Determination of attack precipitating factors for familiar mediterranean fever

Abstract

Background. Familial Mediterranean Fever (FMF) is an inherited disorder characterized by recurrent attacks of fever, peritonitis, pleuritis, arthritis and skin lesions. The disease is restricted primarily to the populations of Mediterranean basin. The prevalence rate varies among Mediterranean populations. The estimated prevalence rate for Armenians is 1 per 400. The frequency of the affected gene is the highest for Armenians living in Armenia. A typical attack lasts from 1 to 4 days. During the attack free period patients generally appear healthy. The only serious complication of FMF is amyloidosis, which gradually leads to the renal insufficiency. The most effective medication currently used for treatment of FMF is colchicine, which reduces the frequency of attacks. Research question and objectives. The goal of the proposed research is to determine what factors determine the occurrence of FMF attacks. The objectives are: •To define the association between occurrence of attacks and high-fat food, physical stress, emotional stress, cold, climate and menstruation. •To determine the association between different types of genetic mutations and various attack precipitants. Methods. The fact that attacks of FMF have no periodicity and regularity, leads to the idea of existence of specific extraneous or environmental attack precipitating factors. The most commonly discussed are high-fat food, emotional, excessive physical activity, cold, climate and menstruation. The proposed case-crossover study is aimed to reveal association between occurrence of attacks and possible attack precipitants. Study instrument is a questionnaire comprising demographic questions and domains on the disease history, hormonal status, general lifestyle and lifestyle regarding the past two-three days period. Sample size. The proposed sample size is equal to 300 cases and 300 controls. Taking into account that cases and controls are the same people, the total number of participants is 300. The sample will be selected from the database of the Center of Medical Genetics of the National Academy of Sciences of Republic of Armenia. Analysis. During the analysis the chi-square test will be used for determination of association between occurrence of attack and discussed attack precipitants. It will be used also for detection of associations between different types of mutations and various attack precipitants. It is expected that the results of the study will allow to prevent development of attacks and to minimize the treatment with Colchicine.