Familial mediterranean fever overview: Difference between revisions

Jump to navigation Jump to search
No edit summary
No edit summary
Line 4: Line 4:


==Overview==
==Overview==
Familial Mediterranean fever is the most frequent form of autoinflammatory disorders that affects groups of patients originating from around the Mediterranean Sea (hence its name).  It is prominently present in the Armenian people (up to 1 in 7 affected), Sephardi Jews (and, to a much lesser extent, Ashkenazi Jews), people from Turkey, the Arab countries and Lebanon.<ref name=Livneh>Livneh A, Langevitz P. Diagnostic and treatment concerns in familial Mediterranean fever. ''Baillieres Best Pract Res Clin Rheumatol'' 2000;14(3):477-98. PMID 10985982.</ref>
[[Familial mediterranean fever|Familial Mediterranean fever]]
==Historical Perspective==
==Historical Perspective==
A New York allergist, Dr. Sheppard Siegal, first described the attacks of [[peritonitis]] in 1945; he termed this "benign paroxysmal peritonitis", as the disease course was essentially benign.<ref>Siegal S. Benign paroxysmal peritonitis. ''Ann Intern Med'' 1945;23:1-21.</ref> Dr. Hobart Reimann, working in the American University in Beirut, described a more complete picture which he termed "periodic disease".<ref>Reiman HA. Periodic disease. Probable syndrome including periodic fever, benign paroxysmal peritonitis, cyclic neutropenia, and intermittent arthralgia. ''[[Journal of the American Medical Association|JAMA]]'' 1948;136:239-44.</ref>
[[Familial mediterranean fever|Familial Mediterranean fever]] was first described in a Jewish schoolgirl by Janeway and Mosenthal in 1908. In 1955, Dr. Heller called this disorder [[Familial mediterranean fever|familial Mediterranean fever]], which refers to its high [[prevalence]] in this region and the key presenting feature of [[Familial mediterranean fever|periodic fever]]. The [[disease]] was life-threatening before the introduction of [[colchicine]] in 1972.
==Classification==
There is no established system for the [[classification]] of [[familial Mediterranean fever]]. However, [[familial Mediterranean fever]] may be classified according to [[Phenotype|phenotypic]] manifestation into three subtypes/groups: type 1, type 2, and type 3.
==Pathophysiology==
The exact [[pathogenesis]] of [[familial mediterranean fever]] is not fully understood. However, nearly all the cases are due to a [[mutation]] in the [[MEFV]] [[gene]], which codes for a [[protein]] called pyrin. Normally, pyrin regulates the production of [[Interleukin-1|interleukin-1β]] (IL-1β), an important [[pro-inflammatory]] [[cytokine]]. When [[mutation]] occurs, [[mutated]] protein is unable to suppress expression of  IL-1β, therefore an inflammatory response would develop results in clinical manifestation of [[FMF]]. The [[disease]] inherits in an [[autosomal recessive]] mode. However, there is an increasing number of data reporting the [[autosomal dominant]] [[inheritance]].
==Causes==
[[Familial Mediterranean fever]] is most often [[Causes|caused]] by a [[mutation]] in the [[MEFV]] [[gene]]. This [[gene]] creates [[proteins]] involved in [[inflammation]]. There are also reports of [[FMF]] cases in the absence of causative [[gene]] in the [[genetic screening]].
==Epidemiology and demographics==
The [[incidence]] of [[familial mediterranean fever]] is estimated 100 per 100,000 individuals worldwide. The [[prevalence]] of [[familial mediterranean fever]] differs widely according to the geographic area. In the non- Ashkenazi Jews, it ranges from 100 to 400 per 100,000 individuals. [[Patients]] of all age groups may develop the [[Familial mediterranean fever|familial Mediterranean fever]] ([[FMF]]). However, it usually manifests during Childhood. This [[disorder]] usually affects individuals of the Turkish, Armenian, Jewish and Arabic communities. However, it is also common among western societies such as Italy, Greece, Crete, France, and Germany.
==Risk factors==


==Causes==
Familial Mediterranean fever is most often caused by a mutation in the MEFV gene. This [[gene]] creates proteins involved in [[inflammation]].
==Diagnosis==
==Diagnosis==
===History and Symptoms===
===History and Symptoms===
The diagnosis is clinically made on the basis of the history of typical attacks, especially in patients from the ethnic groups in which FMF is more highly prevalent.
 
