Scientific Letter
Arthritis as presentation of familial Mediterranean fever
Artritis como forma de presentación de fiebre mediterránea familiar
S. Camacho-Lovillo
, A.C. García-Martínez
Corresponding author
Sección de Inmunopatología y Enfermedades Infecciosas, Unidad de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain
Read
9409
Timeswas read the article
2408
Total PDF
7001
Total HTML
Share statistics
array:24 [ "pii" => "S2341287915001416" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.007" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1820" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:130-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2617 "formatos" => array:3 [ "EPUB" => 167 "HTML" => 1972 "PDF" => 478 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403315000648" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2015.02.004" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1820" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:130-2" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3670 "formatos" => array:3 [ "EPUB" => 151 "HTML" => 3025 "PDF" => 494 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Artritis como forma de presentación de fiebre mediterránea familiar" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "132" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Arthritis as presentation of familial mediterranean fever" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 682 "Ancho" => 1400 "Tamanyo" => 87953 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">RM de caderas. a) Se observa reacción inflamatoria de la cápsula articular de la cadera izquierda que capta contraste en T1 con supresión grasa. b) Se observa incremento del líquido articular en la cadera izquierda en T2.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "S. Camacho-Lovillo, A.C. García-Martínez" "autores" => array:2 [ 0 => array:2 [ "nombre" => "S." "apellidos" => "Camacho-Lovillo" ] 1 => array:2 [ "nombre" => "A.C." "apellidos" => "García-Martínez" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915001416" "doi" => "10.1016/j.anpede.2015.07.007" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001416?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000648?idApp=UINPBA00005H" "url" => "/16954033/0000008300000002/v2_201508010208/S1695403315000648/v2_201508010208/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915001398" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.005" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1830" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "cor" "cita" => "An Pediatr (Barc). 2015;83:132-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2281 "formatos" => array:3 [ "EPUB" => 180 "HTML" => 1641 "PDF" => 460 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Review of published cases of hepatic choristoma. Differential diagnosis of umbilical cord masses" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "132" "paginaFinal" => "134" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Revisión de casos publicados de coristoma hepático. Diagnóstico diferencial de masas de cordón umbilical" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 951 "Ancho" => 975 "Tamanyo" => 165502 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Transillumination of the wine-red mass in the umbilical cord.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Y. González Ruiz, L. Cotaina Gracia, M. Ruiz de Temiño, A. Joana González Esgueda, M.R. Delgado Alvira" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Y." "apellidos" => "González Ruiz" ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Cotaina Gracia" ] 2 => array:2 [ "nombre" => "M." "apellidos" => "Ruiz de Temiño" ] 3 => array:2 [ "nombre" => "A. Joana" "apellidos" => "González Esgueda" ] 4 => array:2 [ "nombre" => "M.R." "apellidos" => "Delgado Alvira" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315000740" "doi" => "10.1016/j.anpedi.2015.02.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315000740?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001398?idApp=UINPBA00005H" "url" => "/23412879/0000008300000002/v1_201508150053/S2341287915001398/v1_201508150053/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001362" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.07.002" "estado" => "S300" "fechaPublicacion" => "2015-08-01" "aid" => "1743" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2015;83:123-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2190 "formatos" => array:3 [ "EPUB" => 123 "HTML" => 1635 "PDF" => 432 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Early prediction of the neurological result at 12 months in newborns at neurological risk" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "129" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Predicción temprana del resultado neurológico a los 12 meses en neonatos de riesgo en Bariloche" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1216 "Ancho" => 2173 "Tamanyo" => 99215 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Neonatal neurological assessment and CAT–CLAMS results at 12 months. AT0: Amiel-Tison assessment at 1 week of life or at 40 weeks in preterm neonates; CAT–CLAMS: Clinical Adaptive Test Clinical Linguistic and Auditory Milestone Scale.