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Unravelling the clinical heterogeneity of undefined recurrent fever over time in the European registries on Autoinflammation. Pediatr Rheumatol Online J 2024; 22:55. [PMID: 38760816 PMCID: PMC11100049 DOI: 10.1186/s12969-024-00987-z] [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: 01/14/2024] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Systemic autoinflammatory disorders (SAIDs) represent a growing spectrum of diseases characterized by dysregulation of the innate immune system. The most common pediatric autoinflammatory fever syndrome, Periodic Fever, Aphthous Stomatitis, Pharyngitis, Adenitis (PFAPA), has well defined clinical diagnostic criteria, but there is a subset of patients who do not meet these criteria and are classified as undefined autoinflammatory diseases (uAID). This project, endorsed by PRES, supported by the EMERGE fellowship program, aimed to analyze the evolution of symptoms in recurrent fevers without molecular diagnosis in the context of undifferentiated AIDs, focusing on PFAPA and syndrome of undifferentiated recurrent fever (SURF), using data from European AID registries. METHODS Data of patients with PFAPA, SURF and uSAID were collected from 3 registries including detailed epidemiological, demographic and clinical data, results of the genetic testing and additional laboratory investigations with retrospective application of the modified Marshall and PRINTO/Eurofever classification criteria on the cohort of PFAPA patients and preliminary SURF criteria on uSAID/SURF patients. RESULTS Clinical presentation of PFAPA is variable and some patients did not fit the conventional PFAPA criteria and exhibit different symptoms. Some patients did not meet the criteria for either PFAPA or SURF, highlighting the heterogeneity within these groups. The study also explored potential overlaps between PFAPA and SURF/uAID, revealing that some patients exhibited symptoms characteristic of both conditions, emphasizing the need for more precise classification criteria. CONCLUSIONS Patients with recurrent fevers without molecular diagnoses represent a clinically heterogeneous group. Improved classification criteria are needed for both PFAPA and SURF/uAID to accurately identify and manage these patients, ultimately improving clinical outcomes.
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L’haploinsuffisance de A20 : que doit connaître le clinicien? Rev Med Interne 2023:S0248-8663(23)01321-8. [PMID: 38160098 DOI: 10.1016/j.revmed.2023.12.004] [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: 08/07/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 01/03/2024]
Abstract
A20 Haploinsufficiency (HA20) is a monogenic autoinflammatory disease associated with an autosomal dominant mutation in the TNFAIP3 gene. It induces a defect in the inactivation of the pro-inflammatory NF-κB pathway. Less than 200 cases have been described worldwide. The clinical picture of the disease is essentially based on the association of recurrent fever and/or biologic inflammatory syndrome, aphtosis, often bipolar, and cutaneous folliculitis. However, the clinical spectrum of HA20 is very broad, including gastrointestinal (mainly colonic ulceration), articular, cutaneous, pericardial and lymph node involvement, as well as frequent association with organ-specific or non-specific autoimmune manifestations and/or autoantibodies, including antinuclear antibodies and anti-dsDNA. As a result, the diagnosis of a number of systemic or organic disorders, most notably Behçet's disease, Crohn's disease, and sometimes even systemic lupus, has been corrected to HA20 by molecular research for a heterozygous mutation with functional deficiency of TNFAIP3. Although the first signs of the disease often appear in the first years of life, the diagnosis is often made in adulthood and requires the involvement of both paediatric and adult physicians. Treatment for HA20 is not codified and relies on conventional or biological immunomodulators and immunosuppressants adapted to the patient's symptomatology. This review highlights the enormous diagnostic challenges in this autoinflammatory disease.
