is the most common surgical emergency in children. Diagnosis and management are often straightforward. However, familial Mediterranean fever is an important condition to consider in the assessment of children with acute abdominal pain, particularly in children with an origin in eastern Mediterranean basin where the disease is common. The key feature of familial Mediterranean fever is relapsing episodes of fever and serositis including peritonitis, pleurisy, or arthritis. The disease is treated with colchicine that prevents acute attacks, control subclinical inflammation between the attacks and the long-term complication of amyloidosis. The acute attacks may be a challenge to identify and distinguish from other causes of acute abdomen, including acute appendicitis, but also small bowel obstruction. Ultrasound and CT scan findings are nonspecific during acute attacks of familial Mediterranean fever, but imaging is useful to identify acute appendicitis and small bowel obstruction. The purpose of this article was to increase the awareness and knowledge of familial Mediterranean fever and provide support for the paediatric surgeon in the clinical care of these children in parts of the world where familial Mediterranean fever is rare.
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Affiliation(s)
- Per Wekell
- grid.459843.70000 0004 0624 0259Department of Pediatrics, NU-Hospital Group, Uddevalla, Sweden ,grid.8761.80000 0000 9919 9582Department of Pediatrics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Tomas Wester
- grid.24381.3c0000 0000 9241 5705Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
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Özdemir Atikel Y, Derinkuyu BE, Bakkaloğlu SA. Unusual presentation of familial Mediterranean fever with co‐existing polyarteritis nodosa and acute post‐streptococcal glomerulonephritis. Clin Case Rep 2022; 10:e6022. [PMID: 35898740 PMCID: PMC9307881 DOI: 10.1002/ccr3.6022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/05/2022] [Accepted: 05/22/2022] [Indexed: 11/16/2022] Open
Abstract
Acute post‐streptococcal glomerulonephritis (APSGN) and polyarteritis nodosa (PAN) may occur simultaneously after streptococcal infection in a child who is previously healthy but carries a Mediterranean fever (MEFV) mutation. The homozygous M694V mutation in the MEFV gene may cause an augmented response to the streptococcal infection that plays a role in the development of both clinical manifestations.
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Affiliation(s)
- Yeşim Özdemir Atikel
- Department of Pediatric Nephrology Gazi University Faculty of Medicine Ankara Turkey
| | | | - Sevcan A. Bakkaloğlu
- Department of Pediatric Nephrology Gazi University Faculty of Medicine Ankara Turkey
- Department of Pediatric Rheumatology Gazi University Faculty of Medicine Ankara Turkey
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Spondyloarthritis in familial Mediterranean fever: a cohort study. Rheumatol Int 2022; 42:1729-1739. [PMID: 35716180 DOI: 10.1007/s00296-022-05158-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
Familial Mediterranean fever (FMF) and spondyloarthritis (SpA) may show several common signs. This study aimed to evaluate the frequency of SpA and its manifestations in FMF, the impact of SpA on FMF, and the associations of non-episodic findings (heel enthesitis, protracted arthritis, and sacroiliitis) with the FMF features. Demographic, clinical, imaging, and genetic data were retrieved from medical records of the patients with adult FMF. To identify patients who met the classification criteria for SpA, data including rheumatologic inquiry were recorded. Patients with SpA and those who did not meet the criteria were compared in terms of FMF features. Regression analyses were performed to determine the factors that were most associated with sacroiliitis, enthesitis, and protracted arthritis. Of the 283 patients with FMF, 74 (26.1%) met the SpA criteria (64 axial, 10 peripheral); and 65 (22.9%) patients had sacroiliitis, 27 (9.5%) protracted arthritis, and 61 (21.6%) heel enthesitis. Patients with SpA were older and had more FMF severity, and heel pain rate than those without; however, genetic features, CRP, resistance to colchicine, and heel enthesitis did not differ. A meaningful number of patients without SpA had also displayed heel enthesitis, protracted arthritis, inflammatory back pain, heel pain, family history of SpA, and elevated CRP. Age was found to be the main predictor of heel enthesitis and protracted arthritis was linked with FMF severity. A significant number of patients with FMF meet the peripheral SpA classification criteria as well as axial SpA. SpA and its shared manifestations with FMF may have an impact on FMF.
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BİNİCİ M, TEKEŞ S, BALKAN M, ORAL D, YÜCEL İ, TUNÇ Ş. Çocuk Ailesel Akdeniz Ateşi Hastalarında MEFV Mutasyonlarının Dağılımı: Türkiye’nin Güneydoğusunda Tek Merkezli Çalışma. DICLE MEDICAL JOURNAL 2022. [DOI: 10.5798/dicletip.1128958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Amaç: Ailevi Akdeniz Ateşi (FMF), Akdeniz'de yaşayan etnik gruplarda (Türkler, Araplar, Yahudiler ve Ermeniler) görülen resesif geçişli otoinflamatuvar bir hastalıktır. Farklı coğrafi bölgelerde ve etnik gruplarda FMF’ deki MEFV mutasyon değişimi farklılık göstermektedir. Bu çalışmada, son yıllara ait mutasyon dağılımını belirleyerek bölgemizdeki MEFV mutasyon dağılım verileri ile ülke geneli ve diğer bölgelerin mutasyon dağılımını karşılaştırmayı amaçladık.
