The prodrome: a prominent yet overlooked pre-attack manifestation of familial Mediterranean fever

• Published in: Journal of rheumatology 2006-06, Vol.33 (6), p.1089-1092
• Main Authors: LIDAR, Merav, YAQUBOV, Marina, ZAKS, Nurit, BEN-HORIN, Shomron, LANGEVITZ, Pnina, LIVNEH, Avi
• Format: Article
• Language: English
• Subjects: Adult; Algorithms; Biological and medical sciences; Disease Progression; Diseases of the osteoarticular system; Early Diagnosis; Familial Mediterranean Fever - diagnosis; Familial Mediterranean Fever - etiology; Familial Mediterranean Fever - physiopathology; Female; Humans; Inflammatory joint diseases; Male; Malformations and congenital and or hereditary diseases involving bones. Joint deformations; Medical sciences; Pain - diagnosis; Pain - physiopathology; Pain Measurement; Severity of Illness Index; Time Factors
• ISSN: 0315-162X; 1499-2752

OBJECTIVE: To identify and characterize pre-attack symptoms (prodrome) in patients with familial Mediterranean fever (FMF). METHODS: Forty-eight patients with FMF whose attacks are preceded by a prodromal period composed the study population. Clinical, demographic, and genetic characteristics of the study group were compared to those of a control group of 48 patients with FMF whose attacks begin without a premonitory phase. Patients of both groups were recruited consecutively, during their routine followup visit to the FMF clinic. RESULTS: A prodrome was found to be a common manifestation of FMF, experienced by about 50% of the patients. Overall, demographic, clinical, and genetic variables were comparable between study and control groups. In affected patients prodrome recurs in most attacks, lasts a mean of 20 hours, and manifests with either a mildly unpleasant sensation at the site of the forthcoming spell (discomfort prodrome), or with a spectrum of physical, emotional, and neuropsychological complaints (variant prodrome). The 2 types of prodromata are frequently accompanied by a host of constitutional symptoms. CONCLUSIONS: A prodromal period heralding attacks is a newly defined and reliable FMF manifestation that reproducibly predicts attacks and may help prevent attacks and elucidate the pathogenesis of the disease.