Abstract: Arthritis as the Sole Episodic Manifestation of Familial Mediterranean Fever

Arthritis as the Sole Episodic Manifestation of Familial Mediterranean Fever

MERAV LIDAR, RON KEDEM, ADAM MOR, DAVID LEVARTOVSKY, PNINA LANGEVITZ, and AVI LIVNEH

ABSTRACT.

Objective. To clinically and genetically characterize patients with familial Mediterranean fever (FMF) in whom arthritis constitutes the only manifestation, and to establish the most important features distinguishing FMF arthritis in such a setting from other forms of mono/oligo arthritides.

Methods. The study population comprised 14 patients with episodes of arthritis as the only manifestation of FMF who nevertheless fulfilled the diagnostic criteria for FMF. The control group consisted of 28 patients with episodic mono/oligo arthritis of different disease entities (palindromic, reactive, inflammatory bowel disease, Reiter's, seronegative spondyloarthropathy, chronic juvenile, Behçet's, and gouty arthritis) who presented to the rheumatology clinic during the study period. Patients in both groups underwent clinical evaluation and donated blood for FMF gene analysis.

Results. The study and control groups shared similar age and sex distribution and experienced the monoarthritic attacks at similar sites, usually the knee and ankle joint. The 2 groups differed significantly in features of arthritis (which were febrile and of short duration in FMF), family history of FMF, mutation analysis, and response to colchicine. These differences allowed the defining of a rule, which readily distinguishes FMF arthritis from other forms of episodic mono/oligo arthritis.

Conclusion. The clinical, ethnic, and genetic features of recurrent monoarthritis of FMF are specific and may separate FMF from other entities with mono/oligo arthritis. (J Rheumatol 2005;32:859-62)

Key Indexing Terms:

FAMILIAL MEDITERRANEAN FEVER
ARTHRITIS
DIAGNOSTIC CRITERIA
MUTATION
COLCHICINE

From the Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer; the Department of Rheumatology, Ichilov Medical Center; and the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.

M. Lidar, MD; R. Kedem, PhD; A. Mor, MD; D. Levartovsky, MD; P. Langevitz, MD, Clinical Professor of Medicine; A. Livneh, MD, Associate Professor of Medicine, Heller Institute of Medical Research, Sheba Medical Center.

Address reprint requests to Prof. A. Livneh, Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer 52621, Israel. E-mail: alivneh@post.tau.ac.il

Accepted for publication December 13, 2004.