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[Monogenic auto-inflammatory diseases associated with actinopathies: A review of the literature]. Rev Med Interne 2023; 44:585-593. [PMID: 37596178 DOI: 10.1016/j.revmed.2023.06.005] [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: 05/03/2023] [Accepted: 06/06/2023] [Indexed: 08/20/2023]
Abstract
Auto-inflammatory diseases (AIDs) are diseases resulting from an inappropriate activation of innate immunity in the absence of any infection. The field of monogenic AIDs is constantly expanding, with the discovery of new pathologies and pathophysiological mechanisms thanks to pangenomic sequencing. Actinopathies with auto-inflammatory manifestations are a new emerging group of AIDs, linked to defects in the regulation of the actin cytoskeleton dynamics. These diseases most often begin in the neonatal period and combine to varying degrees a more or less severe primary immune deficiency, cytopenias (especially thrombocytopenia), auto-inflammatory manifestations (especially cutaneous and digestive), atopic and auto-immune manifestations. The diagnosis is to be evoked essentially in front of a cutaneous-digestive auto-inflammation picture of early onset, associated with a primary immune deficiency and thrombocytopenia or a tendency to bleed. Some of these diseases have specificities, including a risk of macrophagic activation syndrome or a tendency to atopy or lymphoproliferation. We propose here a review of the literature on these new diseases, with a proposal for a practical approach according to the main associated biological abnormalities and some clinical particularities. However, the diagnosis remains genetic, and several differential diagnoses must be considered. The pathophysiology of these diseases is not yet fully elucidated, and studies are needed to better clarify the inherent mechanisms that can guide the choice of therapies. In most cases, the severity of the picture indicates allogeneic marrow transplantation.
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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] [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.
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Breaking down the fences among registries on autoinflammatory diseases: the E-Merge project. Orphanet J Rare Dis 2023; 18:191. [PMID: 37461074 DOI: 10.1186/s13023-023-02812-4] [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: 01/19/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Among the various numbers of different autoinflammatory diseases (AIDs), the absolute majority of them remains rare, with a single representative in large populations. This project, endorsed by PRES, supported by the EMERGE fellowship program, and performed in line with the Metadata registry for the ERN RITA (MeRITA), has the objective of performing a data synchronization attempt of the most relevant research questions regarding clinical features, diagnostic strategies, and optimal management of autoinflammatory diseases. RESULTS An analysis of three large European registries: Eurofever, JIR-cohort and AID-Net, with a total coverage of 7825 patients from 278 participating centers from different countries, was performed in the context of epidemiological and clinical data merging. The data collected and evaluated in the registries does not cover only pediatric patients, but also adults with newly diagnosed AIDs. General aspects of the existing epidemiological data have been discussed in the context of patient global distribution, potential diagnostic delays, access to genetic testing, and the availability of the treatment. CONCLUSIONS In general, the results indicate a great potential for upcoming collaborative work using existing data in cohorts that enhance the quality of medical care performed for patients with autoinflammatory diseases.
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French national diagnostic and care protocol for Kawasaki disease. Rev Med Interne 2023:S0248-8663(23)00647-1. [PMID: 37349225 DOI: 10.1016/j.revmed.2023.06.002] [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: 05/03/2023] [Accepted: 06/04/2023] [Indexed: 06/24/2023]
Abstract
Kawasaki disease (KD) is an acute vasculitis with a particular tropism for the coronary arteries. KD mainly affects male children between 6 months and 5 years of age. The diagnosis is clinical, based on the international American Heart Association criteria. It should be systematically considered in children with a fever, either of 5 days or more, or of 3 days if all other criteria are present. It is important to note that most children present with marked irritability and may have digestive signs. Although the biological inflammatory response is not specific, it is of great value for the diagnosis. Because of the difficulty of recognising incomplete or atypical forms of KD, and the need for urgent treatment, the child should be referred to a paediatric hospital as soon as the diagnosis is suspected. In the event of signs of heart failure (pallor, tachycardia, polypnea, sweating, hepatomegaly, unstable blood pressure), medical transfer to an intensive care unit (ICU) is essential. The standard treatment is an infusion of IVIG combined with aspirin (before 10 days of fever, and for a minimum of 6 weeks), which reduces the risk of coronary aneurysms. In case of coronary involvement, antiplatelet therapy can be maintained for life. In case of a giant aneurysm, anticoagulant treatment is added to the antiplatelet agent. The prognosis of KD is generally good and most children recover without sequelae. The prognosis in children with initial coronary involvement depends on the progression of the cardiac anomalies, which are monitored during careful specialised cardiological follow-up.
