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==Overview== | ==Overview== | ||
Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash. | Common [[physical examination]] findings of [[familial Mediterranean fever]] include [[fever]], [[arthritis]], and [[skin rash]]. | ||
==Physical Examination== | ==Physical Examination== | ||
*Physical examination of patients with [[familial Mediterranean fever]] in periods between attacks is usually normal.<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | *Physical examination of patients with [[familial Mediterranean fever]] in periods between attacks is usually normal.<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | ||
*During attacks, common physical examination findings include [[fever]], [[arthritis]], and [[skin rash]]. | *During attacks, common [[physical examination]] findings include [[fever]], [[arthritis]], and [[skin rash]]. | ||
*[[Tachypnea]] and [[tachycardia]] may be present due to the effect of [[fever]]. | *[[Tachypnea]] and [[tachycardia]] may be present due to the effect of [[fever]]. | ||
*[[Fever]] is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more. | *[[Fever]] is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more. | ||
===Skin=== | ===Skin=== | ||
* Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present. | * Skin examination of patients with [[familial Mediterranean fever]] is usually normal. However, non-specific [[skin lesions]] may also be present. | ||
*Potential skin lesions include: | *Potential skin lesions include: | ||
* Erysipelas like [[erythema]]: painful, red-colored, and hyperthermic skin lesion often located at the shin or foot region.<ref name="pmid22243424">{{cite journal |vauthors=Lidar M, Doron A, Barzilai A, Feld O, Zaks N, Livneh A, Langevitz P |title=Erysipelas-like erythema as the presenting feature of familial Mediterranean fever |journal=J Eur Acad Dermatol Venereol |volume=27 |issue=7 |pages=912–5 |date=July 2013 |pmid=22243424 |doi=10.1111/j.1468-3083.2011.04442.x |url=}}</ref> | |||
* [[Purpura|Purpuric rash]]<ref name="pmid2217666">{{cite journal |vauthors=Majeed HA, Quabazard Z, Hijazi Z, Farwana S, Harshani F |title=The cutaneous manifestations in children with familial Mediterranean fever (recurrent hereditary polyserositis). A six-year study |journal=Q. J. Med. |volume=75 |issue=278 |pages=607–16 |date=June 1990 |pmid=2217666 |doi= |url=}}</ref> | |||
* [[Angioneurotic edema]] | |||
* Diffuse [[erythema]] of palms and soles | |||
* Skin peeling | |||
* [[Raynaud’s phenomenon]] | |||
* Subcutaneous [[nodule]] | |||
===HEENT=== | ===HEENT=== | ||
* HEENT examination of patients with familial Mediterranean fever is usually normal. | * HEENT examination of patients with [[familial Mediterranean fever]] is usually normal. | ||
===Neck=== | ===Neck=== | ||
* Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as: | * Neck examination of [[Patient|patients]] with [[Familial mediterranean fever|familial Mediterranean fever]] is usually normal. However, it may also indicate findings such as: | ||
*[[Lymphadenopathy]] which may be with/without pain | *[[Lymphadenopathy]] which may be with/without [[pain]].<ref name="pmid25637003">{{cite journal |vauthors=Federici S, Sormani MP, Ozen S, Lachmann HJ, Amaryan G, Woo P, Koné-Paut I, Dewarrat N, Cantarini L, Insalaco A, Uziel Y, Rigante D, Quartier P, Demirkaya E, Herlin T, Meini A, Fabio G, Kallinich T, Martino S, Butbul AY, Olivieri A, Kuemmerle-Deschner J, Neven B, Simon A, Ozdogan H, Touitou I, Frenkel J, Hofer M, Martini A, Ruperto N, Gattorno M |title=Evidence-based provisional clinical classification criteria for autoinflammatory periodic fevers |journal=Ann. Rheum. Dis. |volume=74 |issue=5 |pages=799–805 |date=May 2015 |pmid=25637003 |doi=10.1136/annrheumdis-2014-206580 |url=}}</ref> | ||
===Lungs=== | ===Lungs=== | ||
* Pulmonary examination of patients with familial Mediterranean fever may be positive for:<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | * [[Pulmonary examination]] of patients with [[Familial mediterranean fever|familial Mediterranean fever]] may be positive for:<ref name="pmid26316943">{{cite journal |vauthors=Flynn AE, Peters MJ, Morgan LC |title=Attitudes towards Lung Cancer Screening in an Australian High-Risk Population |journal=Lung Cancer Int |volume=2013 |issue= |pages=789057 |date=2013 |pmid=26316943 |doi=10.1155/2013/789057 |url= |issn=}}</ref> | ||
*Lungs are hyporesonant due to associated pleural effusion | *Lungs are hyporesonant due to associated [[pleural effusion]] | ||
