Rheumatology · General Practice · 3 h ago
Oropharyngeal symptoms may precede familial Mediterranean fever by years
A population-based matched case–control study in Israel compared 3,324 patients with familial Mediterranean fever (FMF) with 13,296 controls. Recurrent tonsillitis, oral aphthae and cervical lymphadenitis were more common in patients later diagnosed with FMF, with associations detectable up to 20 years beforehand.
- Study included 3,324 FMF patients and 13,296 matched controls.
- Tonsillitis, aphthae and cervical adenitis were more common before diagnosis.
- Streptococcal sore-throat coding was not increased.
- Authors suggest a possible cue in at-risk populations.
Researchers conducted a population-based matched case–control study using Leumit Health Services records in Israel. They identified 3,324 patients with FMF who had colchicine dispensing and matched them by birth year and sex to 13,296 controls. The study compared oropharyngeal diagnoses, related procedures, antibiotic dispensing and ear, nose and throat visits across periods before and after FMF diagnosis, with analyses extending up to 20 years before diagnosis.
A PFAPA code was recorded in 2.6% of FMF patients and 0.1% of controls (odds ratio [OR] 25.4, 95% CI 14.3–48.5). Up to 20 years before diagnosis, acute tonsillitis was recorded in 35.6% of FMF patients versus 27.2% of controls (OR 1.48); viral-labeled tonsillitis, oral aphthae and cervical lymphadenitis were also more frequent. Streptococcal sore-throat coding was not increased (lifelong OR 1.03, 95% CI 0.94–1.14). Antibiotic dispensing and ENT visits were higher; tonsillectomy was more frequent, but this comparison did not survive false-discovery-rate correction.
The findings suggest a PFAPA-like, non-streptococcal oropharyngeal pattern may precede FMF recognition. The authors propose recurrent pharyngotonsillitis with aphthae or cervical adenitis as a possible cue to consider FMF in at-risk populations. This observational study establishes associations, not causation, and does not show that these symptoms alone can identify FMF.
In practice
In patients from populations at risk for familial Mediterranean fever, recurrent pharyngotonsillitis accompanied by oral aphthae or cervical adenitis, particularly without documented streptococcal disease, may be a reason to consider FMF in the clinical assessment. The evidence comes from an observational population-based case–control study using health-record diagnoses and dispensing data; it shows associations rather than diagnostic accuracy or causation. These symptoms are not shown to be sufficient to diagnose FMF, and the findings do not establish a change in testing or treatment practice.
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Journal of Internal Medicine: Pharyngotonsillitis, aphthous stomatitis, and adenitis precede familial Mediterranean fever by two decades ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.