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Predictors of persistent inflammation in familial Mediterranean fever and association with damage
Hakan Babaoglu1, Berkan Armagan2, Erdal Bodakci3
1Department of Internal Medicine, Division of Rheumatology, Faculty of Medicine, Gazi University, Ankara.
Objective:
Persistent inflammation is an insidious and less studied feature of FMF. We investigated clinical determinants of persistent inflammation and its associations with individual damage items.
Methods:
This is a cross-sectional analysis of 917 FMF patients, who fulfilled the Tel Hashomer criteria and had at least 6 months' follow-up. Patients were stratified based on whether they had persistent inflammation. We used logistic regression analysis to investigate independent predictors of persistent inflammation and the associated individual damage items.
Results:
One hundred and forty-two (15%) patients had persistent inflammation. Active FMF (54%) was the most prominent reason for the persistent inflammation. Spondylarthritis (16%), other inflammatory arthritis (8%) and IBD (2%) were other frequent reasons. Male gender, history of exertional leg pain, inflammatory comorbidities, M694V homozygosity, colchicine resistance, lower education levels and musculoskeletal attack dominance were found to be the independent predictors of persistent inflammation. Earlier disease onset led to a tendency towards persistent inflammation. Patients with persistent inflammation were more likely to suffer damage. There is an increased risk of developing proteinuria, amyloidosis and renal insufficiency.
Conclusion:
We identified, for the first time, the predictors of persistent inflammation in adult FMF patients and related individual damage items of the Autoinflammatory Disease Damage Index. Persistent inflammation is insidious and one of the chief causes of damage; therefore, especially patients with these predictors should be followed up more closely. If detected, underlying inflammatory comorbidities should be assessed meticulously as early detection and proper treatment strategies may favourably impact the natural history of the disease.
Insights
Persistent inflammation in Familial Mediterranean Fever (FMF) is linked to specific patient factors and increases the risk of organ damage, including kidney issues. Close monitoring of FMF patients with these predictors is crucial for better outcomes.
Area of Science:
- Rheumatology
- Genetics
- Internal Medicine
Background:
- Persistent inflammation is an understudied aspect of Familial Mediterranean Fever (FMF).
- Understanding the factors driving persistent inflammation is key to managing FMF-related damage.
Purpose of the Study:
- To identify clinical predictors of persistent inflammation in FMF patients.
- To investigate the association between persistent inflammation and specific damage indicators.
Main Methods:
- Cross-sectional analysis of 917 FMF patients meeting Tel Hashomer criteria.
- Logistic regression used to determine independent predictors and associated damage items.
Main Results:
- 15% of patients had persistent inflammation, often due to active FMF, spondylarthritis, or IBD.
- Male gender, exertional leg pain, inflammatory comorbidities, M694V homozygosity, colchicine resistance, lower education, and musculoskeletal attack dominance predicted persistent inflammation.
- Persistent inflammation correlated with increased risk of proteinuria, amyloidosis, and renal insufficiency.
Conclusions:
- Identified predictors of persistent inflammation and associated damage in FMF.
- Persistent inflammation is a significant contributor to FMF damage.
- Patients with identified predictors require closer monitoring and assessment for underlying inflammatory comorbidities.
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