The enlarging clinical, genetic, and population spectrum of tumor necrosis factor receptor-associated periodic syndrome.
OBJECTIVE
To characterize the frequency, clinical signs, and genotypic features of tumor necrosis factor receptor-associated periodic syndrome (TRAPS) in a series of 394 patients of various ethnic origins who have recurrent inflammatory syndromes.


METHODS
Sequencing of the coding region of the TNFRSF1A gene was performed in 128 patients in whom there was a high suspicion of TRAPS, and denatured high-performance liquid chromatography was used to systematically screen for TNFRSF1A in 266 patients with recurrent inflammatory syndrome and no or only 1 Mediterranean fever gene (MEFV) mutation.


RESULTS
TNFRSF1A mutations were found in 28 (7.1%) of 394 unrelated patients. Nine (32%) of the 28 patients had a family history of recurrent inflammatory syndromes. In 13 patients, the length of the attack of inflammation was fewer than 5 days. Three of the mutations (Y20H, L67P, and C96Y) were novel. Two mutations, R92Q and (mainly) P46L, found in 12 and 10 patients, respectively, had lower penetrance compared with other mutations. TNFRSF1A mutations were found in patients of various ethnic origins, including those at risk for familial Mediterranean fever (FMF): Armenians, Sephardic Jews, and especially Arabs from Maghreb. Only 3 (10.7%) of the 28 patients had amyloidosis.


CONCLUSIONS
TRAPS is an underdiagnosed cause of recurrent inflammatory syndrome. Its presence in the population of persons of Mediterranean ancestry and the short duration of the attacks of inflammation can lead to a fallacious diagnosis of FMF. Because an accurate diagnosis in patients with recurrent inflammatory syndromes is crucial for proper clinical management and treatment, genetic screening for TNFRSF1A is warranted.
Dodé
Catherine
C
Hôpital Cochin, Institut Cochin, and Institut fédéritif de recherche, de l'INSERM, Université Paris V, Paris, France.
André
Marc
M
Bienvenu
Thierry
T
Hausfater
Pierre
P
Pêcheux
Christophe
C
Bienvenu
Jacques
J
Lecron
Jean-Claude
JC
Reinert
Philippe
P
Cattan
Daniel
D
Piette
Jean-Charles
JC
Szajnert
Marie-France
MF
Delpech
Marc
M
Grateau
Gilles
G
D000293:Adolescent; D000328:Adult; D000352:Africa, Northern / Q000208:ethnology; D000368:Aged; D015703:Antigens, CD / Q000235:genetics*; D001136:Armenia / Q000208:ethnology; D002648:Child; D002675:Child, Preschool; D002851:Chromatography, High Pressure Liquid / Q000379:methods; D004252:DNA Mutational Analysis; D005006:Ethnicity / Q000235:genetics*; D010505:Familial Mediterranean Fever / Q000208:ethnology / Q000235:genetics / Q000503:physiopathology; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010297:Paris / Q000453:epidemiology; D010375:Pedigree; D018124:Receptors, Tumor Necrosis Factor / Q000235:genetics*; D047888:Receptors, Tumor Necrosis Factor, Type I
D015703:Antigens, CD; D018124:Receptors, Tumor Necrosis Factor; D047888:Receptors, Tumor Necrosis Factor, Type I