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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
"fever"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
alexander disease
allergic bronchopulmonary aspergillosis
canavan disease
carcinoma of the gallbladder
child syndrome
congenital toxoplasmosis
cushing syndrome
cystinuria
dracunculiasis
erdheim-chester disease
esophageal adenocarcinoma
esophageal carcinoma
familial mediterranean fever
focal myositis
hodgkin lymphoma, classical
lamellar ichthyosis
legionellosis
locked-in syndrome
malignant atrophic papulosis
neonatal adrenoleukodystrophy
neuralgic amyotrophy
oculocutaneous albinism
papillon-lefèvre syndrome
pyomyositis
pyruvate dehydrogenase deficiency
scrub typhus
severe combined immunodeficiency
sneddon syndrome
systemic capillary leak syndrome
triple a syndrome
typhoid
waldenström macroglobulinemia
wolf-hirschhorn syndrome
This symptom has already been validated