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Bustaffa M, Koné-Paut I, Ozen S, Amaryan G, Papadopoulou-Alataki E, Gallizzi R, Carrabba M, Aviel YB, Cantarini L, Alessio M, Anton J, Obici L, Gok F, Batu ED, Moreno E, Brogan P, Trachana M, Simonini G, Rigante D, Uziel Y, Insalaco A, Maggio MC, Ruperto N, Gattorno M, Semerano LR. The impact of the Eurofever criteria and the new InFevers MEFV classification in real life: Results from a large international FMF cohort. Semin Arthritis Rheum 2022; 52:151957. [PMID: 35042149 DOI: 10.1016/j.semarthrit.2022.151957] [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: 07/30/2021] [Revised: 11/19/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION New Eurofever/PRINTO classification criteria (EPCC) for Familial Mediterranean Fever (FMF) and other recurrent fevers have been recently developed, together with the classification of the pathogenicity of MEFV variants. OBJECTIVES To evaluate the impact in real life of both the EPCC and INSAID pathogenicity classification of MEFV variants in the large international Eurofever FMF cohort. METHODS Baseline demographic, genetic and clinical data of FMF patients included in the Eurofever registry were evaluated. The EPCC and the 2018 INSAID classification for MEFV variants were applied in all eligible FMF patients. RESULTS Since November 2009, clinical information was available for 1012 FMF (532 males/480 females, 827 children/185 adults) from 119 centres. Complete data were available for 887 patients in whom 623 (70.2%) satisfied EPCC (EPCC+), while 264 (29.8%) did not (EPCC-). The majority of the EPCC- patients (172, 65.1%) displayed negative or non-informative genetics (monoallelic or biallelic benign variants, monoallelic variant of unknown significance). At baseline, colchicine was used in most of EPCC+ patients (88%) and in a lower percentage of EPCC- patients (69%, p < 0.0001), who were treated in a higher proportion with steroid or NSAID on demand (p = 0.003 and 0.008, respectively). Four percent of patients received Anti-IL-1 treatment. CONCLUSIONS The combination of EPCC and the 2018 INSAID classification of MEFV variants is able to identify two distinct groups of patients, which differ in clinical characteristics, therapeutic approach and response to treatment. EPCC+ patients displayed the typical features of FMF, while EPCC- patients had a more variable phenotype with a lower percentage of response to colchicine.
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Affiliation(s)
- Marta Bustaffa
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy
| | - Isabelle Koné-Paut
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
| | - Seza Ozen
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Gayane Amaryan
- National Pediatric Centre for Familial Mediterranean Fever, Arabkir Medical Complex, Institute of Child and Adolescent Health, Yerevan State Medical University, Yerevan, Armenia
| | | | - Romina Gallizzi
- Department of Medical of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | - Maria Carrabba
- Dipartimento di Medicina Interna, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, UOS Malattie Rare, Milano, Italy
| | | | - Luca Cantarini
- Department of Medical Sciences, Surgery and Neurosciences, Rheumatology Unit, University of Siena, Siena, Italy
| | - Maria Alessio
- Università di Napoli Federico II, Dipartimento di Pediatria, Napoli, Italy
| | - Jordi Anton
- Division of Pediatric Rheumatology, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat (Barcelona), Spain
| | - Laura Obici
- Fondazione IRCCS Policlinico San Matteo, Centro per lo Studio e la Cura delle Amiloidosi Sistemiche, Pavia, Italy
| | - Faysal Gok
- Department of Pediatric Rheumatology, Gulhane Military Medical Faculty, Ankara, Turkey
| | - Ezgi Deniz Batu
- Department of Pediatric Rheumatology, Hacettepe University, Ankara, Turkey
| | - Estefania Moreno
- University Hospital Valle de Hebron, Rheumatology Unit, Barcelona, Spain
| | - Paul Brogan
- UCL GOS Institute of Child Health, London, United Kingdom
| | - Maria Trachana
- First Department of pediatrics, Pediatric Immunology and Rheumatology Referral Center, Hippokration General Hospital, Thessaloniki University School of Medicine, Thessaloniki, Greece
| | - Gabriele Simonini
- Dipartimento di Pediatria, Azienda Ospedaliero Universitaria Meyer, Florence, Italy
| | - Donato Rigante
- Department of Life Sciences and Global Health, IRCCS Policlinico Universitario A. Gemelli, Università Cattolica Sacro Cuore, Rome, Italy
| | - Yosef Uziel
- Meir Medical Centre, Pediatric Rheumatology Unit, Department of Pediatrics, Kfar Saba and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antonella Insalaco
- Division of Rheumatology, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Maria Cristina Maggio
- University Department Pro.Sa.M.I. "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Nicolino Ruperto
- IRCCS Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia, Printo, Genoa, Italy
| | - Marco Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficenze/Clinica Pediatrica e Reumatologia IRCCS Giannina Gaslini, Genoa, Italy; UOSD Centro Malattie Autoinfiammatorie e Immunodeficienze, IRCCS Istituto Giannina Gaslini, Genoa, Italy.
