2. 40
Body Temperature (
Body Temperature (°C)
39
FMF vs TRAPS 39
38
FMF TRAPS
38
37
遺伝 常染色体劣性遺伝 常染色体優勢遺伝
36 37
遺伝子 0 MEFV
1 2 3 Type 1 TNF-Rに対する遺伝子
Day
発症年齢 <20歳 <20歳
36
0 1 2 3 4 5 6 7 8 9
発作期間 2日以内 14日以上 Day
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
発熱以外の症状 漿膜炎,of丹毒様皮疹
Figure 1. Temporal Patterns Fever and Associated Clinical 結膜炎, 筋痛
Findings in a Patient with Familial Mediterranean Fever (Panel
A), a Patient with the Hyper-IgD Syndrome (Panel B), and a Pa-
コルヒチン反応性あり
tient with the Tumor Necrosis Factor (TNF) Receptor–Associat- コルヒチンに不応
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
治療 ed Periodic Syndrome (Panel C).
MEDICAL PROGRESS
ステロイドは不応
Each panel shows the temperature during an attack of fever in ステロイド, エタネルセプトは著効
a hospitalized patient and the symptoms that accompanied the
A
febrile attack. The bar graph below each curve shows the num-
Familial Mediterranean Fever C B TNF-Receptor–Associated Periodic Syndrome
Hyper-IgD Syndrome
ber of attacks that the patient had in a year, when they oc-
curred, and41 their approximate duration. Serositis (peritonitis),
The patient with the 41 41 Conjunctivitis, erythematous skin lesions,
Cervical lymphadenopathy,
vomiting, arthritis,
TNF-receptor–associated periodic syndrome had long attacks myalgia and arthralgia, abdominal pain
erythematous macules,
Body Temperature (°C)
erysipelas-like skin lesions abdominal pain, vomiting,
twice in one year, whereas the patient with familial Mediterra- 40 arthralgia
Body Temperature (°C)
40 the patient with the hyper-IgD syndrome had
nean fever and
shorter but more frequent attacks. 40
Body Temperature (°C)
39
39
38 39
38
37
tacks.17 Proteinuria (more than 0.5 g of protein per 38
24 hours)37 patients with familial Mediterranean fe-
in 36
ver is highly suggestive of amyloidosis.7 0 2 4 6 8 10 12 14 16 18 20 22 24 26
36 37 Day
Pathogenesis 0
and Molecular Genetic Features
1 2 3
After familial Mediterranean fever was mapped to
Day
the short arm of chromosome 16,18 two independent 36
groups were able to clone the gene (MEFV).19,20 The Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
0 1 2 3 4 5 6 7 8 9
protein (pyrin, or marenostrin) encoded by MEFV Day
Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
contains 781 amino acids and has a molecular weight
of 86,000. MEFV is predominantly expressed in my-
Figure 1. Temporal Patterns of Fever and Associated Clinical
N Engl J Med 2001;345:1748-1757
eloid cells, and a Patient with Familial Mediterranean during
Findings in its expression is up-regulated Fever (Panel
A), a Patient with the Hyper-IgD Syndrome (Panel B), and a Pa- Jan. Feb. Mar. Apr. May June July Aug. Sept. Oct. Nov. Dec.
22
7. TABLE 1. Selected Demographic and Clinical
症状はほぼ全例で Characteristics of FMF Patients
発熱と腹膜炎. Patient Could
Patient Not Be
Contacted Contacted
胸膜炎は7割, 関節炎は4-5割, Characteristic (n = 587) (n = 63) P
丹毒様皮疹が2-3割. Female, (%) 51.4 49.2 0.791
Age at initial visit, yr 32.4 T 12.3 29.8 T 10.3 0.111
(mean T SD)
Age at symptom onset, yr 14.1 T 9.1 13.2 T 8.4 0.449
(mean T SD)
Age at diagnosis, yr 27.1 T 12.4 24.8 T 9.2 0.157
(mean T SD)
Fever, (%) 98.6 96.6 0.228
Peritonitis, (%) 97.7 96.8 0.659
Pleuritis, (%) 68.3 69.8 0.887
Arthritis, (%) 47.8 41.3 0.353
Erysipelas-like 30.4 24.2 0.379
erythema, (%)
failure due to non-amyloid kidney diseases. Three other patients
had proteinuria (2 patients) or renal failure (1 patient) and de-
clined biopsy. In total, 44 (7.5%) patients had renal disease. The
presence of amyloidosis or renal disease was not related to age at
disease onset, disease duration, types of attacks, disease severity
score, colchicine usage, colchicine dosage, or M694V mutation
carrier status. Data for the dates of amyloidosis and FMF diagno-
Medicine 2012;91: 131-136 sis were available for 34 patients. Amyloidosis was diagnosed in
21 of these 34 (62%) patients either before or concomitantly with