title: Surgery vs medical treatment in the management of PFAPA syndrome: a comparative trial.
abstract: BACKGROUND
  Periodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is a common disorder in children but there is little or no consensus on its optimal diagnosis and management.
  
  
  OBJECTIVE
  To compare the outcome of different management approaches - medical therapy or tonsillectomy.
  
  
  METHODS
  The medical records of children diagnosed with PFAPA between 2008 and 2013 were retrospectively reviewed according to the modified Thomas test criteria. Patients were divided into two groups: group 1 for medical treatment - corticosteroids, a single intramuscular injection of methylprednisolone, and group 2 for surgery - tonsillectomy alone or tonsillectomy plus adenoidectomy .The course of the disease including the number and duration of episodes and the presence of remission, was documented.
  
  
  RESULTS
  105 patients (30 in group 1, 75 in group 2) met the study's inclusion criteria. Groups 1 and 2 were followed up for a mean (SD) of 23.6 (11.0) and 24 (10.3) months, respectively. At the end of the follow-up period, the number of episodes was 5.8 (6.3) vs 1.8 (1.9) (P<0.01) and their duration was 2.2 (1.3) vs 1.1 (0.8) days (P=0.03), both of which were significantly lower in group 2.The need for hospitalization during this period was significantly lower for group 2 at 1.1 (2.0) vs 0.1 (0.3) (P<0.01) and the remission rate in group 2 was significantly higher than in group 1 (98.6% vs 56.6%, P<0.01).
  
  
  CONCLUSIONS
  This study demonstrated that surgery is superior to medical treatment for PFAPA in terms of increased remission rates and a decrease in the number and duration of episodes.
authors.affiliation: a Department of Pediatrics , Medipol University.
authors.forename: Firat
authors.initials: F
authors.lastname: Erdogan
authors.affiliation: b Department of Pediatrics , Bilim University.
authors.forename: Kudret
authors.initials: K
authors.lastname: Kulak
authors.affiliation: c Department of Otorhinolaryngology , Medipol University , Istanbul , Turkey.
authors.forename: Ozmen
authors.initials: O
authors.lastname: Öztürk
authors.affiliation: a Department of Pediatrics , Medipol University.
authors.forename: İlke Özahı
authors.initials: İÖ
authors.lastname: İpek
authors.affiliation: a Department of Pediatrics , Medipol University.
authors.forename: Ömer
authors.initials: Ö
authors.lastname: Ceran
authors.affiliation: c Department of Otorhinolaryngology , Medipol University , Istanbul , Turkey.
authors.forename: Hüseyin
authors.initials: H
authors.lastname: Seven
mesh_terms: D000233:Adenoidectomy; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000379:methods; D005260:Female; D005334:Fever / Q000150:complications / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008199:Lymphadenitis / Q000150:complications / Q000628:therapy*; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage*; D010612:Pharyngitis / Q000150:complications / Q000628:therapy*; D012189:Retrospective Studies; D013281:Stomatitis, Aphthous / Q000150:complications / Q000628:therapy*; D014068:Tonsillectomy; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone
keywords: Medical treatment; PFAPA syndrome; Periodic fever; Surgery