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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]
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Caractéristiques cliniques de la Covid-19 chez les enfants et adolescents atteints de maladies rhumatismales et inflammatoires : données de la cohorte française RMD COVID-19 de 95 patients. REVUE DU RHUMATISME 2021. [PMCID: PMC8626124 DOI: 10.1016/j.rhum.2021.10.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Introduction Patients et méthodes Résultats Conclusion
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[Transition from pediatric to adult care: Recommendations of the French network for autoimmune and autoinflammatory diseases (FAI 2R)]. Rev Med Interne 2021; 42:633-638. [PMID: 34147259 DOI: 10.1016/j.revmed.2021.02.003] [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: 12/22/2020] [Accepted: 02/07/2021] [Indexed: 11/24/2022]
Abstract
Autoimmune and autoinflammatory diseases (AIDs) are a heterogeneous group of diseases. They can occur in childhood and account for significant morbidity and mortality. Transitioning from pediatric to adult healthcare can be difficult for patients and their families. It can interfere with patient follow-up and management, and eventually lead to complications. Although recommendations exist for the successful transition of patients with chronic diseases, few are specifically adapted to children and adults with AIDs (Suris et al., 2015-Solau-Gervais, 2012). The French working group on transition of the rare autoimmune and autoinflammatory diseases presents its reflections and recommendations for a successful transition. Preparation for transition should start early. Its goals are to empower adolescents by providing them with the knowledge to manage their own care, respond appropriately to changes in their condition, and evolve within the adult healthcare system. This requires the active participation of the patient, his or her family, as well as the pediatric and adult medical teams. The transition process involves multidisciplinary care and dedicated therapeutic education programs. Finally, the identification of medical specialists by region, trained in rare AIDs and accompanied by expert patients, may improve the management of patients with rare AIDs from adolescence to adulthood.
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La fièvre méditerranéenne familiale est-elle uns situation à risque de développer une forme grave d’infection par la COVID19 ? Résultat d’une étude rétrospective sur 627 patients en période et zone endémique en France. Rev Med Interne 2021. [PMCID: PMC8192023 DOI: 10.1016/j.revmed.2021.03.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Introduction La nouvelle pandémie mondiale (COVID19) causée par le coronavirus 2 du syndrome respiratoire aigu sévère (SRAS-CoV-2) est responsable de nombreux décès dans le monde entier au cours des derniers mois. Au cours des formes graves, il a été noté une réponse inflammatoire exagérée connue sous le nom de “orage cytokinique”. Ceci a soulevé la question de la sensibilité et de la gravité de l’infection par le SRAS-CoV2 chez les patients présentant une hyperactivation génétique de l’immunité innée tels que la fièvre méditerranéenne familiale (FMF). En outre, les patients avec FMF prennent de la colchicine au long cours, médicament qui a été testé chez des patients infectés par le SRAS-CoV2 avec des résultats contradictoires [1]. Patients et méthodes Étude menée sur l’infection par le SRAS-CoV2 chez les patients atteints de FMF suivis dans 2 sites du centre de référence national des maladies autoinflammatoires en région parisienne et inclus dans la JIR cohorte, une base de données européenne multicentrique. Les patients adultes et pédiatriques inclus répondaient aux critères internationaux de FMF et avaient un diagnostic génétique confirmé. Résultats Les patients identifiés (n = 627) ont été invités à répondre à un bref questionnaire soit en consultation, soit par téléphone, soit par courrier électronique sur une possible infection par le SARS-CoV2 pendant la période de mars à juin 2020 ; 342 patients ont répondu à l’enquête. Le diagnostic était retenu si le patient présentait des symptômes cliniques avec PCR ou sérologie positive ou scanner thoracique typique. Au total, 27 patients FMF (7,8 % des répondants ; sexe ratio 1/1) ont contracté le virus. Tous les 27 patients FMF-COVID+ sauf un prenaient de la colchicine quotidiennement depuis une période médiane de 23 ans, la dose moyenne de colchicine était de 1 mg/jour. Quatre