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Asher I, Sheiner E, Willner NT, Zeller L, Pariente G. Perinatal outcomes and long-term infectious morbidity of offspring born to mothers with familial Mediterranean fever. Arch Gynecol Obstet 2024; 310:1417-1424. [PMID: 38127142 DOI: 10.1007/s00404-023-07317-w] [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: 09/26/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE To investigate perinatal outcomes and long-term infectious morbidity in children of mothers with familial Mediterranean fever (FMF). METHODS A population-based cohort study comparing perinatal outcomes and long-term infectious morbidity of offspring of mothers with and without FMF was conducted. All singleton deliveries between the years 1991-2021 in a tertiary medical center were included. The study groups were followed until 18 years of age for long-term infectious morbidity. A Kaplan-Meier survival curve was used to compare the cumulative incidence of long-term infectious morbidity, and generalized estimation equation (GEE) models as well as Cox proportional hazards models were constructed to control for confounders. RESULTS During the study period, 356,356 deliveries met the inclusion criteria. 411 of them were women with FMF. The mean follow-up period interval was 9.7 years (SD = 6.2) in both study groups. Using GEE models, preterm delivery, cesarean delivery, and low birth weight were independently associated with maternal FMF. The total infectious-related hospitalization rate was significantly higher in offspring born to mothers with FMF compared to the comparison group (Kaplan-Meier survival curve, log-rank p < 0.001). Using a Cox proportional hazards model, controlling for gestational age, maternal age, diabetes mellitus, cesarean delivery, and hypertensive disorders, being born to a mother with FMF was found to be an independent risk factor for long-term infection-related hospitalization of the offspring. CONCLUSION Maternal FMF was found to be independently associated with long-term infection-related hospitalization of the offspring. This positive correlation may reflect an intra-uterine pro-inflammatory environment which may result in the offspring's long-term susceptibility to infection.
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Affiliation(s)
- Itay Asher
- The Goldman Medical School at the Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - N Tifferet Willner
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Lior Zeller
- Division of Internal Medicine, Soroka University Medical Center, Beer-Sheva, Israel
| | - Gali Pariente
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Poddighe D, Romano M, Garcia-Bournissen F, Demirkaya E. Conventional and novel therapeutic options in children with familial Mediterranean fever: A rare autoinflammatory disease. Br J Clin Pharmacol 2021; 88:2484-2499. [PMID: 34799863 DOI: 10.1111/bcp.15149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/15/2022] Open
Abstract
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory disease and is usually diagnosed in childhood, especially in the first decade of life. Paediatric FMF is characterized by a protean clinical expression and a variable therapeutic response, which can make its medical management very challenging. However, even if long-term complications of untreated FMF (e.g. amyloidosis and related organ damage) are less frequent in children compared to adults, they are not uncommon. Colchicine is the mainstay of the therapy in paediatric FMF; however, if children develop colchicine intolerance and/or resistance, biologics, particularly interleukin-1 antagonists, must be considered. Other conventional or biological therapeutic options do not currently have appropriate evidence-based support, except for some specific clinical presentations (e.g., arthritis). In this review, we discuss the biological basis and the clinical evidence for the current pharmacological treatment options available for paediatric FMF.