*Normal/reduced [[tactile fremitus]] | *Normal/reduced [[tactile fremitus]] | ||
===Heart=== | ===Heart=== | ||
* Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings: | * [[Cardiovascular]] [[examination]] of [[Patient|patients]] with familial Mediterranean fever may be associated with the following findings:<ref name="pmid415347">{{cite journal |vauthors=Bartolucci S |title=[Presence of lens antigens on the level of chicken-liver membranes during development] |language=Italian |journal=Riv. Biol. |volume=70 |issue=1-2 |pages=49–76 |date=1977 |pmid=415347 |doi= |url=}}</ref> | ||
*Chest tenderness upon palpation due to pericarditis | *[[Chest]] [[tenderness]] upon palpation due to [[pericarditis]] | ||
*[[Friction rub]] | *[[Friction rub]] | ||
===Abdomen=== | ===Abdomen=== | ||
* Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.<ref name="pmid17240429">{{cite journal |vauthors=Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E |title=Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent? |journal=Semin. Arthritis Rheum. |volume=36 |issue=5 |pages=316–21 |date=April 2007 |pmid=17240429 |doi=10.1016/j.semarthrit.2006.11.002 |url=}}</ref> | * Abdominal examination of patients with [[Familial mediterranean fever|familial Mediterranean fever]] may show rigidity and [[tenderness]].<ref name="pmid17240429">{{cite journal |vauthors=Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E |title=Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent? |journal=Semin. Arthritis Rheum. |volume=36 |issue=5 |pages=316–21 |date=April 2007 |pmid=17240429 |doi=10.1016/j.semarthrit.2006.11.002 |url=}}</ref> | ||
* [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may also be present. | * [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]] may also be present. | ||
* Other possible causes of an acute abdomen should be ruled out. | * Other possible causes of an [[acute abdomen]] should be ruled out. | ||
===Back=== | ===Back=== | ||
* Back examination of patients with familial Mediterranean fever is usually normal. | * Back examination of patients with [[Familial mediterranean fever|familial Mediterranean fever]] is usually normal. | ||
* Signs of sacroileitis such may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref><ref name="pmid18795391">{{cite journal |vauthors=Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C |title=The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis |journal=Clin. Rheumatol. |volume=28 |issue=1 |pages=41–6 |date=January 2009 |pmid=18795391 |doi=10.1007/s10067-008-0980-3 |url=}}</ref> | * Signs of [[sacroileitis]] such may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref><ref name="pmid18795391">{{cite journal |vauthors=Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C |title=The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis |journal=Clin. Rheumatol. |volume=28 |issue=1 |pages=41–6 |date=January 2009 |pmid=18795391 |doi=10.1007/s10067-008-0980-3 |url=}}</ref> | ||
===Genitourinary=== | ===Genitourinary=== | ||
* Genitourinary examination of patients with familial Mediterranean fever is usually normal. | * Genitourinary examination of patients with [[Familial mediterranean fever|familial Mediterranean fever]] is usually normal. | ||
* Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.<ref name="pmid1456246">{{cite journal |vauthors=Gedalia A, Mordehai J, Mares AJ |title=Acute scrotal involvement in children with familial Mediterranean fever |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1419–20 |date=December 1992 |pmid=1456246 |doi= |url=}}</ref><ref name="pmid10663841">{{cite journal |vauthors=Majeed HA, Ghandour K, Shahin HM |title=The acute scrotum in Arab children with familial Mediterranean fever |journal=Pediatr. Surg. Int. |volume=16 |issue=1-2 |pages=72–4 |date=2000 |pmid=10663841 |doi= |url=}}</ref><ref name="pmid8044614">{{cite journal |vauthors=Eshel G, Vinograd I, Barr J, Zemer D |title=Acute scrotal pain complicating familial Mediterranean fever in children |journal=Br J Surg |volume=81 |issue=6 |pages=894–6 |date=June 1994 |pmid=8044614 |doi= |url=}}</ref> | * [[Scrotal swelling]] may be seen in case of acute scrotum due to [[FMF]], which rarely involves both [[testicles]].<ref name="pmid1456246">{{cite journal |vauthors=Gedalia A, Mordehai J, Mares AJ |title=Acute scrotal involvement in children with familial Mediterranean fever |journal=Am. J. Dis. Child. |volume=146 |issue=12 |pages=1419–20 |date=December 1992 |pmid=1456246 |doi= |url=}}</ref><ref name="pmid10663841">{{cite journal |vauthors=Majeed HA, Ghandour K, Shahin HM |title=The acute scrotum in Arab children with familial Mediterranean fever |journal=Pediatr. Surg. Int. |volume=16 |issue=1-2 |pages=72–4 |date=2000 |pmid=10663841 |doi= |url=}}</ref><ref name="pmid8044614">{{cite journal |vauthors=Eshel G, Vinograd I, Barr J, Zemer D |title=Acute scrotal pain complicating familial Mediterranean fever in children |journal=Br J Surg |volume=81 |issue=6 |pages=894–6 |date=June 1994 |pmid=8044614 |doi= |url=}}</ref> | ||