recevaient en plus un inhibiteur de l’IL-1. Parmi les 27 patients FMF-COVID+, sept symptomatiques ont été hospitalisés (25 %) et six ont eu besoin d’oxygène ; trois (11 %) ont développé un syndrome de détresse respiratoire aiguë nécessitant des soins intensifs pour une ventilation mécanique et une hémodialyse. Deux patients sont décédés (7 %) mais présentaient respectivement 3 et 4 comorbidités pour une infection grave par le SRAS-CoV2 ; le troisième patient, âgé de 40 ans, souffrait d’hypertension et d’obésité. Les patients âgés de plus de 65 ans représentaient 17 % de l’ensemble de la cohorte FMF-COVID + ; 75 % ont été hospitalisés et ont eu besoin d’oxygène ; l’un d’eux est décédé. Trois patients FMF-COVID + avaient une amylose AA : 2 ont été hospitalisés et un est décédé. Aucun traitement anti-viral supplémentaire n’a été administré. Les 5 survivants après hospitalisation sont rentrés chez eux. Aucun d’entre eux n’a présenté de signes cliniques de crise de FMF lors de l’infection par le SRAS-CoV2. Discussion Le profil des patients FMF atteints d’une forme grave ou potentiellement mortelle par le SRAS-CoV2 était le même que celui de la population générale. Ainsi, seuls les patients FMF présentant des facteurs de risque connus (tels que âge avancé, maladie rénale chronique, hypertension, maladie vasculaire, obésité et dysfonctionnement pulmonaire) ont développé une infection grave par le SARS-CoV2 [2]. Cette étude n’est pas en faveur d’un surrisque en soi de développer une infection sévère à SRAS-CoV2 en présence d’une maladie autoinflammatoire monogénique touchant un inflammasome. Aucune conclusion formelle ne peut être tirée sur l’effet préventif de la colchicinothérapie au long cours, bien que ce travail rétrospectif porte sur une large cohorte de patients traités par colchicine depuis plusieurs années. Il est difficile de conclure à l’efficacité du traitement par inhibiteur d’IL1 vis-à-vis l’infection par le SRAS-CoV-2 chez les patients FMF, mais 50 % des patients traités au long cours sont décédés mais avaient plusieurs comorbidités ; et des publications récentes semblent plaider en faveur de l’efficacité de l’anakinra dans l’infection grave par le SRAS-CoV-2 [3]. Conclusion La FMF ne semble pas constituer un facteur de risque de développer une forme sévère d’infection par SARS-CoV2 chez les patients traités au long cours par de la colchicine quotidienne, par rapport à la population générale.
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[Periodic fever syndrome associated with mutations in the TNF type 1 receptor gene: A differential diagnosis of familial Mediterranean fever that should not be overlooked in patients of Mediterranean origin]. Rev Med Interne 2020; 42:459-464. [PMID: 33131906 DOI: 10.1016/j.revmed.2020.08.007] [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: 06/29/2020] [Revised: 08/23/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Tumor Necrosis Factor Type 1 Receptor Associated Periodic Syndrome (TRAPS) is a rare autosomal dominant autosomal autoinflammatory disease associated with mutations in the TNF type 1 receptor gene (TNFRSF1A). It is characterized by relatively long recurrent febrile seizures with an average duration of 7 days accompanied by arthralgia, myalgia, and usually a rash. In a patient of Mediterranean origin with recurrent fever, familial Mediterranean fever is the first diagnosis to be suspected by argument of frequency. METHODS A retrospective observational study was conducted on patients from Mediterranean origin followed for TRAPS and included in the "Juvenile Inflammatory Rheumatism" (JIR) observational cohort in the national French autoinflammatory center. The age of onset of symptoms, age of diagnosis, number of years of wandering and treatments received were collected for each index case. RESULTS Nine patients from 6 families of Mediterranean origin were included. A molecular diagnosis confirmed TRAPS in all patients. The median age at diagnosis was 26 years, the mean number of years of wandering was 17 years. The diagnosis of FMF was made first in all patients. AA amyloidosis revealed TRAPS in 2 patients. Colchicine was started without any efficacy in all cases. Five patients were treated with interleukin-1 inhibitory biotherapy with 100% efficacy. CONCLUSION In a patient of Mediterranean origin presenting with recurrent febrile abdominal pain of AA amyloidosis, the first diagnosis to be suspected is FMF. Long relapses, dominant transmission, a non-Mediterranean relative, and the ineffectiveness of colchicine should evoke TRAPS.
