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Familial Mediterranean Fever: Recent Developments in Pathogenesis and New
Recommendations for Management
#MMPMID28386255
Özen S
; Batu ED
; Demir S
Front Immunol
2017[]; 8
(?): 253
PMID28386255
show ga
Familial Mediterranean fever (FMF) is the most common monogenic autoinflammatory
disease (AID) affecting mainly the ethnic groups originating from Mediterranean
basin. The disease is characterized by self-limited inflammatory attacks of fever
and polyserositis along with elevated acute phase reactants. FMF is inherited
autosomal recessively; however, a significant proportion of heterozygotes also
express the phenotype. FMF is caused by mutations in the MEFV gene coding for
pyrin, which is a component of inflammasome functioning in inflammatory response
and production of interleukin-1? (IL-1?). Recent studies have shown that pyrin
recognizes bacterial modifications in Rho GTPases, which results in inflammasome
activation and increase in IL-1?. Pyrin does not directly recognize Rho
modification but probably affected by Rho effector kinase, which is a downstream
event in the actin cytoskeleton pathway. Recently, an international group of
experts has published the recommendations for the management of FMF. Colchicine
is the mainstay of FMF treatment, and its regular use prevents attacks and
controls subclinical inflammation in the majority of patients. Furthermore, it
decreases the long-term risk of amyloidosis. However, a minority of FMF patients
fail to response or tolerate colchicine treatment. Anti-interleukin-1 drugs could
be considered in these patients. One should keep in mind the possibility of
non-compliance in colchicine-non-responders. Although FMF is a relatively
well-described AID and almost 20?years has passed since the discovery of the MEFV
gene, there are still a number of unsolved problems about it such as the exact
mechanism of the disease, symptomatic heterozygotes and their treatment, and the
optimal management of colchicine resistance.