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Exertional leg pain in familial mediterranean Fever: a manifestation of an underlying enthesopathy and a marker of more severe disease.
[familial mediterranean fever]
Exertional
leg
pain
is
a
characteristic
musculoskeletal
manifestation
of
familial
Mediterranean
fever
(
FMF
)
.
We
aimed
to
define
the
frequency
and
characteristics
of
exertional
leg
pain
in
a
large
cohort
of
FMF
patients
and
to
evaluate
for
additional
signs
and
symptoms
of
spondyloarthritis
(
SpA
)
in
this
patient
population
.
FMF
patients
were
allocated
into
study
or
control
groups
based
on
the
presence
or
absence
of
exertional
leg
pain
.
Randomly
selected
patients
underwent
magnetic
resonance
imaging
(
MRI
)
of
the
ankle
as
well
as
plain
radiography
of
the
sacroiliac
joints
.
The
prevalence
of
exertional
leg
pain
among
the
170
FMF
patients
included
in
the
study
was
58
.
2
%
.
Patients
with
exertional
leg
pain
had
significantly
more
joint
attacks
(
74
.
7
%
versus
40
.
8
%
;
P
<
0
.
0001
)
,
fever
attacks
(
35
.
4
%
versus
15
.
5
%
;
P
=
0
.
004
)
,
and
pleuritis
attacks
(
48
.
5
%
versus
29
.
6
%
;
P
=
0
.
013
)
as
well
as
more
attacks
per
year
.
Elevations
of
inflammation
markers
were
significantly
more
frequent
among
the
study
group
(
for
the
erythrocyte
sedimentation
rate
,
44
.
4
%
of
patients
versus
21
.
1
%
of
patients
;
P
=
0
.
016
)
(
for
the
C-
reactive
protein
level
,
48
.
4
%
of
patients
versus
31
.
8
%
of
patients
;
P
=
0
.
013
)
,
and
M
694
V
homozygosity
was
more
prevalent
among
the
study
group
(
45
.
5
%
versus
21
.
1
%
;
P
=
0
.
001
)
.
Signs
compatible
with
enthesopathy
on
MRI
were
observed
in
73
.
5
%
of
patients
in
the
study
group
and
in
33
.
3
%
of
patients
in
the
control
group
(
P
=
0
.
046
)
.
Definite
SpA
was
diagnosed
in
41
.
2
%
of
the
patients
in
the
study
group
compared
to
none
of
the
controls
(
P
=
0
.
07
)
(
odds
ratio
1
.
7
[
95
%
confidence
interval
1
.
2
-
2
.
3
]
)
.
Exertional
leg
pain
is
a
common
manifestation
of
FMF
and
is
a
marker
of
a
more
severe
disease
phenotype
.
Additionally
,
exertional
leg
pain
is
frequently
associated
with
sacroiliitis
and
an
underlying
ankle
enthesopathy
and
should
therefore
be
considered
a
new
feature
of
SpA
.