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Erratum à « Borréliose de Lyme et autres maladies vectorielles à tiques. Recommandations des sociétés savantes françaises » [Med. Mal. Infect. 49 (2019) 296–317]. Med Mal Infect 2019; 49:558-559. [DOI: 10.1016/j.medmal.2019.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies. Med Mal Infect 2019; 49:296-317. [PMID: 31257066 DOI: 10.1016/j.medmal.2019.05.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/31/2019] [Indexed: 12/19/2022]
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Lyme borreliosis and other tick-borne diseases. Guidelines from the French scientific societies (II). Biological diagnosis, treatment, persistent symptoms after documented or suspected Lyme borreliosis. Med Mal Infect 2019; 49:335-346. [PMID: 31155367 DOI: 10.1016/j.medmal.2019.05.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/07/2019] [Indexed: 11/18/2022]
Abstract
The serodiagnosis of Lyme borreliosis is based on a two-tier strategy: a screening test using an immunoenzymatic technique (ELISA), followed if positive by a confirmatory test with a western blot technique for its better specificity. Lyme serology has poor sensitivity (30-40%) for erythema migrans and should not be performed. The seroconversion occurs after approximately 6 weeks, with IgG detection (sensitivity and specificity both>90%). Serological follow-up is not recommended as therapeutic success is defined by clinical criteria only. For neuroborreliosis, it is recommended to simultaneously perform ELISA tests in samples of blood and cerebrospinal fluid to test for intrathecal synthesis of Lyme antibodies. Given the continuum between early localized and disseminated borreliosis, and the efficacy of doxycycline for the treatment of neuroborreliosis, doxycycline is preferred as the first-line regimen of erythema migrans (duration, 14 days; alternative: amoxicillin) and neuroborreliosis (duration, 14 days if early, 21 days if late; alternative: ceftriaxone). Treatment of articular manifestations of Lyme borreliosis is based on doxycycline, ceftriaxone, or amoxicillin for 28 days. Patients with persistent symptoms after appropriate treatment of Lyme borreliosis should not be prescribed repeated or prolonged antibacterial treatment. Some patients present with persistent and pleomorphic symptoms after documented or suspected Lyme borreliosis. Another condition is eventually diagnosed in 80% of them.
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La transition de la pédiatrie à l’âge adulte dans les maladies auto-inflammatoires : l’expérience d’un centre de référence adulte sur 72 patients. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Les maladies auto-inflammatoires associées aux mutations de NLRC4 : revue systématique de la littérature. Rev Med Interne 2018. [DOI: 10.1016/j.revmed.2018.03.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Familial Mediterranean Fever (FMF) is the most frequent monogenic auto-inflammatory disease. FMF is an autosomal recessive disease, which affects populations from Mediterranean origin and is associated with MEFV gene mutations encoding for the protein pyrin. Pyrin activation enhances the secretion of interleukin 1 by myelo-monocytic cells. Main features of the disease are acute attacks of serositis mainly located on the abdomen, less frequently on chest and joints, accompanied by fever and biological inflammatory markers elevation. Usually attacks last 1 to 3 days and spontaneously stop. A daily oral colchicine intake of 1 to 2mg/day is able to prevent attack's occurrence, frequency, intensity and duration among most patients. Colchicine is also able to prevent the development of inflammatory amyloidosis, the most severe complication of FMF. This state of the art article will focus on the diagnosis of FMF, the treatment and an update on the pathophysiology including the recent described dominant form of MEFV-associated new auto-inflammatory diseases.
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[Clinical overview of auto-inflammatory diseases]. Rev Med Interne 2018; 39:214-232. [PMID: 29501512 DOI: 10.1016/j.revmed.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 12/28/2017] [Accepted: 01/28/2018] [Indexed: 12/12/2022]
Abstract
Monogenic auto-inflammatory diseases are characterized by genetic abnormalities coding for proteins involved in innate immunity. They were initially described in mirror with auto-immune diseases because of the absence of circulating autoantibodies. Their main feature is the presence of peripheral blood inflammation in crisis without infection. The best-known auto-inflammatory diseases are mediated by interleukines that consisted in the 4 following diseases familial Mediterranean fever, cryopyrinopathies, TNFRSF1A-related intermittent fever, and mevalonate kinase deficiency. Since 10 years, many other diseases have been discovered, especially thanks to the progress in genetics. In this review, we propose the actual panorama of the main known auto-inflammatory diseases. Some of them are recurrent fevers with crisis and remission; some others evaluate more chronically; some are associated with immunodeficiency. From a physiopathological point of view, we can separate diseases mediated by interleukine-1 and diseases mediated by interferon. Then some polygenic inflammatory diseases will be shortly described: Still disease, Schnitzler syndrome, aseptic abscesses syndrome. The diagnosis of auto-inflammatory disease is largely based on anamnesis, the presence of peripheral inflammation during attacks and genetic analysis, which are more and more performant.