| | - L Rossi Semerano
- Department of Pediatric Rheumatology, National Referral Centre of Auto-Inflammatory Diseases and inflammatory amyloidosis, CEREMAIA, CHU de Biĉetre, APHP, University of Paris Saclay, Le Kremlin Biĉetre, France
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Farag Y, Salah S, Tawfik H, Hamed M, Marzouk H. Toll-like receptor-4 gene variations in Egyptian children with familial Mediterranean fever. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-020-00053-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Familial Mediterranean fever (FMF) is an autosomal recessive disorder affecting people in the region of the Mediterranean Sea. It is usually associated with mutation in Mediterranean fever (MEFV) gene that encodes the pyrin protein, which affects the innate inflammatory response. Toll-like receptors (TLR) are a family of pattern recognition receptors that recognize pathogenic microbes and activate antimicrobial defense mechanisms. Toll-like receptor 4 (TLR-4) is concerned with recognition of gram-negative organisms. There is growing clinical evidence suggesting a role for expression of TLRs in the immune pathogenesis of FMF. Thus, the aim of the current study was to evaluate the presence of TLR-4 (p.Asp299Gly) and TLR-4 (p.Thr399Ile) gene variants in association with Egyptian children having FMF, furthermore, its effect on disease course and severity.
Results
Seventy Egyptian children diagnosed as having FMF, together with 50 age and gender-matched controls were enrolled in the study. The TLR-4 (p.Asp299Gly) and (Thr399Ile) gene variants were determined by PCR-RFLP analysis for all studied patients and controls. TLR-4 p.Asp299Gly gene variant was detected in 1 (1.4%) of the patients and p.Thr399Ile gene variant was detected in 2 (2%). None of the controls had any of the two tested gene variants. All found variations were heterozygous. We could not find a statistically significant association with disease severity in cases with or without TLR-4 gene variants (P = 0.568). Patients with M694V gene mutation showed a higher disease severity (P = 0.035).
Conclusion
TLR-4 (p.Asp299Gly) and (p.Thr399Ile) gene variants were not found to have a link with the occurrence, the clinical picture of FMF, its severity, and response to colchicine treatment in Egyptian children. M694V gene mutation seems to be associated with higher disease severity. Further larger studies are needed to verify these results.
