Abstract
Introduction/objectives
The clinicians initially prefer to define patients with the systemic autoinflammatory disease (SAID)’s based on recommended clinical classification criteria; then, they confirm the diagnosis with genetic testing. We aimed to compare the initial phenotypic diagnoses of the patients who were followed up with the preliminary diagnosis of a monogenic SAID, and the genotypic results obtained from the next-generation sequence (NGS) panel.
Method
Seventy-one patients with the preliminary diagnosis of cryopyrin-associated periodic fever syndrome (CAPS), mevalonate kinase deficiency (MKD), or tumor necrosis factor-alpha receptor-associated periodic fever syndrome (TRAPS) were included in the study. The demographic data, clinical findings, laboratory results, and treatments were recorded. All patients were examined by NGS panel analysis including 16 genes. The genetic results were compared with the initial Federici score to determine whether they were compatible with each other.
Results
Thirty patients were initially classified as MKD, 22 as CAPS, and 19 as TRAPS. The frequency of clinical manifestations was urticarial rash 57.7%, diarrhea 49.2%, abdominal pain 47.8%, arthralgia 45%, oral aphthae 43.6%, myalgia 32.3%, tonsillitis 28.1%, and conjunctivitis 25.3%, respectively. After NGS gene panel screening, 13 patients were diagnosed with CAPS, 8 with MKD, 7 with familial Mediterranean fever, 5 with TRAPS, and 2 with NLRP12-associated periodic syndrome. The remaining 36 patients were genetically identified as undefined SAID since they were not classified as one of the defined SAIDs after the result of the NGS panel.
Conclusions
We have demonstrated that clinical diagnostic criteria may not always be sufficient to establish the correct diagnosis. There is still low accordance between clinical diagnoses and molecular analyses. In the case of a patient with a preliminary diagnosis of a monogenic SAID with the negative result of target gene analysis, other autoinflammatory diseases should also be kept in mind in the differential diagnosis.
Key Points • Monogenic autoinflammatory diseases can present with different clinical manifestations. • The clinical diagnostic criteria may not always be sufficient to reach the correct diagnosis in autoinflammatory diseases. • In the case of a patient with a preliminary diagnosis of a monogenic SAID with the negative result of target gene analysis, other autoinflammatory diseases should be kept in mind in the differential diagnosis. |
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References
Stoffels M, Kastner DL (2016) Old dogs, new tricks: monogenic autoinflammatory disease unleashed. Annu Rev Genomics Hum Genet 17:245–272
Federici S, Sormani MP, Ozen S et al (2015) Paediatric Rheumatology International Trials Organisation (PRINTO) and Eurofever Project. Evidence-based provisional clinical classification criteria for autoinflammatory periodic fevers. Ann Rheum Dis 74:799–805
Federici S, Vanoni F, Ben-Chetrit E, Cantarini L, Frenkel J, Goldbach-Mansky R, Gul A, Hoffman H, Koné-Paut I, Kuemmerle-Deschner J, Lachmann HJ, Martini A, Obici L, Ozen S, Simon A, Hofer M, Ruperto N, Gattorno M, Eurofever and the Pediatric Rheumatology International Trials Organization (PRINTO) (2019) An international Delphi survey for the definition of new classification criteria for familial Mediterranean fever, mevalonate kinase deficiency, TNF receptor-associated periodic fever syndromes, and cryopyrin-associated periodic syndrome. J Rheumatol 46:429–436
Gattorno M, Hofer M, Federici S, Vanoni F, Bovis F, Aksentijevich I, Anton J, Arostegui JI, Barron K, Ben-Cherit E, Brogan PA, Cantarini L, Ceccherini I, de Benedetti F, Dedeoglu F, Demirkaya E, Frenkel J, Goldbach-Mansky R, Gul A, Hentgen V, Hoffman H, Kallinich T, Kone-Paut I, Kuemmerle-Deschner J, Lachmann HJ, Laxer RM, Livneh A, Obici L, Ozen S, Rowczenio D, Russo R, Shinar Y, Simon A, Toplak N, Touitou I, Uziel Y, van Gijn M, Foell D, Garassino C, Kastner D, Martini A, Sormani MP, Ruperto N, Eurofever Registry and the Paediatric Rheumatology International Trials Organisation (PRINTO) (2019) Classification criteria for autoinflammatory recurrent fevers. Ann Rheum Dis 78:1025–1032
Russo RA, Brogan PA (2014) Monogenic autoinflammatory diseases. Rheumatology(Oxford) 53:1927–1939
Rowczenio DM, Trojer H, Russell T, Baginska A, Lane T, Stewart NM, Gillmore JD, Hawkins PN, Woo P, Mikoluc B, Lachmann HJ (2013) Clinical characteristics in subjects with NLRP3 V198M diagnosed at a single UK center and a review of the literature. Arthritis Res Ther 15:R30
De Pieri C, Vuch J, De Martino E et al (2015) Genetic profiling of autoinflammatory disorders in patients with periodic fever: a prospective study. Pediatr Rheumatol Online J 13:11
Ozyilmaz B, Kirbiyik O, Koc A, Ozdemir TR, Kaya Ozer O, Kutbay YB, Erdogan KM, Saka Guvenc M, Ozturk C (2019) Molecular genetic evaluation of NLRP3, MVK and TNFRSF1A associated periodic fever syndromes. Int J Immunogenet 46:232–240