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Apport de la télédermatologie dans un service de pédiatrie hospitalière. Arch Pediatr 2018; 25:13-17. [DOI: 10.1016/j.arcped.2017.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 02/09/2017] [Accepted: 10/26/2017] [Indexed: 11/26/2022]
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[Multiple facets of ADA2 deficiency: Vasculitis, auto-inflammatory disease and immunodeficiency: A literature review of 135 cases from literature]. Rev Med Interne 2017; 39:297-306. [PMID: 29273180 DOI: 10.1016/j.revmed.2017.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 11/25/2017] [Indexed: 01/15/2023]
Abstract
Deficiency of adenosine deaminase 2 (DADA2) is a recently described auto-inflammatory disorder. It is an autosomal recessive inherited disease, caused by mutations in the ADA2 gene (formerly known as CECR1) encoding ADA2 enzyme. Besides its role in the purine metabolism, it has been postulated that ADA2 may act as a growth factor for endothelial cells and in the differenciation of monocytes. Thus, deficiency of ADA2 would lead to endothelial damage and a skewing of monocytes into M1 pro-inflammatory macrophage, causing DADA2 manifestations. Three core clinical features have been described: inflammatory-vascular signs, hematologic abnormalities and immunodeficiency. Clinically, patients display intermittent fever, cutaneous vascular manifestations, such as livedo, ischemic strokes, arthralgia and abdominal pain crisis. Corticosteroids and immunosuppressive agents (i.e. cyclophosphamide, azathioprine, ciclosporin, methotrexate) appear to be poorly effective. Although the mechanism has not been elucidated, anti-TNF agents have been proven efficient in DADA2 and should therefore be used as first line therapy for vasculitis. Role of anti-platelet and anticoagulant therapies in stroke-prophylaxis remains to be discussed, as those patients display a high risk of intracranial bleeding.
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Le déficit en ADA2, à la frontière entre vasculopathie, maladie auto-inflammatoire et immunodépression : revue de littérature de 93 cas. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Implication des mastocytes dans la fièvre méditerranéenne familiale : une étude prospective sur 50 patients. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Efficacité des anti-Il1 dans le TRAPS : expérience du centre de référence et revue de la littérature. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.10.412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Connaissance et prise en charge de la fièvre méditerranéenne familiale en ville : enquête auprès de 32 médecins généralistes. Rev Med Interne 2017. [DOI: 10.1016/j.revmed.2017.03.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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25
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26
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Enquête sur la résistance à la colchicine dans la fièvre méditerranéenne familiale en France : à propos de 46 cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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27
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Les mutations à l’origine de la fièvre méditerranéenne familiale entraînent un abaissement du seuil d’activation spécifique de l’inflammasome pyrine. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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28
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Le syndrome PFAPA (ou syndrome de Marshall) existe-t-il chez les adultes ? À propos de 20 cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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29
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Les fièvres héréditaires périodiques associées à des mutations de NLRP12 : revue systématique de la littérature. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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30
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Apport de la télédermatologie dans un service de pédiatrie hospitalière. Ann Dermatol Venereol 2016. [DOI: 10.1016/j.annder.2016.09.474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Cytolyse au cours de la fièvre méditerranéenne familiale : étude prospective chez 19 adultes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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32
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Amylose AA au cours du déficit en mévalonate kinase : à propos de 14 cas. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.10.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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THU0562 A Survey of Resistance To Colchicine Treatment in French Patients with Familial Mediterranean Fever. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Les maladies autoinflammatoires inclassées existent-t- elles? A propos de 56 cas adultes. Rev Med Interne 2016. [DOI: 10.1016/j.revmed.2016.04.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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35
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36