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Affiliation(s)
- Dimitri Poddighe
- Department of Medicine, Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan.,Clinical Academic Department of Pediatrics, National Research Center of Maternal and Child Health, University Medical Center, Nur-Sultan, Kazakhstan
| | - Micol Romano
- Schulich School of Medicine & Dentistry, Department of Pediatrics, Division of Pediatric Rheumatology, University of Western Ontario, London, ON, Canada.,Schulich School of Medicine & Dentistry, Department of Pediatrics, Canadian Behcet and Autoinflammatory Center (CAN BE AID), University of Western Ontario, London, ON, Canada
| | - Facundo Garcia-Bournissen
- Schulich School of Medicine & Dentistry, Department of Pediatrics, Division of Pharmacology, University of Western Ontario, London, ON, Canada.,Schulich School of Medicine & Dentistry, Department of Epidemiology and Biostatistics, University of Western Ontario, London, ON, Canada
| | - Erkan Demirkaya
- Schulich School of Medicine & Dentistry, Department of Pediatrics, Division of Pediatric Rheumatology, University of Western Ontario, London, ON, Canada.,Schulich School of Medicine & Dentistry, Department of Pediatrics, Canadian Behcet and Autoinflammatory Center (CAN BE AID), University of Western Ontario, London, ON, Canada.,Schulich School of Medicine & Dentistry, Department of Pediatrics, Division of Pharmacology, University of Western Ontario, London, ON, Canada
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Brucato A, Pluymaekers N, Tombetti E, Rampello S, Maestroni S, Lucianetti M, Valenti A, Adler Y, Imazio M. Management of idiopathic recurrent pericarditis during pregnancy. Int J Cardiol 2019; 282:60-65. [PMID: 30773267 DOI: 10.1016/j.ijcard.2019.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/26/2019] [Accepted: 02/04/2019] [Indexed: 01/30/2023]
Abstract
BACKGROUND Data concerning idiopathic recurrent pericarditis in pregnancy are scarce. OBJECTIVES To evaluate the management and outcome of idiopathic recurrent pericarditis during pregnancy. METHODS AND RESULTS Twenty-one pregnancies were evaluated in fourteen women with a history of recurrent idiopathic pericarditis (mean maternal age 31.5 years, mean gestational age 39.0 weeks), and subdivided in 2 cohorts: eight pregnancies were analyzed retrospectively (2002-2010), thirteen (2011-2017) prospectively and followed according a predefined management protocol. Ten pregnancies were uneventful, three ended in spontaneous early abortion, one fetal death occurred at 19 weeks. Recurrences of pericarditis occurred in eight and were treated by adding NSAIDs in two cases; in five cases the dose of corticosteroids was increased and in two cases aspirin was started/increased; paracetamol was always allowed. Colchicine was used in two cases in the prospective cohort. HELLP syndrome occurred in one patient, which resolved after delivery, and one patient experienced arterial hypertension and elevated transaminase. All infants had a good outcome (mean birth weight 3114 g, 10 males). Birth weight was significantly lower in the retrospective cohort (respectively 2806 g vs. 3320 g, p-value 0.017) in which higher doses of corticosteroids were used (median dose respectively 10.0 mg vs. 2.5 mg, p-value 0.048). Five recurrences of pericarditis occurred after delivery, easily treated with standard therapy. CONCLUSION General outcomes of pregnancy in patients with idiopathic recurrent pericarditis is good, especially when patients are carefully followed by multidisciplinary teams according to standardized protocols.
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Affiliation(s)
- Antonio Brucato
- Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Italy
| | - Nikki Pluymaekers
- Department of Cardiology, Maastricht University Medical Center (MUMC+) and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Enrico Tombetti
- Department of Biomedical and Clinical Science "L. Sacco", University of Milano, Italy
| | - Stefania Rampello
- Department of Obstetrics and Gynaecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Silvia Maestroni
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Marzia Lucianetti
- Department of Obstetrics and Gynaecology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Anna Valenti
- Department of Internal Medicine, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Yehuda Adler
- The Gertner Institute, Sheba Medical Center, affiliated to Sackler Medical school, Tel Aviv University and the College for Academic Studies, Israel
| | - Massimo Imazio
- University Cardiology AOU, Città della Salute e della Scienza di Torino, Torino, Italy
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Batu ED, Arici ZS, Bilginer Y, Özen S. Current therapeutic options for managing familial Mediterranean fever. Expert Opin Orphan Drugs 2015. [DOI: 10.1517/21678707.2015.1073149] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Yanmaz MN, Özcan AJ, Savan K. The impact of familial Mediterranean fever on reproductive system. Clin Rheumatol 2014; 33:1385-8. [PMID: 24924605 DOI: 10.1007/s10067-014-2709-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 05/30/2014] [Indexed: 12/27/2022]
Abstract
Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by recurrent attacks of fever, peritonitis, pleuritis, arthritis, or erysipelas-like skin lesion. FMF is the most common periodic febrile syndrome affecting more than 150,000 people worldwide. The majority of patients develop FMF before the age of 20. FMF may cause amyloidosis, which mainly affects the kidneys but may also be accumulated in other organs such as the heart, gastrointestinal tract, and reproductive organs. FMF being a systemic disorder with a risk for amyloidosis, affecting patients in their childbearing years, and with its lifelong colchicine therapy raises concern about its effect on the reproductive system. In this article, we review the impact of FMF and its treatment to the reproductive system of male and female patients, pregnancy, and lactation.