* Testicular torsion must always be ruled out. | * [[Testicular torsion]] must always be ruled out. | ||
===Neuromuscular=== | ===Neuromuscular=== | ||
* Neuromuscular examination of patients with familial Mediterranean fever is usually normal. | * Neuromuscular examination of [[Patient|patients]] with [[Familial mediterranean fever|familial Mediterranean fever]] is usually normal. | ||
* Patient is usually oriented to persons, place, and time. | * [[Patient]] is usually oriented to persons, place, and time. | ||
* | * Focal neurological signs may also be present.<ref name="KalyoncuEker2010">{{cite journal|last1=Kalyoncu|first1=Umut|last2=Eker|first2=Amber|last3=Oguz|first3=Kader K.|last4=Kurne|first4=Asli|last5=Kalan|first5=Isilay|last6=Topcuoglu|first6=Akif M.|last7=Anlar|first7=Banu|last8=Bilginer|first8=Yelda|last9=Arici|first9=Mustafa|last10=Yilmaz|first10=Engin|last11=Kiraz|first11=Sedat|last12=Calguneri|first12=Meral|last13=Karabudak|first13=Rana|title=Familial Mediterranean Fever and Central Nervous System Involvement|journal=Medicine|volume=89|issue=2|year=2010|pages=75–84|issn=0025-7974|doi=10.1097/MD.0b013e3181d5dca7}}</ref> | ||
===Extremities=== | ===Extremities=== | ||
* FMF usually affects large joints of lower extremity and signs of inflammation may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref> | * [[FMF]] usually affects large joints of lower extremity and signs of [[inflammation]] may be present.<ref name="pmid9093587">{{cite journal |vauthors=Majeed HA, Rawashdeh M |title=The clinical patterns of arthritis in children with familial Mediterranean fever |journal=QJM |volume=90 |issue=1 |pages=37–43 |date=January 1997 |pmid=9093587 |doi=10.1093/qjmed/90.1.37 |url=}}</ref> | ||
* The small joints of the hands can also be involved. | * The small [[Joint|joints]] of the hands can also be involved. | ||
==References== | ==References== | ||
Latest revision as of 16:05, 10 June 2019
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sahar Memar Montazerin, M.D.[2]
Overview
Common physical examination findings of familial Mediterranean fever include fever, arthritis, and skin rash.
Physical Examination
- Physical examination of patients with familial Mediterranean fever in periods between attacks is usually normal.[1]
- During attacks, common physical examination findings include fever, arthritis, and skin rash.
- Tachypnea and tachycardia may be present due to the effect of fever.
- Fever is usually short lasting (12-72 h) with a wide frequency ranging from weekly intervals to every season or more.
Skin
- Skin examination of patients with familial Mediterranean fever is usually normal. However, non-specific skin lesions may also be present.
- Potential skin lesions include:
- Erysipelas like erythema: painful, red-colored, and hyperthermic skin lesion often located at the shin or foot region.[2]
- Purpuric rash[3]
- Angioneurotic edema
- Diffuse erythema of palms and soles
- Skin peeling
- Raynaud’s phenomenon
- Subcutaneous nodule
HEENT
- HEENT examination of patients with familial Mediterranean fever is usually normal.
Neck
- Neck examination of patients with familial Mediterranean fever is usually normal. However, it may also indicate findings such as:
- Lymphadenopathy which may be with/without pain.[4]
Lungs
- Pulmonary examination of patients with familial Mediterranean fever may be positive for:[1]
- Lungs are hyporesonant due to associated pleural effusion
- Normal/reduced tactile fremitus
Heart
- Cardiovascular examination of patients with familial Mediterranean fever may be associated with the following findings:[5]
- Chest tenderness upon palpation due to pericarditis
- Friction rub
Abdomen
- Abdominal examination of patients with familial Mediterranean fever may show rigidity and tenderness.[6]
- Hepatomegaly / splenomegaly / hepatosplenomegaly may also be present.
- Other possible causes of an acute abdomen should be ruled out.
Back
- Back examination of patients with familial Mediterranean fever is usually normal.
- Signs of sacroileitis such may be present.[7][8]
Genitourinary
- Genitourinary examination of patients with familial Mediterranean fever is usually normal.