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Manifestations neurologiques associées à la varicelle : apport de l’amplification génique dans le liquide céphalo-rachidien. Arch Pediatr 2015; 22:491-7. [DOI: 10.1016/j.arcped.2015.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/16/2014] [Accepted: 02/10/2015] [Indexed: 12/27/2022]
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AB0911 Characteristics of PFAPA Patients Responding to Colchicine Treatment: A Retrospective Study of 21 Children. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.6041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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OP0119 Patient Journey and Treatment Route to Use of First Biologic in Rare Autoinflammatory Diseases: an International Retrospective Chart Review. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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PReS-FINAL-2231: A series of 41 mutations of TNFRAF1A. Pediatr Rheumatol Online J 2013. [PMCID: PMC4042902 DOI: 10.1186/1546-0096-11-s2-p221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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41
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PReS-FINAL-2337: The eurofever registry: 3 years of enrollment. Pediatr Rheumatol Online J 2013. [PMCID: PMC4044970 DOI: 10.1186/1546-0096-11-s2-p327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Concordance entre la CRP et la SAA dans la fièvre méditerranéenne familiale hors crise : étude sur 218 patients. Rev Med Interne 2013. [DOI: 10.1016/j.revmed.2013.10.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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PW01-022 – Dissociation between CRP and SAA in FMF. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953047 DOI: 10.1186/1546-0096-11-s1-a75] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Antibiothérapie des infections ORL sévères du nourrisson et de l’enfant : propositions thérapeutiques du Groupe de pathologie infectieuse pédiatrique (GPIP) de la Société française de pédiatrie. Arch Pediatr 2013; 20 Suppl 3:e14-9. [DOI: 10.1016/s0929-693x(13)71422-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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PW02-022 - Recurrent fever syndromes: multiple gene mutations. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953312 DOI: 10.1186/1546-0096-11-s1-a162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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PW02-016 - 41 cases of TRAPS, a rare autoinflammatory disease. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952102 DOI: 10.1186/1546-0096-11-s1-a156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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OR2-002 – The risk of FMF in MEFV heterozygotes. Pediatr Rheumatol Online J 2013. [PMCID: PMC3952258 DOI: 10.1186/1546-0096-11-s1-a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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P02-014 - Consequences of Arginine 92 mutations in TNFR1. Pediatr Rheumatol Online J 2013. [PMCID: PMC3953032 DOI: 10.1186/1546-0096-11-s1-a121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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The phenotype of TNF receptor-associated autoinflammatory syndrome (TRAPS) at presentation: a series of 158 cases from the Eurofever/EUROTRAPS international registry. Ann Rheum Dis 2013; 73:2160-7. [PMID: 23965844 PMCID: PMC4251160 DOI: 10.1136/annrheumdis-2013-204184] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate the genetic findings, demographic features and clinical presentation of tumour necrosis factor receptor-associated autoinflammatory syndrome (TRAPS) in patients from the Eurofever/EUROTRAPS international registry. METHODS A web-based registry collected retrospective data on patients with TNFRSF1A sequence variants and inflammatory symptoms. Participating hospitals included paediatric rheumatology centres and adult centres with a specific interest in autoinflammatory diseases. Cases were independently validated by experts in the disease. RESULTS Complete information on 158 validated patients was available. The most common TNFRSF1A variant was R92Q (34% of cases), followed by T50M (10%). Cysteine residues were disrupted in 27% of cases, accounting for 39% of sequence variants. A family history was present in 19% of patients with R92Q and 64% of those with other variants. The median age at which symptoms began was 4.3 years but 9.1% of patients presented after 30 years of age. Attacks were recurrent in 88% and the commonest features associated with the pathogenic variants were fever (88%), limb pain (85%), abdominal pain (74%), rash (63%) and eye manifestations (45%). Disease associated with R92Q presented slightly later at a median of 5.7 years with significantly less rash or eye signs and more headaches. Children were more likely than adults to present with lymphadenopathy, periorbital oedema and abdominal pains. AA amyloidosis has developed in 16 (10%) patients at a median age of 43 years. CONCLUSIONS In this, the largest reported case series to date, the genetic heterogeneity of TRAPS is accompanied by a variable phenotype at presentation. Patients had a median 70 symptomatic days a year, with fever, limb and abdominal pain and rash the commonest symptoms. Overall, there is little evidence of a significant effect of age or genotype on disease features at presentation.
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