1
|
Georgin-Lavialle S, Savey L, Cuisset L, Boursier G, Boffa JJ, Delplanque M, Bourguiba R, Monfort JB, Touitou I, Grateau G, Kone-Paut I, Hentgen V. French protocol for the diagnosis and management of familial Mediterranean fever. Rev Med Interne 2023; 44:602-616. [PMID: 37903671 DOI: 10.1016/j.revmed.2023.10.441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/08/2023] [Indexed: 11/01/2023]
Abstract
Familial Mediterranean fever is the most common monogenic auto-inflammatory disease in the world. It mainly affects people originating from the Mediterranean region. The mutated gene is MEFV, which codes for pyrin. Transmission is autosomal recessive. Patients present with recurrent attacks of fever since childhood associated with abdominal and/or thoracic pain lasting an average of 2-3days and a biological inflammatory syndrome. Other symptoms include arthralgia or arthritis in large joints such as the knees and ankles, myalgia in the lower limbs and pseudo-erysipelas in the ankles. The most serious complication is inflammatory amyloidosis, which can lead to kidney failure. Treatment is based on colchicine, which helps to prevent flares and the onset of renal amyloidosis. This paper proposes national guidelines for the diagnosis, management and follow-up of familial Mediterranean fever in France, where we estimate there are between 5000 and 10,000 patients with the disease at all stages of life. The diagnosis is suspected on the basis of clinical and anamnestic factors and confirmed by genetic analysis. These guidelines also suggest a "treat-to-target" approach to disease management, particularly in case of suspected colchicine resistance - a very rare situation that should remain a diagnosis of elimination, especially after colchicine compliance has been verified. Two special situations are also addressed in these guidelines: kidney failure and pregnancy.
Collapse
Affiliation(s)
- S Georgin-Lavialle
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France.
| | - L Savey
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - L Cuisset
- Genetics, Cochin Hospital, Paris, France
| | - G Boursier
- Genetics, Montpellier University, Montpellier, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - J-J Boffa
- Nephrology, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - M Delplanque
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - R Bourguiba
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - J-B Monfort
- Dermatology, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - I Touitou
- Genetics, Montpellier University, Montpellier, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - G Grateau
- Internal Medicine, Sorbonne University, Tenon Hospital, Paris, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - I Kone-Paut
- Rhumatopediatry, Kremlin-Bicêtre Hospital, Le Kremlin-Bicêtre, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| | - V Hentgen
- Paediatric Rheumatology, Versailles Hospital, Versailles, France; CEREMAIA: French National Reference Center for Auto-inflammatory Diseases and AA Amyloidosis, Paris, France
| |
Collapse
|