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Frequency, characteristics, and clinical determinants of 'prodrome' in familial Mediterranean fever patients

H Babaoglu1, N Atas1, O Varan1

  • 1Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Gazi University, Ankara, Turkey.

Scandinavian Journal of Rheumatology
|September 4, 2019
PubMed

Insights

Prodrome, warning signs before a Familial Mediterranean Fever (FMF) attack, occurs in 35.2% of patients. Male gender and a history of peritonitis or arthritis are key predictors of FMF prodrome.

Area of Science:

  • Rheumatology
  • Genetics
  • Internal Medicine

Background:

  • Familial Mediterranean Fever (FMF) is a genetic autoinflammatory disorder characterized by recurrent attacks of fever and inflammation.
  • Prodrome, defined as manifestations preceding an FMF attack, is recognized but its frequency and determinants require further elucidation.
  • Understanding prodrome is crucial for predicting attacks and potentially developing secondary prevention strategies.

Purpose of the Study:

  • To determine the frequency and characteristics of prodrome in patients with Familial Mediterranean Fever (FMF).
  • To identify clinical determinants associated with the presence of prodrome in FMF patients.
  • To explore the implications of prodrome for understanding FMF pathogenesis and treatment.

Main Methods:

  • A cross-sectional study involving 401 FMF patients in a tertiary rheumatology clinic.
  • Standardized questionnaires were administered to collect data on pre-attack manifestations (prodrome).
  • Prodrome was defined as recurrent pre-attack symptoms occurring at least 4 hours before an FMF attack.

Main Results:

  • Prodrome was reported by 141 patients (35.2%).
  • Prodrome-positive patients were more likely to be male and have homozygous MEFV mutations (M694V/M694V), peritonitis, pleuritis, or arthritis.
  • Independent clinical determinants of prodrome included male gender and a history of peritonitis or arthritis.

Conclusions:

  • Clinicians should actively inquire about prodromal symptoms in all FMF patients, especially males and those with a history of peritonitis or arthritis.
  • Prodrome offers valuable insights into FMF pathogenesis and presents an opportunity for secondary prevention strategies.
  • Further research into FMF prodrome may facilitate the development of novel, cost-effective treatments beyond colchicine resistance.

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