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Retinal changes in children with Familial Mediterranean Fever: the effect of chronic subclinical inflammation
Nadide M Sav1, Kuddusi Teberik2
1Department of Pediatric Nephrology, Duzce University, Duzce, Turkey. savmelike@gmail.com.
Background:
In Familial Mediterranean Fever (FMF), acute-phase reactants rise during attacks, indicating active inflammation. However, subclinical inflammation-present even during remission-may contribute to organ damage, including ocular involvement. This study aimed to investigate the effects of subclinical chronic inflammation on ocular structures in children with FMF.
Methods:
The study involved 51 pediatric FMF patients in remission for at least three months and healthy controls. Spectral domain optical coherence tomography (SD-OCT) was used to measure intraocular pressure, axial length, peripapillary retinal nerve fiber layer (RNFL) thickness, central macular thickness, and subfoveal choroidal thickness.
Results:
Acute-phase reactant levels were significantly elevated in the FMF group (p < 0.001). Inferotemporal RNFL thickness was notably reduced (p = 0.008), along with central macular, subfoveal, nasal, and temporal choroidal thicknesses. A mild positive correlation was observed between proteinuria and axial length (r = 0.282, p = 0.045).
Conclusion:
Subclinical inflammation in FMF may lead to early structural changes in the eye, potentially progressing over time. These findings highlight the importance of long-term ophthalmologic monitoring in pediatric FMF patients to better understand the cumulative impact of persistent inflammation.
Impact:
This study assessed peripapillary RNFL thickness and choroidal vascular structure in children with FMF using SD-OCT to evaluate ocular effects of subclinical inflammation. It was found that chronic inflammation may lead to thinning of the retina and choroid even in children with relatively short disease duration. Peripapillary RNFL thickness was reduced in the temporal inferior quadrant and correlated with serum amyloid levels; additionally, choroidal thickness was significantly lower in the patient group, suggesting early ocular involvement and its potential as a marker of subclinical systemic inflammation.
Insights
Subclinical inflammation in pediatric Familial Mediterranean Fever (FMF) patients is linked to early ocular structural changes, including reduced retinal nerve fiber layer thickness. This highlights the need for regular eye monitoring in these children.
Area of Science:
- Ophthalmology
- Rheumatology
- Pediatrics
Background:
- Familial Mediterranean Fever (FMF) involves inflammation, with subclinical inflammation potentially causing organ damage.
- Ocular involvement is a concern in FMF patients, even during remission periods.
- Investigating subclinical inflammation's impact on ocular structures in children with FMF is crucial.
Purpose of the Study:
- To evaluate the effects of subclinical chronic inflammation on ocular structures in pediatric FMF patients.
- To assess peripapillary retinal nerve fiber layer (RNFL) thickness and choroidal vascular structure in children with FMF.
- To determine if ocular changes can serve as markers of subclinical systemic inflammation in FMF.
Main Methods:
- Study included 51 pediatric FMF patients in remission and healthy controls.
- Spectral domain optical coherence tomography (SD-OCT) was employed for ocular measurements.
- Key parameters measured included RNFL thickness, macular thickness, and choroidal thickness.
Main Results:
- Elevated acute-phase reactant levels were observed in the FMF group.
- Reduced inferotemporal RNFL thickness and decreased central macular and choroidal thicknesses were noted in FMF patients.
- A positive correlation between proteinuria and axial length was found.
Conclusions:
- Subclinical inflammation in FMF can induce early structural changes in the eye.
- These ocular changes may progress over time, emphasizing the need for monitoring.
- Ocular findings suggest potential as early indicators of subclinical systemic inflammation in pediatric FMF.
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