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "F. Herbón, G. Garibotti, J. Moguilevsky" "autores" => array:3 [ 0 => array:2 [ "nombre" => "F." "apellidos" => "Herbón" ] 1 => array:2 [ "nombre" => "G." "apellidos" => "Garibotti" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Moguilevsky" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403314004718" "doi" => "10.1016/j.anpedi.2014.10.009" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403314004718?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001362?idApp=UINPBA00005H" "url" => "/23412879/0000008300000002/v1_201508150053/S2341287915001362/v1_201508150053/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Arthritis as presentation of familial Mediterranean fever" "tieneTextoCompleto" => true "saludo" => "Dear Editor:" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "130" "paginaFinal" => "132" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "S. Camacho-Lovillo, A.C. García-Martínez" "autores" => array:2 [ 0 => array:4 [ "nombre" => "S." "apellidos" => "Camacho-Lovillo" "email" => array:1 [ 0 => "marisolcl73@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "A.C." "apellidos" => "García-Martínez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Sección de Inmunopatología y Enfermedades Infecciosas, Unidad de Pediatría, Hospital Universitario Virgen del Rocío, Sevilla, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Artritis como forma de presentación de fiebre mediterránea familiar" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 682 "Ancho" => 1400 "Tamanyo" => 102002 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pelvis MRI. (a) Inflammatory response of the articular capsule of the left hip with contrast enhancement in a fat-suppressed T1 image. (b) Increase in joint fluid in the left hip in T2-weighted image.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Familial Mediterranean fever (FMF) is the most prevalent autoinflammatory disease (AD) with a known genetic basis. All ADs involve alterations in innate immunity with inflammasome dysfunction. The inheritance pattern of FMF is autosomal recessive, although there are descriptions of a few mutations that show an autosomal dominant behaviour. The mutations are located in the MEVF gene, which encodes the pyrin protein, also known as marenostrin. There is a high incidence of FMF in populations along the Mediterranean coast (Jews, Arabs, Armenians and Turks). Onset occurs before 20 years of age in 80% of the cases. Attacks are characterised by fever and serositis or synovitis and last 1–3 days. The most widely criteria used for its diagnosis are the Tel Hashomer criteria (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>), based on which diagnostic criteria for children have been proposed. The first-line treatment is colchicine, both to avoid the occurrence of attacks and to prevent amyloidosis, or even partially revert it once it has established. Amyloidosis is the most frequent long-term complication.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">1</span></a></p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">In FMF, arthritis is usually acute, oligoarticular and non-erosive, and affects large joints in the lower limbs, especially knees and ankles.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">1,2</span></a> In this paper, we present two children with FMF in whom arthritis was the main clinical feature.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0015" class="elsevierStylePara elsevierViewall">The patient was a 5-year-old Caucasian girl that presented with bilateral inguinal pain of 4 days of duration and low-grade fever. There was no history of trauma.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The most relevant finding of the physical examination was pain, with the patient assuming an antalgic position with the right hip flexed in external rotation. Mobility was limited in both hips. There was a faint erythematous exanthem at the upper region of the lower limbs.