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Fraisse T, Savey L, Hentgen V, Rossi-Semerano L, Koné-Paut I, Grateau G, Georgin-Lavialle S, Ducharme-Bénard S. Non-amyloid liver involvement in familial Mediterranean fever: A systematic literature review. Liver Int 2020; 40:1269-1277. [PMID: 32196885 DOI: 10.1111/liv.14445] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Revised: 03/09/2020] [Accepted: 03/11/2020] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Familial Mediterranean fever (FMF), the most frequent autoinflammatory disease, is caused by mutations in the MEFV gene. It is characterized by recurrent febrile attacks of polyserositis. Liver abnormalities may develop during its course, but they remain poorly defined. OBJECTIVE To describe liver involvement in FMF patients. METHODS A systematic search was conducted through PubMed/Medline and Embase from 1946 to January 2020. All articles describing children and adults with FMF and liver involvement were included. Patients with amyloidosis were excluded. The selected full-text articles were independently reviewed by three investigators. RESULTS Forty-three articles were identified, of which 20 articles with a total of 99 patients were included: 74 adults, 23 children and two patients of unknown age. Ten patients had cryptogenic cirrhosis, 48 had nonalcoholic fatty liver disease (NAFLD), four had Budd-Chiari syndrome (BCS), 12 had isolated hyperbilirubinaemia and 25 had elevated liver enzymes. CONCLUSION Despite a low prevalence of metabolic risk factors, FMF may be associated with NAFLD and cryptogenic cirrhosis as a consequence of chronic or recurrent inflammation. FMF patients should be regularly screened for liver injury. The latter may be prevented and treated by daily colchicine intake. The evidence was insufficient to establish an association with BCS, hyperbilirubinaemia or autoimmune hepatitis.
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Affiliation(s)
- Thibault Fraisse
- Service de médecine interne, Hôpital Tenon, APHP, Université Sorbonne, Paris, France
| | - Léa Savey
- Service de médecine interne, Hôpital Tenon, APHP, Université Sorbonne, Paris, France
| | | | - Linda Rossi-Semerano
- Service de rhumatologie-pédiatrie, Hôpital Bicêtre, APHP, Université Paris-Sud, Paris, France
| | - Isabelle Koné-Paut
- Service de rhumatologie-pédiatrie, Hôpital Bicêtre, APHP, Université Paris-Sud, Paris, France
| | - Gilles Grateau
- Service de médecine interne, Hôpital Tenon, APHP, Université Sorbonne, Paris, France
| | | | - Stéphanie Ducharme-Bénard
- Service de médecine interne, Hôpital Tenon, APHP, Université Sorbonne, Paris, France.,Service de médecine interne, Hôpital du Sacré-Cœur de Montréal, Université de Montréal, Montréal, Québec, Canada
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Kilic A, Varkal MA, Durmus MS, Yildiz I, Yıldırım ZNY, Turunc G, Oguz F, Sidal M, Omeroglu RE, Emre S, Yilmaz Y, Kelesoglu FM, Gencay GA, Temurhan S, Aydin F, Unuvar E. Relationship between clinical findings and genetic mutations in patients with familial Mediterranean fever. Pediatr Rheumatol Online J 2015; 13:59. [PMID: 26759267 PMCID: PMC4711108 DOI: 10.1186/s12969-015-0057-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 12/11/2015] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is one of the most frequent genetic diseases encountered in the Mediterranean region. We aimed to investigate the correlation between genetic mutations and the clinical findings in 562 patients with FMF. METHODS In this retrospective cross-sectional study conducted with patients' files between 2006, and 2013, reverse hybridization assay for MEFV gene mutations was used and the 12 most frequent mutations were screened. Mutation types and clinical findings were compared with variance analysis. RESULTS The mean age was 6.9 ± 3.4 years (range, 1.8-11.6 years). The most common symptom was fever (97.3%). Thirty-four of the patients (6.04%) were admitted with periodic fever only. Of these patients, M694V was the most common mutation type (73.5%). The percentage of the patients predominantly presenting with recurrent abdominal pain was 77.78% and the most frequent mutations were M694V and E148Q. The rate of arthritis and arthralgia was significantly higher in patients with M694V and E148Q mutations. Chest pain was reported more often in patients homozygous for M694V (61.4%). Pericardial effusion was documented in the echocardiography of 10.9% of the 229 children with chest pain. Some patients had both FMF and Henoch Schönlein purpura (HSP), and were more likely to harbor either homozygote M694V or E148Q mutations. The frequency of episodes was higher in patients with homozygous M694V mutations (number of attacks = 4.4 ± 1.6/month). Proteinuria was detected in 106 patients of cases (29.2%), at an average of 854 ± 145 mg/L. Most of the patients with proteinuria and elevated serum amyloid-A had homozygous M694V mutation. CONCLUSION The most common mutation in children in Turkey with FMF is the M694V mutation. Recurrent abdominal pain, arthritis or arthralgia, chest pain, and pericarditis were commonly seen in patients with M694V and E148Q mutations.