- Scrotal swelling may be seen in case of acute scrotum due to FMF, which rarely involves both testicles.[9][10][11]
- Testicular torsion must always be ruled out.
Neuromuscular
- Neuromuscular examination of patients with familial Mediterranean fever is usually normal.
- Patient is usually oriented to persons, place, and time.
- Focal neurological signs may also be present.[12]
Extremities
- FMF usually affects large joints of lower extremity and signs of inflammation may be present.[7]
- The small joints of the hands can also be involved.
References
- ↑ 1.0 1.1 Flynn AE, Peters MJ, Morgan LC (2013). "Attitudes towards Lung Cancer Screening in an Australian High-Risk Population". Lung Cancer Int. 2013: 789057. doi:10.1155/2013/789057. PMID 26316943.
- ↑ Lidar M, Doron A, Barzilai A, Feld O, Zaks N, Livneh A, Langevitz P (July 2013). "Erysipelas-like erythema as the presenting feature of familial Mediterranean fever". J Eur Acad Dermatol Venereol. 27 (7): 912–5. doi:10.1111/j.1468-3083.2011.04442.x. PMID 22243424.
- ↑ Majeed HA, Quabazard Z, Hijazi Z, Farwana S, Harshani F (June 1990). "The cutaneous manifestations in children with familial Mediterranean fever (recurrent hereditary polyserositis). A six-year study". Q. J. Med. 75 (278): 607–16. PMID 2217666.
- ↑ Federici S, Sormani MP, Ozen S, Lachmann HJ, Amaryan G, Woo P, Koné-Paut I, Dewarrat N, Cantarini L, Insalaco A, Uziel Y, Rigante D, Quartier P, Demirkaya E, Herlin T, Meini A, Fabio G, Kallinich T, Martino S, Butbul AY, Olivieri A, Kuemmerle-Deschner J, Neven B, Simon A, Ozdogan H, Touitou I, Frenkel J, Hofer M, Martini A, Ruperto N, Gattorno M (May 2015). "Evidence-based provisional clinical classification criteria for autoinflammatory periodic fevers". Ann. Rheum. Dis. 74 (5): 799–805. doi:10.1136/annrheumdis-2014-206580. PMID 25637003.
- ↑ Bartolucci S (1977). "[Presence of lens antigens on the level of chicken-liver membranes during development]". Riv. Biol. (in Italian). 70 (1–2): 49–76. PMID 415347.
- ↑ Berkun Y, Ben-Chetrit E, Klar A, Ben-Chetrit E (April 2007). "Peritoneal adhesions and intestinal obstructions in patients with familial Mediterranean fever--are they more frequent?". Semin. Arthritis Rheum. 36 (5): 316–21. doi:10.1016/j.semarthrit.2006.11.002. PMID 17240429.
- ↑ 7.0 7.1 Majeed HA, Rawashdeh M (January 1997). "The clinical patterns of arthritis in children with familial Mediterranean fever". QJM. 90 (1): 37–43. doi:10.1093/qjmed/90.1.37. PMID 9093587.
- ↑ Kaşifoğlu T, Calişir C, Cansu DU, Korkmaz C (January 2009). "The frequency of sacroiliitis in familial Mediterranean fever and the role of HLA-B27 and MEFV mutations in the development of sacroiliitis". Clin. Rheumatol. 28 (1): 41–6. doi:10.1007/s10067-008-0980-3. PMID 18795391.
- ↑ Gedalia A, Mordehai J, Mares AJ (December 1992). "Acute scrotal involvement in children with familial Mediterranean fever". Am. J. Dis. Child. 146 (12): 1419–20. PMID 1456246.
- ↑ Majeed HA, Ghandour K, Shahin HM (2000). "The acute scrotum in Arab children with familial Mediterranean fever". Pediatr. Surg. Int. 16 (1–2): 72–4. PMID 10663841.
- ↑ Eshel G, Vinograd I, Barr J, Zemer D (June 1994). "Acute scrotal pain complicating familial Mediterranean fever in children". Br J Surg. 81 (6): 894–6. PMID 8044614.
- ↑ Kalyoncu, Umut; Eker, Amber; Oguz, Kader K.; Kurne, Asli; Kalan, Isilay; Topcuoglu, Akif M.; Anlar, Banu; Bilginer, Yelda; Arici, Mustafa; Yilmaz, Engin; Kiraz, Sedat; Calguneri, Meral; Karabudak, Rana (2010). "Familial Mediterranean Fever and Central Nervous System Involvement". Medicine. 89 (2): 75–84. doi:10.1097/MD.0b013e3181d5dca7. ISSN 0025-7974.