Livneh A, Langevitz P, Zemer D, Zaks N, Kees S, Lidar T, Migdal A, Padeh S, Pras M (1997) Criteria for the diagnosis of familial Mediterranean fever. Arthritis Rheum 40:1879–1885
Thomas KT, Feder HM Jr, Lawton AR, Edwards KM (1999) Periodic fever syndrome in children. J Pediatr 135:15–21
Shinar Y, Obici L, Aksentijevich I, Bennetts B, Austrup F, Ceccherini I, Costa JM, de Leener A, Gattorno M, Kania U, Kone-Paut I, Lezer S, Livneh A, Moix I, Nishikomori R, Ozen S, Phylactou L, Risom L, Rowczenio D, Sarkisian T, van Gijn M, Witsch-Baumgartner M, Morris M, Hoffman HM, Touitou I, European Molecular Genetics Quality Network (2012) Guidelines for the genetic diagnosis of hereditary recurrent fevers. Ann Rheum Dis 71:1599–1605
Jéru I, Le Borgne G, Cochet E et al (2011) Identification and functional consequences of a recurrent NLRP12 missense mutation in periodic fever syndromes. Arthritis Rheum 63:1459–1464
Papa R, Doglio M, Lachmann HJ et al (2017) A web-based collection of genotype-phenotype associations in hereditary recurrent fevers from the Eurofever registry. Orphanet J Rare Dis 12:167
Richards S, Aziz N, Bale S et al (2015) Standards and guidelines for the interpretation of sequence variants: a joint consensus recommendation of the American College of Medical Genetics and Genomics and the Association for Molecular Pathology. Genet Med 17:405–424
Van Gijn ME, Ceccherini I, Shinar Y et al (2018) New workflow for classification of genetic variants’ pathogenicity applied to hereditary recurrent fevers by the International Study Group for Systemic Autoinflammatory Diseases (INSAID). J Med Genet 55:530–537
Karadag SG, Sonmez HE, Tanatar A et al (2020) Profile of new referrals to a single pediatric rheumatology center in Turkey. Rheumatol Int 40:313–321
Hashkes PJ (2003) Profile of a pediatric rheumatology practice in Israel. Clin Exp Rheumatol 21:123–128
Rusmini M, Federici S, Caroli F, Grossi A, Baldi M, Obici L, Insalaco A, Tommasini A, Caorsi R, Gallo E, Olivieri AN, Marzano AV, Coviello D, Ravazzolo R, Martini A, Gattorno M, Ceccherini I (2016) Next-generation sequencing and its initial applications for molecular diagnosis of systemic auto-inflammatory diseases. Ann Rheum Dis 75:1550–1557
Demir F, Doğan ÖA, Demirkol YK, Tekkuş KE, Canbek S, Karadağ ŞG, Sönmez HE, Ayaz NA, Doğanay HL, Sözeri B (2020) Genetic panel screening in patients with clinically unclassified systemic autoinflammatory diseases. Clin Rheumatol. https://doi.org/10.1007/s10067-020-05108-1
Kosukcu C, Taskiran EZ, Batu ED, Sag E, Bilginer Y, Alikasifoglu M, Ozen S (2020) Whole exome sequencing in unclassified autoinflammatory diseases: more monogenic diseases in the pipeline? Rheumatology (Oxford). https://doi.org/10.1093/rheumatology/keaa165
Ter Haar NM, Eijkelboom C, Cantarini L et al (2019) Clinical characteristics and genetic analyses of 187 patients with undefined autoinflammatory diseases. Ann Rheum Dis 78:1405–1411
Chandrakasan S, Chiwane S, Adams M, Fathalla BM (2014) Clinical and genetic profile of children with periodic fever syndromes from a single medical center in South East Michigan. J ClinImmunol 34:104–113
Vitale A, Sota J, Obici L, et al (2020) Role of colchicine treatment in tumor necrosis factor receptor associated periodic syndrome (TRAPS): real-life data from the AIDA Network. Mediators Inflamm. 27;2020:1936960
Livneh A, Zemer D, Langevitz P, Shemer J, Sohar E, Pras M (1993) Colchicine in the treatment of AA and AL amyloidosis. Semin Arthritis Rheum 23:206–214
Demir F, Bolac GL, Merter T et al (2020) The musculoskeletal system manifestations in children with familial Mediterranean fever. North Clin Istanb. https://doi.org/10.14744/nci.2020.96636
Wang W, Zhou Y, Zhong LQ, Li Z, Jian S, Tang XY, Song HM (2019) The clinical phenotype and genotype of NLRP12- autoinflammatory disease: a Chinese case series with literature review. World J Pediatr. 16:514–519. https://doi.org/10.1007/s12519-019-00294-8
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We are grateful to all participating children and their families.
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B.S. and F.D. developed the concept and designed the study; B.S., F.D., H.E.S., S.G.K., and N.A.A. performed research and acquired data; B.S., F.D., Ö.A.K., Y.K.D., and H.L.D. analyzed and interpreted data; B.S. and F.D. wrote and reviewed the manuscript. All authors reviewed and revised the final version of the manuscript and they take full responsibility for the integrity of the study.
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Sözeri, B., Demir, F., Sönmez, H.E. et al. Comparison of the clinical diagnostic criteria and the results of the next-generation sequence gene panel in patients with monogenic systemic autoinflammatory diseases. Clin Rheumatol 40, 2327–2337 (2021). https://doi.org/10.1007/s10067-020-05492-8
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DOI: https://doi.org/10.1007/s10067-020-05492-8