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The patient was admitted for suspected septic arthritis of the hip, and empirical antibiotic treatment with cefotaxime and clindamycin was initiated. An ultrasound scan was performed that revealed bilateral effusion in the coxofemoral joints. At admission, complete blood count was normal, C reactive protein (CRP) level was 172<span class="elsevierStyleHsp" style=""></span>mg/L and erythrocyte sedimentation rate (ESR) was 94<span class="elsevierStyleHsp" style=""></span>mm/h. Arthrocentesis was performed to collect joint fluid, which had 32,000<span class="elsevierStyleHsp" style=""></span>cells/mm<span class="elsevierStyleSup">3</span> with 90% of polymorphonuclear leukocytes. Joint fluid and blood cultures were negative. Magnetic resonance imaging did not reveal involvement of the bone or surrounding soft tissues (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Chest radiography, echocardiography, antistreptolysin O titre, peripheral blood smear and funduscopic exam were all normal. Rheumatoid factor, antinuclear antibodies and the Mantoux test were negative. Parvovirus, <span class="elsevierStyleItalic">Coxiella</span> and <span class="elsevierStyleItalic">Brucella</span> serology tests were negative. An intermittent fever of up to 38<span class="elsevierStyleHsp" style=""></span>°C persisted in the early days, and subsequently the patient remained afebrile with improvement of hip mobility and pain, so she was discharged with oral ibuprofen and transitioned to outpatient follow-up. A year later, she developed arthritis of the left hip again, with elevated CRP (75<span class="elsevierStyleHsp" style=""></span>mg/L) and intermittent low-grade fever in a self-limited course that lasted 10 days. Later on, she experienced joint inflammations that subsided after 24–48<span class="elsevierStyleHsp" style=""></span>h in the ankle, proximal interphalangeal (PIP) joint and hip. Genetic testing for FMF was requested, detecting the heterozygous mutation p.A744S in exon 10 of the MEVF gene.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0030" class="elsevierStylePara elsevierViewall">Caucasian girl, 13 years old, that since age 6 experienced intermittent inflammation in carpal, PIP and metacarpophalangeal joints as well as cervicalgia. Although the patient did not meet the criteria for juvenile idiopathic arthritis (JIA) because inflammation did not last more than 6 weeks, treatment with oral corticosteroids and methotrexate was initiated, with little improvement. Several relatives on the mother's side had a diagnosis of seronegative rheumatoid arthritis. Given the family history and the intermittent joint symptoms, we requested a genetic test that detected the heterozygous mutation p.E148Q in exon 2 of the MEVF gene, and the heterozygous mutation p.V726A in exon 10 of the same gene.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Familial Mediterranean fever may present as episodes of joint inflammation and be initially confused with septic arthritis or later in its course with JIA,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">3</span></a> as we observed in the cases we are presenting. Usually it can be distinguished in that arthritis is episodic, accompanied by fever, and leaves no sequelae, although in some cases arthritis of the hip can be chronic and destructive (5%).<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">2</span></a> Family history, ethnicity, the detection of mutations and a favourable response to colchicine support the diagnosis of FMF.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In published case series, arthritis has been the presenting complaint in 16% of patients with FMF, and 31–59% have had joint involvement during the course of the disease. In 70%, joint involvement was monoarticular, in 26% oligoarticular and in 4% polyarticular.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">2,5,6</span></a> The most frequently affected joint was the knee (63%), followed by ankles (42%), elbows (15%), wrists (17%), small joints of the hand (5–10%) and sacroiliac joints (1%).<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">5,6</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">We would like to emphasise the importance of correctly diagnosing patients with arthritis as a presenting feature of FMF to avoid unnecessary tests and treatments, and to allow prompt initiation of appropriate treatment.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: Camacho-Lovillo S, García-Martínez AC. Artritis como forma de presentación de fiebre mediterránea familiar. An Pediatr (Barc). 2015;83:130–132.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 682 "Ancho" => 1400 "Tamanyo" => 102002 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Pelvis MRI. (a) Inflammatory response of the articular capsule of the left hip with contrast enhancement in a fat-suppressed T1 image. (b) Increase in joint fluid in the left hip in T2-weighted image.