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Familial Mediterranean fever: genotype-phenotype correlations in Japanese patients.
[familial mediterranean fever]
Familial
Mediterranean
fever
(
FMF
)
is
an
autoinflammatory
disease
caused
by
MEditerranean
FeVer
gene
(
MEFV
)
mutations
.
In
Japan
,
patients
with
FMF
have
been
previously
reported
,
including
a
mild
or
incomplete
form
.
Several
factors
are
presumed
to
contribute
to
the
variable
penetrance
and
to
the
phenotypic
variability
of
FMF
.
We
conducted
the
current
study
to
investigate
the
correlation
of
variable
clinical
presentations
and
MEFV
genotypic
distributions
in
Japanese
FMF
patients
.
We
analyzed
demographic
,
clinical
,
and
genetic
data
for
311
FMF
patients
enrolled
in
the
study
.
Clinically
,
we
classified
FMF
into
2
phenotypes
:
1
)
the
"
typical
"
form
of
FMF
,
and
2
)
the
"
atypical
"
form
of
FMF
according
to
the
Tel
Hashomer
criteria
.
Patients
with
the
typical
FMF
phenotype
had
a
higher
frequency
of
febrile
episodes
,
a
shorter
duration
of
febrile
attacks
,
more
frequent
thoracic
pain
,
abdominal
pain
,
a
family
history
of
FMF
,
and
MEFV
exon
10
mutations
.
Conversely
,
patients
with
the
atypical
FMF
phenotype
had
a
lower
frequency
of
fever
episodes
and
more
frequent
arthritis
in
atypical
distribution
,
myalgia
,
and
MEFV
exon
3
mutations
.
Multivariate
analysis
showed
that
the
variable
associated
with
typical
FMF
presentation
was
the
presence
of
MEFV
exon
10
mutations
.
Typical
FMF
phenotype
frequencies
were
decreased
in
patients
carrying
2
or
a
single
low
-penetrance
mutations
compared
with
those
carrying
2
or
a
single
high
-penetrance
mutations
(
M
694
I
)
,
with
an
opposite
trend
for
the
atypical
FMF
phenotype
.
In
addition
,
patients
having
more
than
2
MEFV
mutations
had
a
younger
disease
onset
and
a
higher
prevalence
of
thoracic
pain
than
those
carrying
a
single
or
no
mutations
.
Thus
,
MEFV
exon
10
mutations
are
associated
with
the
more
typical
FMF
phenotype
.
In
contrast
,
more
than
half
of
the
Japanese
FMF
patients
without
MEFV
exon
10
mutations
presented
with
an
atypical
FMF
phenotype
,
indicating
that
Japanese
FMF
patients
tend
to
be
divided
into
2
phenotypes
by
a
variation
of
MEFV
mutations
.
Diseases
Validation
Diseases presenting
"pain"
symptom
achondroplasia
acute rheumatic fever
adrenal incidentaloma
adrenomyeloneuropathy
aniridia
aromatase deficiency
carcinoma of the gallbladder
cholangiocarcinoma
coats disease
congenital diaphragmatic hernia
congenital toxoplasmosis
cushing syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dentin dysplasia
dracunculiasis
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
erythropoietic protoporphyria
esophageal adenocarcinoma
esophageal carcinoma
esophageal squamous cell carcinoma
fabry disease
familial mediterranean fever
focal myositis
hirschsprung disease
hodgkin lymphoma, classical
holt-oram syndrome
junctional epidermolysis bullosa
kabuki syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
locked-in syndrome
lymphangioleiomyomatosis
malignant atrophic papulosis
neuralgic amyotrophy
oligodontia
oral submucous fibrosis
papillon-lefèvre syndrome
phenylketonuria
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
scrub typhus
sneddon syndrome
systemic capillary leak syndrome
thoracic outlet syndrome
trochlear dysplasia
typhoid
von hippel-lindau disease
waldenström macroglobulinemia
well-differentiated liposarcoma
wolf-hirschhorn syndrome
This symptom has already been validated