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Do we consider enough the presence of triggering factors in the evaluation of patients with FMF? Triggering factors are highly prevalent in colchicine-resistant FMF patients

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Abstract

The aim of the study is to investigate the frequency of triggering factors in colchicine-resistant and -responsive Familial Mediterranean Fever (FMF) patients as well as the effect of  interleukin (IL)-1 antagonist treatment on the triggering factors. Both colchicine-resistant (patients on IL-1 antagonist treatment) and colchicine-responsive (patients on colchicine who had ≤ 3 attacks in the last year) patients were questioned for the presence of 12 different triggering factors, including exposure to cold, emotional stress, fatigue, physical activity, menstruation (for females), sleeplessness, prolonged standing, long-duration travel, high-fat diet intake, starvation, infection, and trauma. Colchicine-resistant patients were questioned for the presence of triggering factors for two time periods, before and after treatment with IL-1 antagonists. We studied 28 colchicine-resistant and 35 colchicine-responsive patients. Overall 77.8% of patients had at least one triggering factor. Triggering factors were associated with 28.5% of the total number of attacks. More than half of the patients (57.1%) declared that they had avoided these conditions. The frequency of triggering factors was higher in the colchicine-resistant group as compared to the colchicine-responsive group (89.3% vs 68.6%; p = 0.04). In colchicine-resistant FMF patients, the frequency of triggering factors (89.3% vs 32.1%) and the percentage of attacks initiated by triggering factors (27.8 vs 14.4%; p < 0.001) were decreased after treatment with IL-1 antagonists. In this study, triggering factors were more frequent in colchicine-resistant patients as compared to colchicine-responsive patients. Treatment with IL-1 antagonists seems to increase the endurance of colchicine-resistant patients in stressful conditions.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey

    Bayram Farisogullari, Levent Kilic, Gozde Kubra Yardimci & Ali Akdogan

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  1. Bayram Farisogullari
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  2. Levent Kilic
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  3. Gozde Kubra Yardimci
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  4. Ali Akdogan
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Contributions

BF, LK, and GKY collected the data, and performed the data analysis, and wrote the first draft of the manuscript. LK and AA designed the study and supervised the work. All the authors contributed to writing the manuscript, read, and approved the final manuscript.

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Correspondence to Bayram Farisogullari.

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Conflict of interest

BF: no conflicts of interest, LK: no conflicts of interest, GKY: no conflicts of interest, and AA: no conflicts of interest.

Ethical approval

The study was approved by the ethics committee of Hacettepe University (25 May 2021; KA-20139).

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For this study, all participants provided informed consent prior to their participation.

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Farisogullari, B., Kilic, L., Yardimci, G.K. et al. Do we consider enough the presence of triggering factors in the evaluation of patients with FMF? Triggering factors are highly prevalent in colchicine-resistant FMF patients. Intern Emerg Med 19, 391–397 (2024). https://doi.org/10.1007/s11739-023-03486-3

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  • DOI: https://doi.org/10.1007/s11739-023-03486-3

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