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Affiliation(s)
- Muyesser Nergiz Yanmaz
- Istanbul Kemerburgaz University School of Medicine, Internal Medicine and Rheumatology, Medicalpark Hospital, Kültür sok No. 1, 34160, Istanbul, Turkey,
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Sarı İ, Birlik M, Kasifoğlu T. Familial Mediterranean fever: An updated review. Eur J Rheumatol 2014; 1:21-33. [PMID: 27708867 DOI: 10.5152/eurjrheum.2014.006] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 02/05/2014] [Indexed: 12/21/2022] Open
Abstract
Familial Mediterranean Fever (FMF) is a hereditary autoinflammatory disorder characterised by acute attacks of fever and serosal inflammation. FMF primarily affects Jewish, Armenian, Turkish, and Arab populations. The disease is accompanied by a marked decrease in quality of life due to the effects of attacks and subclinical inflammation in the attack-free periods. Untreated or inadequately treated patients run the risk of amyloidosis, which is an important cause of morbidity and mortality. In this review, the current information available on FMF is summarised.
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Affiliation(s)
- İsmail Sarı
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Merih Birlik
- Department of Internal Medicine, Division of Rheumatology, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Timuçin Kasifoğlu
- Department of Internal Medicine, Division of Rheumatology, Osmangazi University Faculty of Medicine, Eskişehir, Turkey
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Ocak Z, Ocak T, Duran A, Ozlü T, Kocaman EM. Frequency of MEFV mutation and genotype-phenotype correlation in cases with dysmenorrhea. J Obstet Gynaecol Res 2013; 39:1314-8. [PMID: 23800337 DOI: 10.1111/jog.12061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 12/28/2012] [Indexed: 11/27/2022]
Abstract
AIM We aimed to investigate the relation between mutations and polymorphisms playing roles in the onset of clinical findings of Familial Mediterranean Fever (FMF) and clinical phenotypic reflections manifesting with painful episodes, such as dysmenorrhea. MATERIAL AND METHODS A total of 1000 female patients who had not responded well to non-steroidal anti-inflammatory drugs in the menstrual period, and who had presented to the emergency room with the complaint of recurrent pain episodes were included in the study. All the patients were Turkish women living in Istanbul. In this study, the mutations most frequently seen in the Mediterranean Fever Gene (MEFV), namely M694V, E148Q, M680I(G/C), V726A, P369S, R761H, A744S, M694I, K695R, F479L, M680I(G/A), and I692del were examined using the DNA sequence analysis following DNA isolation. RESULTS The number of individuals who had a mutation in at least one allele for FMF was 511 out of 1000 patients. Of these 511 patients, homozygous mutations were found in 21% (n = 109), compound heterozygous mutations were found in 27% (n = 136), and heterozygous mutations were found in 52% (n = 266). The most frequent homozygous genotype seen in our study population was M694V/M694V. The most common compound heterozygote genotypes were M694V/M680I, M694V/V726A, M694V/E148Q, and M680I/V726A; and 11.7% (n = 60) of the families in whom mutations were found had consanguinity. CONCLUSION Women who present to the emergency room with the complaint of dysmenorrhea that is irresponsive to non-steroidal anti-inflammatory drugs may have several types of MEFV mutations that are responsible for FMF.
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Affiliation(s)
- Zeynep Ocak
- Department of Medical Genetics, Suleymaniye Maternity Hospital for Research and Training, Istanbul, Turkey.
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