AB1325 DIAGNOSTIC DELAY IN FAMILIAL MEDITERRANEAN FEVER: IS IT STILL A PROBLEM?

Background

Familial Mediterranean fever (FMF) is a rare hereditary autoinflammatory disease with disease onset in childhood in most cases. Although autoinflammatory disease awareness is increasing among physicians, delayed diagnosis is still prevalent as a cause of greater morbidity[1].

Objectives

We aimed to study the characteristics of FMF patients diagnosed between 2000-2010 and 2011-2021 and to see if there was a difference in diagnostic delay.

Methods

We retrospectively evaluated the medical records of the FMF patients followed up in our rheumatology clinic that were diagnosed between 2000-2021 and split them into two groups according to the year they received their diagnosis. There were 1151 patients diagnosed between 2000-2010 (Group 1) and 821 patients diagnosed between 2011-2021 (Group 2). The data studied included gender, age of onset, diagnostic delay, attack characteristics, MEFV mutation, and family history.

Results

The median current age of patients in Group 1 is 37 years (IQR:30-46) and the median current age of the patients in Group 2 is 36 years (IQR:29-44). The female to male ratio was 1.57 in Group 1 and 1.75 in Group 2, with no significant difference between the groups. Group 2 had later disease onset (p<0.001) and later diagnosis (p<0.001) than Group 1 as shown in the Table 1. The proportion of patients with at least one M694V mutation was higher in Group 2 (p<0.001). The attack durations did not vary between the groups. There was no significant difference in the prevalence of abdominal pain, fever, arthritis, and arthralgia between Group 1 and Group 2. Chest pain (p=0.005), myalgia (p<0.001), and erysipelas-like erythema (p=0.041) were more common in Group 2 than Group 1. Patients with positive family history were more frequent in Group 2 than Group 1 (p=0.046).

Table 1.Group 1 (2000-2010, n=1151)Group 2 (2011-2021, n=821)pFemale/Male, n704/447522/2990.275Age at onset, median (IQR) years13 (7-21)18 (12-26)<0.001Delay in diagnosis, median (IQR) years4 (1-11)5,5(2-15)<0.001Attack duration, median (IQR) years3(2-4)3(2-4)0.325Presence of at least one M694V mutation (%)526(46%)390(60%)<0.001Presence of abdominal pain in the initial attack (%)936(81%)669(81%)0.926Presence of fever in the initial attack (%)855(74%)592(72%)0.281Presence of chest pain in the initial attack (%)218(19%)199(24%)0.005Presence of arthritis in the initial attack (%)330(29%)215(26%)0.224Presence of arthralgia in the initial attack (%)213(19%)170(21%)0.223Presence of myalgia in the initial attack (%)45(4%)65(8%)<0.001Presence of erysipelas like erythema in the initial attack (%)31(3%)36(4%)0.041Presence of positive family history (%)652(57%)502(61%)0.046

Conclusion

There was some increase in the diagnostic delay in 2011-2021 compared to 2000-2010. This may be partly due to the later onset of symptoms in patients diagnosed in 2011-2021, which could have led the physicians to consider other differential diagnoses. Nevertheless, diagnostic delay in FMF still seems a prevalent problem that should be addressed to prevent excess morbidity and mortality.

References

[1]Erdogan M, Ugurlu S, Ozdogan H, Seyahi E. Familial Mediterranean fever: misdiagnosis and diagnostic delay in Turkey. Clin Exp Rheumatol. 2019;37 Suppl 121(6):119-124.

Disclosure of Interests

None declared

Clomipramine trial for treatment-resistant persistent genital arousal disorder: a case series

INTRODUCTION

Treatment of persistent genital arousal disorder (PGAD), as a chronic and disabling condition, implicates substantial compelling complexities.

METHODS

In this case series, seven women diagnosed with PGAD who were referred to the Sexual Dysfunction Unit of Psychotherapy Outpatient Clinic of Bakirkoy Research and Training Hospital for Psychiatry, Neurology, and Neurosurgery, Istanbul, Turkey between 2006 and 2009 were included. All patients were previously resistant to other antidepressants, antipsychotics and antiepileptics. The additional details of PGAD onset, frequency, type and duration of arousal, previous pharmacological interventions, and maximum and maintenance doses of clomipramine were recorded.

RESULTS

All patients achieved a substantial symptomatic improvement with clomipramine within the follow-up period of 2-9 years.

DISCUSSION

Based on our study results, we recommend clomipramine in combination with psychotherapy as the treatment of choice in PGAD and to be used before any invasive procedure such as electroconvulsive therapy (ECT) or surgery.

Microvessel density as a prognostic factor in preinvasive and invasive cervical lesions

OBJECTIVE

To assess angiogenesis in preinvasive and invasive cervical lesions and its prognostic value in squamous cell carcinoma (SCC).

METHODS

Twenty-seven cervical intraepithelial lesions (CIN I, II and III), 27 Stage Ib-IIa SCC and 12 normal cervical epithelium were included in the study. Clinico-pathological prognostic factors were re-evaluated from the patients' files and previous tissue sections. Microvessel density (MVD), a marker for angiogenesis, was assessed from new tissue blocks by an immunohistochemical staining method. Statistical tests included Kruskall-Wallis analysis, the Mann-Whitney U-test, Fisher's exact t-test to analyse the categorical data and Cox regression and Kaplan-Meier survival analyses to define the effect of prognosticators on survival.

RESULTS

CIN II and III lesions had significantly higher MVD counts than normal epithelium and CIN I lesions, both of which had similar MVD count. Compared to preinvasive lesions invasive SCC had significantly higher MVD counts. Among SCC cases, only pelvic lymph node involvement appeared to be independent risk factor on unvariate analysis. However, MVD, as a cut-off value of 21 determined by ROC analysis, was found to be an independent prognosticator in early stage SCC cases by multivariate analysis.

CONCLUSION

Despite the small number of enrolled cases, the results of this study suggest that angiogenesis involved in the development and progression of cervical neoplasms and MVD might be used as a prognostic factor.

Short-term intravaginal maximal electrical stimulation for refractive detrusor instability

OBJECTIVES

To determine the efficacy of intravaginal maximal electrical stimulation for the treatment of refractive detrusor instability.

METHODS

Thirty-five consecutive patients, treated by maximal electrical stimulation for pure refractive detrusor instability were evaluated subjectively by patient's questionnaires and 24-h urinary diary and objectively by 1-h standardized pad test and subtracted cystometry before and 1 week after the treatment. Paired-t and chi(2)-tests were used for the statistical analysis of the data.

RESULTS

Thirty-one (88.6%) of the 35 patients were found to be either cured or improved, subjectively. The overall objective success rates based on the 1-h pad test and subtracted cystometry were 80.0% and 74.3%, respectively. The results of all subjective and objective assessment tests, except postvoiding residual urine volume, improved significantly after the treatment (P<0.01). No significant adverse effect related to the treatment was observed, except vaginal irritation noted only by 5 (14.3%) patients.

CONCLUSION

Maximal electrical stimulation could offer a safe, non-invasive and effective treatment for patients with detrusor instability who respond poorly to other conservative therapies.