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Affiliation(s)
- Ayse Kilic
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
| | - Muhammet Ali Varkal
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
| | - Mehmet Sait Durmus
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
| | - Ismail Yildiz
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
| | | | - Gorkem Turunc
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Fatma Oguz
- Department of Pediatrics, Istanbul University, Institute of Child Health, Istanbul, Turkey.
| | - Mujgan Sidal
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
| | - Rukiye Eker Omeroglu
- Department of Pediatric Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Sevinc Emre
- Department of Pediatric Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Yasin Yilmaz
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Fatih Mehmet Kelesoglu
- Department of Pediatric Rheumatology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Genco Ali Gencay
- Department of Pediatrics, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Sonay Temurhan
- Department of Medical Biology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Filiz Aydin
- Department of Medical Biology, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
| | - Emin Unuvar
- Department of General Pediatrics, Istanbul University, Istanbul Medical Faculty, 34090, Istanbul, Turkey.
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Bonyadi MJ, Somi MH, Khoshknab MMP, Eslami F, Montazam M, Gerami SMN. FMF Genotype-phenotype correlation in Iranian Azeri Turks: Association between M694V/R761H mutation and amyloidosis. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2015; 18:659-63. [PMID: 26351556 PMCID: PMC4556758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 06/03/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Familial Mediterranean fever (FMF), an inherited autosomal recessive disorder, is frequently present among individuals of Mediterranean origin. Differences in the clinical manifestations of FMF between different ethnic groups have been documented. The aim of the present study was to determine the most common characteristics of FMF and the relationship between clinical findings and the most common mutant alleles of the MEFV gene in an Iranian Azeri Turk population. MATERIALS AND METHODS We analyzed clinical and genetic data from 415 patients identified as having FMF clinical symptoms and who were referred to the Molecular Genetics Laboratory of Tabriz/Iran over the last 3 years. The mutation type and clinical characteristics were determined for each patient. RESULTS The following primary clinical characteristics of the patients were observed peritonitis was observed in 378 (93.8%), high-grade fever in 351 (86.88%), arthritis in 215 (54.57%), pleuritis in 207 (53.49%), myalgia in 153 (41.69%), AA amyloidosis in 149 (40.16%), and erysipelas-like erythema in 54 (14.96%) subjects. A positive response to colchicines treatment was noted in 374 (95.1%) patients including 303 patients with two mutated alleles and 71 patients with one identified mutation. CONCLUSION In contrast to previous studies, there was no significant association between M694V mutation and development of amyloidosis. The M680I/M680I, M680I, M694I, and M694V/R761H genotypes were found to be associated with the development of amyloidosis. These results indicate that physicians need to pay careful attention to patients with asymptomatic or mildly symptomatic FMF with these genotypes.
