Familial mediterranean fever patients may have unmet needs for the treatments of exertional leg pain and enthesitis.

INTRODUCTION: Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. MATERIAL AND METHODS: We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks' frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. RESULTS: Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p=0.002) and enthesis VAS scores (p=0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. CONCLUSION: FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.

Familial mediterranean fever patients may have unmet needs for the treatments of exertional leg pain and enthesitis / Los pacientes con fiebre mediterránea familiar podrían tener necesidades no satisfechas de tratamiento del dolor en piernas con el esfuerzo y entesitis

Introduction: Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. Material and methods: We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks’ frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. Results: Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p=0.002) and enthesis VAS scores (p=0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. Conclusion: FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.(AU)

Introducción: El dolor en piernas con el esfuerzo (ELP) y la entesitis son hallazgos musculoesqueléticos en la fiebre mediterránea familiar (FMF), no aceptados como dianas de tratamiento principales. En este estudio evaluamos la efectividad de los tratamientos para ELP y entesitis. Material y métodos: Incluimos en el estudio a 218 pacientes con FMF. Comparamos retrospectivamente la frecuencia de los ataques de FMF, su duración e intensidad (escala analógica visual [VAS] del ataque de FMF) y los niveles VAS para ELP y las puntuaciones VAS para entesitis entre la etapa previa al tratamiento y la etapa en que los pacientes estaban siendo tratados en la última visita. Resultados: Cuarenta y nueve (22,5%) y 52 (23,9%) pacientes tuvieron entesitis y ELP, respectivamente. Todos los pacientes recibieron colchicina. Los ataques de serositis respondieron significativamente a los tratamientos. Además, tanto las puntuaciones VAS para ELP (p=0,002) como para entesis (p=0,17) mejoraron con el tratamiento, pero únicamente fueron significativas las puntuaciones VAS para ELP. Conclusión: Los tratamientos para FMF tuvieron un efecto favorable para ELP y entesitis en los pacientes con FMF. Sin embargo, las tasas de respuesta serían inadecuadas. Por tanto, existiría una necesidad no satisfecha de tratamiento de ambas situaciones.(AU)

Familial Mediterranean Fever Patients may have Unmet Needs for the Treatments of Exertional Leg Pain and Enthesitis.

INTRODUCTION: Exertional leg pain (ELP) and enthesitis are musculoskeletal findings in familial Mediterranean fever (FMF). They are not accepted as principal treatment targets. In this study, we assessed the effectiveness of treatments on ELP and enthesitis. MATERIAL AND METHODS: We have included 218 FMF patients to the study. We retrospectively compared the FMF attacks' frequency, duration and intensity (FMF attack VAS score) and levels of ELP VAS and enthesitis VAS scores between pre-treatment stage and while patients were on treatment at the last visit. RESULTS: Forty-nine (22.5%) and 52 (23.9%) of the patients had enthesitis and ELP respectively. All patients were on colchicine treatment. Serositis attacks respond the treatments significantly. Moreover, both ELP VAS scores (p=0.002) and enthesis VAS scores (p=0.17) were improved with treatment. But only improvement in ELP VAS scores was significant. CONCLUSION: FMF treatments had favourable effect on ELP and enthesitis in FMF patients. However, the response rates would be inadequate. Therefore, there would be unmet need for treatment of both conditions.

Enthesitis may be one of the signs of severe disease in familial Mediterranean fever.

OBJECTIVE: Familial Mediterranean fever (FMF) is an auto-inflammatory disease that is also characterized with some of the common musculoskeletal features of spondyloarthritis (SpA). Enthesitis is the hallmark of SpA. Recently, it was postulated that exertional leg pain is a possible sign of lower extremity enthesitis associated with FMF severity. In this study, we have evaluated the association between the enthesitis, enthesitis score and disease severity in FMF patients. METHODS: We enrolled 238 FMF patients that fulfilled the modified Tel-Hashomer criteria. We assessed the presence of enthesitis at the Maastricht Ankylosing Spondylitis Enthesitis Score (MASES) defined sites with standard palpation method. Then, FMF patients dichotomised two groups as enthesitis group and controls. Herein, we evaluated the enthesis extensity with MASES. FMF disease severity was determined via the international severity scoring system for FMF (ISSF). Firstly, we have compared demographic properties, disease-related features and ISSF scores of the groups. Then, we have correlated ISSF with MASES in enthesitis group. RESULTS: We showed that 54 (22.6%) of 238 patients had enthesitis. The demographic features were similar between the groups. The enthesitis group had higher ISSF scores (p < 0.001); higher frequency of fever (p = 0.004), exertional leg pain (p < 0.001), myalgia (p < 0.001) and arthritis (p = 0.01); and more intense, widespread, frequent and longer attacks compared with controls. Moreover, there was a weak correlation between ISSF and MASES in the patients with enthesitis. CONCLUSION: Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other musculoskeletal manifestations resemble SpA. Key points •More than one-fifth of the patients with FMF would suffer from enthesitis. •The FMF patients with enthesitis had higher ISSF scores; higher frequency of fever, exertional leg pain, myalgia and arthritis; and more intense, widespread, frequent and longer attacks as compared with controls. •Enthesitis may be a sign of more severe FMF phenotype and frequently associated with other SpA-like musculoskeletal feature.

Serum leptin levels do not correlate with disease activity in rheumatoid arthritis.

OBJECTIVES: Leptin, is a fat tissue hormone which effects energy expenditure, food intake , hematopoiesis, osteogenesis, angiogenesis, reproductive and immune systems. We aimed to determine serum leptin levels and investigate the association between disease activity and other parameters in RA patients. METHODS: Patients with RA (n=106) as the study group, healthy controls (n=52) and osteoarthritis (OA) patients (n=37) as a control group were enrolled to the study. RA patients were categorized in four different groups according to DAS28 scores: remission ,low (LDA), moderate (MDA) or high (HDA) disease activity . RESULTS: No differences were present between the body mass indices of the three groups. Mean leptin levels in RA patients, OA group and healthy individuals were 25,60 ± 13,41, 23,03 ± 11,51 and 23,81 ± 12,85 ng/ml, respectively and no significant difference was present between the groups. Nine of (8,5%) RA patients were in remission, 16 (15,1%) were in LDA, 40 (37,7%) in MDA and 41 (38,7%) were in HDA. Leptin levels did not correlate with DAS28 scores of RA patients (r=-0,12, p=0,11). Mean leptin levels in RA patients with remission was 32,65 ± 7, 28 in LDA 23,94 ± 10,94 in MDA 26,73 ± 14,92 and in HDA 23,59 ± 13,50 ng/ml (p=NS). No associations were observed between leptin levels and CRP, ESR, RF positivity and disease duration. CONCLUSIONS: Our study revealed no correlation of disease activity and serum leptin levels. Therefore leptin does not seem to be an appropriate biomarker to monitorize inflammation in RA.