</p>" ] ] 1 => array:7 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:3 [ "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The diagnosis requires at least 1 major criterion or 2 minor criteria, or at least 1 minor criterion plus 5 or more supportive criteria, or at least 1 minor criterion and 4 criteria of the first 5 supportive criteria.</p><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">ESR, erythrocyte sedimentation rate; FMF, familial Mediterranean fever; SAA, serum amyloid A.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Major \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Minor \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Supportive criteria \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">Typical attacks<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1–3 incomplete attacks in 1 or more of the following: \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Family history of FMF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">1. Peritonitis (generalised) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">1. Abdomen \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2. Ethnic origin associated with FMF \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">2. Pleuritis (unilateral) or pericarditis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">2. Chest \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3. Age <20 years at disease onset \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">3. Monoarthritis (hip, knee, ankle) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">3. Joint \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4–6 features of attacks: \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="left" valign="top">4. Fever alone \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">4. Exertional leg pain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">4. Severe: requiring bed rest</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">5. Favourable response to colchicine \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">5. Spontaneous remission</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">6. Symptom-free interval</span> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">7. Transitory elevated acute-phase reactants (leukocytes, ESR, SAA and/or fibrinogen) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">8. Episodic proteinuria/haematuria \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">9. Unproductive laparotomy or removal of white appendix \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="" valign="top"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">10. Consanguinity of parents \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab869306.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Typical attacks: recurrent (≥3 of the same type); febrile (rectal temperature ≥38°<span class="elsevierStyleHsp" style=""></span>C) and short (duration between 12<span class="elsevierStyleHsp" style=""></span>h and 3 days).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Tel Hashomer criteria for the diagnosis of familial Mediterranean fever.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:6 [ 0 => array:3 [ "identificador" => "bib0035" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Consensus document on the differential diagnosis and therapeutic approach to recurrent fever by the Paediatric Infectology Society and the Paediatric Rheumatology Society" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Calvo Rey" 1 => "P. Soler-Palacín" 2 => "R. Merino Muñoz" 3 => "J. Saavedra Lozano" 4 => "J. Antón López" 5 => "J.I. Aróstegui" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "An Pediatr (Barc)" "fecha" => "2011" "volumen" => "74" "paginaInicial" => "194.e1" "paginaFinal" => "194.e16" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0040" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthritis in familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "I. Uthman" 1 => "R.A. Hajj-Ali" 2 => "T. Arayssi" 3 => "A.F. Masri" 4 => "F. Nasr" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rheumatol Int" "fecha" => "2001" "volumen" => "20" "paginaInicial" => "145" "paginaFinal" => "148" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11411958" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0045" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The medical odyssey of a boy with arthritis of familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "W. Conca" 1 => "G. Ghatasheh" 2 => "S. Al-Salam" 3 => "K. Neidl Van Gorkom" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Int J Rheum Dis" "fecha" => "2012" "volumen" => "15" "paginaInicial" => "37" "paginaFinal" => "39" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0050" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthritis as the sole episodic manifestation of familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M. Lidar" 1 => "R. Kedem" 2 => "A. Mor" 