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Levels of acute-phase reactants ie, C-reactive protein, erythrocyte sedimentation rate, amyloid A protein, fibrinogen are elevated. The white blood cell count is usually elevated during an attack. The elevated levels rapidly return to the reference range as the attack abates.
On urine studies, proteinuria should raise a concern about possible amyloidosis. Genetic testing is now available for FMF. Testing for a limited of genes may be appropriate in patients with a known ethnic background. Complete gene sequencing may be more helpful in patients of mixed or unknown ethnicity. Patients with no gene mutations who meet criteria for FMF should be offered a trial of colchicine. Given the high gene frequency and low penetrance in certain populations eg, Ashkenazi Jews, Armeniansgene testing should be closely correlated to clinical findings to avoid false-positive.
An expert committee of European pediatric rheumatologists has developed the following recommendations for genetic diagnosis of familial Mediterranean fever [ 17 ] :. FMF patients carrying two of the common mutated alleles homozygotes FMF in Miami compound heterozygotesespecially for MV mutation or mutations at position to on exon 10, must be considered at risk of having a more severe disease.
Patients homozygous for MV mutation are at risk for early-onset disease and at very high risk of developing a severe phenotype; those who are not reporting symptoms should be evaluated and followed closely in order to consider therapy. Patients with two pathogenic mutations for FMF who do not report symptoms but have risk factors for AA amyloidosis eg, country of origin; family history; persistently elevated inflammatory markers, particularly serum amyloid A proteinshould have close follow-up and be considered for treatment.
Findings during an acute attack in patients with peritonitis, pleuritis, and arthritis are as expected and include air-fluid levels, pleural effusions, and synovial effusions. Massive amyloid infiltration of the blood vessels and of the endothelial side of the glomerular basement membrane occurs in the kidneys.
In the rectal submucosa, the amyloid is found near the blood vessels. Amyloidosis can be pd in patients with FMF, particularly those of North African descent who have proteinuria. Renal biopsy or, alternatively, submucosal rectal biopsy, is indicated in these patients. While the patients with amyloid kidney disease AKD had more proteinuria and more of them had more than 3. The AKD patients had more severe disease and were more likely to have hypertension. Padeh S, Berkun Y. Familial Mediterranean fever.
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Intravenous colchicine for treatment of patients with familial Mediterranean fever unresponsive to oral colchicine. Clin Rheumatol. Makay B, Gulez N. Long-term follow-up of paediatric MEFV carriers. Familial Mediterranean fever successfully treated with etanercept. J Clin Rheumatol. Anakinra: new therapeutic approach in children with Familial Mediterranean Fever resistant to colchicine. t Bone Spine. A Randomized Trial. Ann Intern Med. The effect of interferon alpha administration on acute attacks of familial Mediterranean fever: A double-blind, placebo-controlled trial. Interferon-alpha as a treatment modality for colchicine- resistant familial Mediterranean fever.
The efficacy of continuous interferon alpha administration as an adjunctive agent to colchicine-resistant familial Mediterranean fever patients. Efficacy of anti-IL-1 treatment in familial Mediterranean fever: a systematic review of the literature. Ilaris canakinumab [package insert]. September, Available at [Full Text]. The outcome of pregnancy in the wives of men with familial mediterranean fever treated with colchicine. For You. Decision Point. Log In. Up It's Free! Register Log In. No. If you log out, you will be required to username and password the next time you visit.
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Laboratory Studies of routine blood tests performed during the acute attacks of familial Mediterranean fever FMF are nonspecific. FMF is a clinical diagnosis; it can be supported but not excluded by genetic testing.
Imaging Studies Findings during an acute attack in patients with peritonitis, pleuritis, and arthritis are as expected and include air-fluid levels, pleural effusions, and synovial effusions. Histologic Findings Massive amyloid infiltration of the blood vessels and of the endothelial side of the glomerular basement membrane occurs in the kidneys. Biopsy Amyloidosis can be pd in patients with FMF, particularly those of North African descent who have proteinuria.
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