===Laboratory Findings===
===Laboratory Findings===
An [[acute phase response]] is present during attacks, with high [[C-reactive protein]] levels, an elevated [[white blood cell]] count and other markers of [[inflammation]]. In patients with a long history of attacks, monitoring the [[renal function]] is of importance in predicting [[chronic renal failure]].<ref name=Livneh/>
 
===Other Diagnostic Studies===
===Other Diagnostic Studies===
A genetic test is also available now that the disease has been linked to mutations in the ''MEFV'' gene.  Sequencing of exons 2, 3, 5, and 10 of this gene detects an estimated 97% of all known mutations.<ref name=Livneh>Livneh A, Langevitz P. Diagnostic and treatment concerns in familial Mediterranean fever. ''Baillieres Best Pract Res Clin Rheumatol'' 2000;14(3):477-98. PMID 10985982.</ref>


==Treatment==
==Treatment==
===Medical Therapy===
===Medical Therapy===
Attacks are self-limiting, and require [[analgesia]] and [[non-steroidal anti-inflammatory drug]]s (such as [[diclofenac]]).<ref name=Livneh/>


Since the 1970s, [[colchicine]], a drug otherwise mainly used in [[gout]], has been shown to decrease attack frequency in FMF patients. The exact way in which colchicine suppresses attacks is unclear. While this agent is not without side-effects (such as [[abdominal pain]] and [[myalgia|muscle pains]]), it may markedly improve quality of life in patients. The dosage is typically 1-2 mg a day. Development of amyloidosis is delayed with colchicine treatment. [[Interferon]] is being studied as a therapeutic modality.<ref name=Livneh>Livneh A, Langevitz P. Diagnostic and treatment concerns in familial Mediterranean fever. ''Baillieres Best Pract Res Clin Rheumatol'' 2000;14(3):477-98. PMID 10985982.</ref>
==References==
==References==



Revision as of 02:36, 5 June 2019

Familial Mediterranean Fever Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Familial Mediterranean Fever from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Diagnostic study of choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X ray

Echocardiography and Ultrasound

CT scan

MRI

Other imaging Studies

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary prevention

Secondary prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Familial mediterranean fever overview On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Familial mediterranean fever overview

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Familial mediterranean fever overview

CDC on Familial mediterranean fever overview

Familial mediterranean fever overview in the news

Blogs on Familial mediterranean fever overview

Directions to Hospitals Treating Familial mediterranean fever

Risk calculators and risk factors for Familial mediterranean fever overview

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Familial Mediterranean fever

Historical Perspective

Familial Mediterranean fever was first described in a Jewish schoolgirl by Janeway and Mosenthal in 1908. In 1955, Dr. Heller called this disorder familial Mediterranean fever, which refers to its high prevalence in this region and the key presenting feature of periodic fever. The disease was life-threatening before the introduction of colchicine in 1972.

Classification

There is no established system for the classification of familial Mediterranean fever. However, familial Mediterranean fever may be classified according to phenotypic manifestation into three subtypes/groups: type 1, type 2, and type 3.

Pathophysiology

The exact pathogenesis of familial mediterranean fever is not fully understood. However, nearly all the cases are due to a mutation in the MEFV gene, which codes for a protein called pyrin. Normally, pyrin regulates the production of interleukin-1β (IL-1β), an important pro-inflammatory cytokine. When mutation occurs, mutated protein is unable to suppress expression of IL-1β, therefore an inflammatory response would develop results in clinical manifestation of FMF. The disease inherits in an autosomal recessive mode. However, there is an increasing number of data reporting the autosomal dominant inheritance.

Causes

Familial Mediterranean fever is most often caused by a mutation in the MEFV gene. This gene creates proteins involved in inflammation. There are also reports of FMF cases in the absence of causative gene in the genetic screening.

Epidemiology and demographics

The incidence of familial mediterranean fever is estimated 100 per 100,000 individuals worldwide. The prevalence of familial mediterranean fever differs widely according to the geographic area. In the non- Ashkenazi Jews, it ranges from 100 to 400 per 100,000 individuals. Patients of all age groups may develop the familial Mediterranean fever (FMF). However, it usually manifests during Childhood. This disorder usually affects individuals of the Turkish, Armenian, Jewish and Arabic communities. However, it is also common among western societies such as Italy, Greece, Crete, France, and Germany.

Risk factors

Diagnosis

History and Symptoms

Laboratory Findings

Other Diagnostic Studies

Treatment

Medical Therapy

References

Template:WH Template:WS