The prodrome: a prominent yet overlooked pre-attack manifestation of familial Mediterranean fever.
OBJECTIVE
To identify and characterize pre-attack symptoms (prodrome) in patients with familial Mediterranean fever (FMF).


METHODS
Forty-eight patients with FMF whose attacks are preceded by a prodromal period composed the study population. Clinical, demographic, and genetic characteristics of the study group were compared to those of a control group of 48 patients with FMF whose attacks begin without a premonitory phase. Patients of both groups were recruited consecutively, during their routine followup visit to the FMF clinic.


RESULTS
A prodrome was found to be a common manifestation of FMF, experienced by about 50% of the patients. Overall, demographic, clinical, and genetic variables were comparable between study and control groups. In affected patients prodrome recurs in most attacks, lasts a mean of 20 hours, and manifests with either a mildly unpleasant sensation at the site of the forthcoming spell (discomfort prodrome), or with a spectrum of physical, emotional, and neuropsychological complaints (variant prodrome). The 2 types of prodromata are frequently accompanied by a host of constitutional symptoms.


CONCLUSIONS
A prodromal period heralding attacks is a newly defined and reliable FMF manifestation that reproducibly predicts attacks and may help prevent attacks and elucidate the pathogenesis of the disease.
Lidar
Merav
M
Heller Institute of Medical Research, Sheba Medical Center, Tel-Hashomer 52621, Israel.
Yaqubov
Marina
M
Zaks
Nurit
N
Ben-Horin
Shomron
S
Langevitz
Pnina
P
Livneh
Avi
A
D000328:Adult; D000465:Algorithms; D018450:Disease Progression; D042241:Early Diagnosis; D010505:Familial Mediterranean Fever / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D010146:Pain / Q000175:diagnosis* / Q000503:physiopathology*; D010147:Pain Measurement; D012720:Severity of Illness Index; D013997:Time Factors