Rheumatology Advance Access published online on January 10, 2006
Rheumatology, doi:10.1093/rheumatology/kei279
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1 Centre for Amyloidosis and Acute Phase Proteins, Royal Free and University College Medical School, London, UK
* To whom correspondence should be addressed. Objective. To prospectively monitor inflammatory activity over a prolonged period in a cohort of Turkish patients with FMF, their healthy relatives and healthy controls and to relate this to their MEFV genotypes. Methods. 43 patients with FMF and 75 of their asymptomatic relatives underwent fortnightly assessments and venesection for measurement of CRP and SAA over 5 months. 50 unrelated healthy population matched controls were also studied. MEFV genotyping was performed on all participants and comparisons were made between the different groups. Results. Paired MEFV mutations were detected in 84% of FMF patients and single mutations in 12%. Substantial acute phase reactivity was seen among the patients with FMF during attacks (median SAA 693 mg/l, CRP 115 mg/l). Between attacks there was also some inflammatory activity (median SAA 6 mg/l, CRP 4 mg/l). Among healthy controls 16% were heterozygose for MEFV mutations and 4% had two mutations. As expected there was substantial carrier rates among healthy relatives with mutations detected in almost 92%. Asymptomatic MEFV heterozygotes had elevated acute phase proteins compared to wild type subjects. Conclusion. Substantial sub-clinical inflammation occurs widely and over prolonged periods in patients with FMF, indicating that the relatively infrequent clinically overt attacks represent the ‘tip of the iceberg’ in this disorder. Both basal and peak acute phase protein concentrations were greater in MEFV heterozygotes than in wild-type controls, regardless of mutation demonstrating a ‘pro-inflammatory’ phenotype among FMF carriers. Upregulation of the acute phase response among carriers of FMF may their innate host response and contributed to better resistance to infection.
Received August 25, 2005
Accepted November 25, 2005
Original Papers
Clinical and subclinical inflammation in patients with familial Mediterranean fever and in heterozygous carriers of MEFV mutations
H. J. Lachmann 1 *,
B. 
engül 2,
T. U. Yavuz
en 2,
D. R. Booth 1,
S. E. Booth 1,
A. Bybee 1,
J. R. Gallimore 1,
M. Soytürk 2,
S. Akar 2,
M. Tunca 2,
and
P. N. Hawkins 1
2 Department of Internal Medicine, Dokuz Eylül University School of Medicine, Izmir, Turkey
H. J. Lachmann, E-mail: h.lachmann{at}medsch.ucl.ac.uk
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