Yöntemler: Merkezimize sevk edilen FMF klinik semptomları tespit edilen 286 hastanın moleküler test sonuçlarını değerlendirdik. Moleküler analiz için hastaların, pyrosequencing yöntemi kullanılarak MEFV genindeki 22 yaygın mutasyon analizi yapıldı.
Bulgular: 286 hastanın genetik analizi sonucu; 74 (%25,87) hastanın 27’sinin homozigot (%9,44),47’ sinin bileşik heterozigot (%16,44) mutasyona sahip olduğunu, 212'sinin (%74,13) isesadece tek bir mutasyon taşıdığını ortaya koydu. Allel frekansları göz önüne alındığında en yaygın mutasyonlar; E148Q (%32,50), M694V (%26,94), V726A (%10,83), R761H (%10,83), M680I (G>C) (%6,11) ve P369S (%5,56) şeklindedir.
Sonuç: Bu tek merkezli çalışmada, Türkiye'nin güneydoğusundaki çocuk FMF hastalarından elde edilen yaygın MEFV gen mutasyonlarının sıklıkları hakkında bilgi verdik. Hastaların yaklaşık yarısı alellerinde en az bir E148Q veya M694V mutasyonu taşıyordu. Bölgemizdeki verileri ülke geneli ve Ege bölgesi ile karşılaştırdığımızda en sık rastlanan mutasyon açısından farklılıklar olduğu gözlenmektedir. Çalışma sonuçlarımız ülkemizin Güneydoğu Anadolu Bölgesinde yapılan önceki çalışmalarla karşılaştırıldığında, mutasyon oranları arasında farklılıklar olduğu gözlemlenmektedir. Bu çalışmayla bölgemizdeki FMF hastalarının mutasyon dağılımlarının güncel verileri elde edilerek literatüre katkıda bulunulmuştur.
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Sahin S, Romano M, Guzel F, Piskin D, Poddighe D, Sezer S, Kasapcopur O, Appleton CT, Yilmaz I, Demirkaya E. Assessment of Surrogate Markers for Cardiovascular Disease in Familial Mediterranean Fever-Related Amyloidosis Patients Homozygous for M694V Mutation in MEFV Gene. Life (Basel) 2022; 12:life12050631. [PMID: 35629299 PMCID: PMC9146909 DOI: 10.3390/life12050631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/16/2022] [Accepted: 04/21/2022] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular disease (CVD) remains underestimated in familial Mediterranean fever-associated AA amyloidosis (FMF-AA). We aimed to compare early markers of endothelial dysfunction and atherosclerosis in FMF-AA with a homozygous M694V mutation (Group 1 = 76 patients) in the Mediterranean fever (MEFV) gene and in patients with other genotypes (Group 2 = 93 patients). Measures of increased risk for future CVD events and endothelial dysfunction, including flow-mediated dilatation (FMD), pentraxin-3 (PTX3), and carotid intima-media thickness (cIMT), and fibroblast growth factor 23 (FGF23) as a marker of atherosclerotic vascular disease were compared between groups. The frequency of clinical FMF manifestations did not differ between the two groups apart from arthritis (76.3% in Group 1 and 59.1% in Group 2, p < 0.05). FMD was significantly lower in Group 1 when compared with Group 2 (MD [95% CI]: −0.6 [(−0.89)−(−0.31)]). cIMT, FGF23, and PTX3 levels were higher in Group 1 (cIMT MD [95% CI]: 0.12 [0.08−0.16]; FGF23 MD [95% CI]: 12.8 [5.9−19.6]; PTX3 MD [95% CI]: 13.3 [8.9−17.5]). In patients with FMF-AA, M694V homozygosity is associated with lower FMD values and higher cIMT, FGF23, and PTX3 levels, suggesting increased CVD risk profiles. These data suggest that a genotype−phenotype association exists in terms of endothelial dysfunction and atherosclerosis in patients with FMF-AA.
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Affiliation(s)
- Sezgin Sahin
- Department of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
- Correspondence:
| | - Micol Romano
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
| | - Ferhat Guzel
- Molecular Genetics Laboratories, Genetics Research and Genome Center, Department of Research and Development, Ant Biotechnology, Istanbul 34775, Turkey;
| | - David Piskin
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
| | - Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan 010000, Kazakhstan;
- Clinical Academic Department of Pediatrics, National Research Center of Maternal and Child Health, University Medical Center, Nur-Sultan 010000, Kazakhstan
| | - Siren Sezer
- Division of Nephrology, Atilim University Faculty of Medicine, Ankara 06830, Turkey;
| | - Ozgur Kasapcopur
- Department of Paediatric Rheumatology, Istanbul University-Cerrahpasa, Istanbul 34098, Turkey;
| | - C. Thomas Appleton
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
- Division of Rheumatology, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada
| | - Ilker Yilmaz
- Epigenetic Health Solutions, Unit of Nephrology, Ankara 06810, Turkey;
| | - Erkan Demirkaya
- Division of Paediatric Rheumatology, Department of Paediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON N6A 5C1, Canada; (M.R.); (E.D.)
- Canadian Behcet and Autoinflammatory Disease Center (CAN-BE-AID), University of Western Ontario, London, ON N6A 5C1, Canada;
- Lawson Health Research Institute, London Health Sciences Center, London, ON N6C 2R5, Canada;
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