Ankara University

The MEditerranean FeVer (MEFV) gene is a critical regulator of the innate immune response. The prototypical disease related to the MEFV gene is familial Mediterranean fever (FMF). Heterozygous MEFV gene variants have increasingly been reported in association with a wide range of inflammatory disorders besides FMF. The aim of this study was to evaluate the diagnostic spectrum and clinical and demographic findings of patients carrying heterozygous MEFV variants. This retrospective study included pediatric patients carrying heterozygous MEFV variants who were followed up at our center between January 2012 and January 2025. Diagnosis, demographics, and clinical manifestations were reviewed. A total of 270 patients with a median age of 7 years were identified. The diagnoses of the study population included FMF (67%), IgA vasculitis (7%), PFAPA syndrome (6%), inflammatory bowel disease (3%), juvenile idiopathic arthritis (3%), chronic nonbacterial osteomyelitis (2%), Behçet's disease (1%), and other vasculitides (1%). Fourteen percent of the patients were asymptomatic carriers. During follow-up, 22 of the 74 patients (30%) initially diagnosed with other inflammatory conditions later developed clinical features consistent with FMF. Colchicine therapy was initiated not only for typical attacks of FMF but also for selected indications in other inflammatory diseases. Heterozygous MEFV variants have been reported to be associated with various inflammatory diseases besides FMF. Long-term follow-up is essential, as some patients may later develop FMF. MEFV gene testing should be considered in other inflammatory diseases with severe or atypical manifestations, particularly in populations where FMF is highly prevalent. • Heterozygous MEFV variants have been associated with FMF and several inflammatory diseases. • This large pediatric cohort demonstrates that heterozygous MEFV variants may be encountered across a broad spectrum of inflammatory diseases, and some patients initially diagnosed with other conditions may subsequently develop FMF during follow-up.

View on PubMed → DOI →

Evidence-based provisional clinical classification criteria for autoinflammatory periodic fevers.

Federici S, Sormani MP, Ozen S, Lachmann HJ, Amaryan G , et al.

Annals of the rheumatic diseases • 2015-May-01

The objective of this work was to develop and validate a set of clinical criteria for the classification of patients affected by periodic fevers. Patients with inherited periodic fevers (familial Mediterranean fever (FMF); mevalonate kinase deficiency (MKD); tumour necrosis factor receptor-associated periodic fever syndrome (TRAPS); cryopyrin-associated periodic syndromes (CAPS)) enrolled in the Eurofever Registry up until March 2013 were evaluated. Patients with periodic fever, aphthosis, pharyngitis and adenitis (PFAPA) syndrome were used as negative controls. For each genetic disease, patients were considered to be 'gold standard' on the basis of the presence of a confirmatory genetic analysis. Clinical criteria were formulated on the basis of univariate and multivariate analysis in an initial group of patients (training set) and validated in an independent set of patients (validation set). A total of 1215 consecutive patients with periodic fevers were identified, and 518 gold standard patients (291 FMF, 74 MKD, 86 TRAPS, 67 CAPS) and 199 patients with PFAPA as disease controls were evaluated. The univariate and multivariate analyses identified a number of clinical variables that correlated independently with each disease, and four provisional classification scores were created. Cut-off values of the classification scores were chosen using receiver operating characteristic curve analysis as those giving the highest sensitivity and specificity. The classification scores were then tested in an independent set of patients (validation set) with an area under the curve of 0.98 for FMF, 0.95 for TRAPS, 0.96 for MKD, and 0.99 for CAPS. In conclusion, evidence-based provisional clinical criteria with high sensitivity and specificity for the clinical classification of patients with inherited periodic fevers have been developed.

View on PubMed → DOI →