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Affiliation(s)
| | - Mohammad Hossein Somi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Forough Eslami
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehrdad Montazam
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sousan Mir Najd Gerami
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Corresponding author: Sousan Mir Najd Gerami. Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel: +98-413-3367473;
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Kasifoglu T, Bilge SY, Sari I, Solmaz D, Senel S, Emmungil H, Kilic L, Oner SY, Yildiz F, Yilmaz S, Bakirli DE, Tufan MA, Yilmaz S, Yazisiz V, Pehlivan Y, Bes C, Cetin GY, Erten S, Gonullu E, Temel T, Sahin F, Akar S, Aksu K, Kalyoncu U, Direskeneli H, Erken E, Kisacik B, Sayarlioglu M, Korkmaz C. Amyloidosis and its related factors in Turkish patients with familial Mediterranean fever: a multicentre study. Rheumatology (Oxford) 2013; 53:741-5. [DOI: 10.1093/rheumatology/ket400] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Šedivá A, Horváth R, Maňásek V, Gregorová A, Plevová P, Horáčková M, Tesařová M, Toplak N, Debeljak M. Cluster of patients with Familial Mediterranean fever and heterozygous carriers of mutations inMEFVgene in the Czech Republic. Clin Genet 2013; 86:564-9. [DOI: 10.1111/cge.12323] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 11/04/2013] [Accepted: 11/15/2013] [Indexed: 11/28/2022]
Affiliation(s)
- A. Šedivá
- Department of Immunology; Charles University, 2nd School of Medicine, Faculty Hospital Motol; Prague Czech Republic
| | - R. Horváth
- Department of Immunology; Charles University, 2nd School of Medicine, Faculty Hospital Motol; Prague Czech Republic
| | - V. Maňásek
- Complex Center for Oncology; Hospital Nový Jičín; Nový Jičín Czech Republic
| | - A. Gregorová
- Department of Medical Genetics; University Hospital Ostrava; Ostrava Czech Republic
| | - P. Plevová
- Department of Medical Genetics; University Hospital Ostrava; Ostrava Czech Republic
| | - M. Horáčková
- Department of Internal Medicine; Charles University, 2nd School of Medicine, Faculty Hospital Motol; Prague Czech Republic
| | - M. Tesařová
- Department of Paediatrics and Adolescent medicine, 1st Faculty of Medicine; Charles University in Prague and General University Hospital in Prague; Prague Czech Republic
| | - N. Toplak
- Molecular Genetic Laboratory and Department of Allergology, Rheumatology and Clinical Immunology; University Children's Hospital, University Medical Centre Ljubljana; Ljubljana Slovenia
| | - M. Debeljak
- Molecular Genetic Laboratory and Department of Allergology, Rheumatology and Clinical Immunology; University Children's Hospital, University Medical Centre Ljubljana; Ljubljana Slovenia
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Colonic lymphoid nodular hyperplasia in childhood: causes of familial Mediterranean fever need extra attention. J Pediatr Gastroenterol Nutr 2013; 57:817-21. [PMID: 24280993 DOI: 10.1097/mpg.0b013e3182a9083b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES The clinical importance and etiology of colonic lymphoid nodular hyperplasia (LNH) are not clear. It has been considered a response to some antigenic stimuli. Although food allergies, infections, inflammatory bowel diseases, and immunodeficiencies may be listed in the etiology of colonic LNH, the etiology has remained unclear in many cases. This study investigated the etiology of colonic LNH and its relation to familial Mediterranean fever (FMF) in children. FMF as an etiologic factor for colonic LNH has not been reported before in the literature. METHODS Medical files of patients who underwent colonoscopy between 2007 and 2011 were examined retrospectively. Demographic features, presenting symptoms, colonoscopy indications, colonoscopic findings, and final diagnoses of patients were evaluated. According to etiologies, patients with colonic LNH were divided into 2 groups: group A consisted of patients with FMF and group B consisted of diseases other than FMF. RESULTS A total of 311 patients were included in the study. Forty (12.6%) patients had isolated colonic LNH. In 23 (57.5%) patients, isolated LNH was observed in some colonic segments and total colonic LNH was noted in 17 (42.5%) patients. FMF was the etiologic factor in 6 (15%) patients. Thirty-four patients (85%) had etiologic factors other than FMF. We did not find any etiologic factor for LNH in 3.53% (11/311) of patients. CONCLUSIONS FMF may be an etiologic factor for colonic LNH in children besides food allergies, infections, inflammatory bowel diseases, and immunodeficiencies.
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