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The Prodrome: A Prominent Yet Overlooked Pre-Attack Manifestation of Familial Mediterranean Fever
MERAV LIDAR, MARINA YAQUBOV, NURIT ZAKS, SHOMRON BEN-HORIN, PNINA LANGEVITZ, and AVI LIVNEH ABSTRACT. Objective. To identify and characterize pre-attack symptoms (prodrome) in patients with familial Mediterranean fever (FMF). Methods. Forty-eight patients with FMF whose attacks are preceded by a prodromal period composed the study population. Clinical, demographic, and genetic characteristics of the study group were compared to those of a control group of 48 patients with FMF whose attacks begin without a premonitory phase. Patients of both groups were recruited consecutively, during their routine followup visit to the FMF clinic. Results. A prodrome was found to be a common manifestation of FMF, experienced by about 50% of the patients. Overall, demographic, clinical, and genetic variables were comparable between study and control groups. In affected patients prodrome recurs in most attacks, lasts a mean of 20 hours, and manifests with either a mildly unpleasant sensation at the site of the forthcoming spell (discomfort prodrome), or with a spectrum of physical, emotional, and neuropsychological complaints (variant prodrome). The 2 types of prodromata are frequently accompanied by a host of constitutional symptoms. Conclusions. A prodromal period heralding attacks is a newly defined and reliable FMF manifestation that reproducibly predicts attacks and may help prevent attacks and elucidate the pathogenesis of the disease. (J Rheumatol 2006;33:1089–92) Key Indexing Terms:
FAMILIAL MEDITERRANEAN FEVER
From the Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer, Israel. M. Lidar, MD; M. Yaqubov, MD; N. Zaks, MD; S. Ben-Horin, MD; P. Langevitz, MD, Clinical Professor of Medicine; Avi Livneh, MD, Associate Professor of Medicine. Address reprint requests to Professor A. Livneh, Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer 52621, Israel. E-mail: alivneh@post.tau.ac.il Accepted for publication January 26, 2006.
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