3 => "D. Levartovsky" 4 => "P. Langevitz" 5 => "A. Livneh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Rheumatol" "fecha" => "2005" "volumen" => "32" "paginaInicial" => "859" "paginaFinal" => "862" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15868622" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0055" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The clinical patterns of arthritis in children with familial Mediterranean fever" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H.A. Majeed" 1 => "M. Rawashdeh" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "QJM" "fecha" => "1997" "volumen" => "90" "paginaInicial" => "37" "paginaFinal" => "43" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9093587" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0060" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Arthritis patterns in familial Mediterranean fever patients and association with M694V mutation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R.A. Jarjour" 1 => "R. Dodaki" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s11033-010-0326-5" "Revista" => array:6 [ "tituloSerie" => "Mol Biol Rep" "fecha" => "2011" "volumen" => "38" "paginaInicial" => "2033" "paginaFinal" => "2036" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20845072" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008300000002/v1_201508150053/S2341287915001416/v1_201508150053/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008300000002/v1_201508150053/S2341287915001416/v1_201508150053/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001416?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 18 | 10 | 28 |
| 2024 October | 128 | 54 | 182 |
| 2024 September | 106 | 42 | 148 |
| 2024 August | 122 | 67 | 189 |
| 2024 July | 167 | 37 | 204 |
| 2024 June | 115 | 31 | 146 |
| 2024 May | 138 | 47 | 185 |
| 2024 April | 110 | 36 | 146 |
| 2024 March | 113 | 24 | 137 |
| 2024 February | 139 | 26 | 165 |
| 2024 January | 145 | 23 | 168 |
| 2023 December | 171 | 21 | 192 |
| 2023 November | 116 | 24 | 140 |
| 2023 October | 100 | 24 | 124 |
| 2023 September | 93 | 30 | 123 |
| 2023 August | 80 | 29 | 109 |
| 2023 July | 65 | 30 | 95 |
| 2023 June | 96 | 27 | 123 |
| 2023 May | 101 | 19 | 120 |
| 2023 April | 61 | 17 | 78 |
| 2023 March | 80 | 30 | 110 |
| 2023 February | 82 | 25 | 107 |
| 2023 January | 70 | 23 | 93 |
| 2022 December | 103 | 38 | 141 |
| 2022 November | 110 | 38 | 148 |
| 2022 October | 83 | 50 | 133 |
| 2022 September | 60 | 37 | 97 |
| 2022 August | 62 | 48 | 110 |
| 2022 July | 55 | 43 | 98 |
| 2022 June | 69 | 34 | 103 |
| 2022 May | 66 | 37 | 103 |
| 2022 April | 88 | 28 | 116 |
| 2022 March | 113 | 42 | 155 |
| 2022 February | 84 | 30 | 114 |
| 2022 January | 87 | 43 | 130 |
| 2021 December | 72 | 45 | 117 |
| 2021 November | 84 | 65 | 149 |
| 2021 October | 80 | 60 | 140 |
| 2021 September | 72 | 43 | 115 |
| 2021 August | 70 | 42 | 112 |
| 2021 July | 100 | 38 | 138 |
| 2021 June | 72 | 40 | 112 |
| 2021 May | 71 | 39 | 110 |
| 2021 April | 144 | 83 | 227 |
| 2021 March | 59 | 34 | 93 |
| 2021 February | 70 | 17 | 87 |
| 2021 January | 54 | 29 | 83 |
| 2020 December | 82 | 23 | 105 |
| 2020 November | 66 | 17 | 83 |
| 2020 October | 51 | 20 | 71 |
| 2020 September | 66 | 22 | 88 |
| 2020 August | 67 | 22 | 89 |
| 2020 July | 63 | 25 | 88 |
| 2020 June | 72 | 15 | 87 |
| 2020 May | 78 | 23 | 101 |
| 2020 April | 42 | 21 | 63 |
| 2020 March | 66 | 24 | 90 |
| 2020 February | 58 | 28 | 86 |
| 2020 January | 56 | 14 | 70 |
| 2019 December | 73 | 27 | 100 |
| 2019 November | 48 | 13 | 61 |
| 2019 October | 57 | 14 | 71 |
| 2019 September | 58 | 23 | 81 |
| 2019 August | 60 | 18 | 78 |
| 2019 July | 58 | 28 | 86 |
| 2019 June | 43 | 22 | 65 |
| 2019 May | 152 | 30 | 182 |
| 2019 April | 113 | 59 | 172 |
| 2019 March | 69 | 17 | 86 |
| 2019 February | 60 | 19 | 79 |
| 2019 January | 63 | 27 | 90 |
| 2018 December | 78 | 35 | 113 |
| 2018 November | 92 | 31 | 123 |
| 2018 October | 137 | 25 | 162 |
| 2018 September | 53 | 6 | 59 |
| 2018 August | 13 | 0 | 13 |
| 2018 July | 5 | 0 | 5 |
| 2018 June | 2 | 0 | 2 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 47 | 0 | 47 |
| 2018 March | 35 | 0 | 35 |
| 2018 February | 24 | 0 | 24 |
| 2018 January | 46 | 0 | 46 |
| 2017 December | 29 | 0 | 29 |
| 2017 November | 18 | 0 | 18 |
| 2017 October | 24 | 0 | 24 |
| 2017 September | 35 | 0 | 35 |
| 2017 August | 23 | 0 | 23 |
| 2017 July | 25 | 0 | 25 |
| 2017 June | 32 | 3 | 35 |
| 2017 May | 33 | 6 | 39 |
| 2017 April | 14 | 4 | 18 |
| 2017 March | 13 | 3 | 16 |
| 2017 February | 10 | 6 | 16 |
| 2017 January | 6 | 4 | 10 |
| 2016 December | 31 | 5 | 36 |
| 2016 November | 51 | 10 | 61 |
| 2016 October | 58 | 7 | 65 |
| 2016 September | 49 | 4 | 53 |
| 2016 August | 34 | 5 | 39 |
| 2016 July | 8 | 4 | 12 |
Show all
