Rheumatology & Rehabilitation, Mansoura University Hospitals, Mansoura, Egypt.
Community & Public Health, Mansoura University Faculty of Medicine, Mansoura, Egypt.
Mod Rheumatol. 2023 Jul 4;33(4):830-835. doi: 10.1093/mr/roac068.
To explore early features that can predict colchicine resistance in familial Mediterranean fever (FMF) patients.
It included FMF cases who fulfilled the Yalcinkaya-Ozen criterion and were on colchicine for at least 6 months. Data were collected from medical files and interpreted with respect to clinical parameters, incluing the auto-inflammatory diseases activity index (AIDAI) and FMF severity score. FMF50 score assessed the treatment response. Laboratory findings and genetic analysis of Mediterranean fever (MEFV) mutations were evaluated according to the standard technique. Patients were classified into two groups according to their response to colchicine. Both groups were compared, and significant variables were entered into a logistic regression model to detect independent predictors. The diagnostic accuracy of these predictors was assessed using the receiver operating characteristic curve.
In all, 120 FMF children were included. After the exclusion of 16 non-compliant patients (13.3%), colchicine responders were 66 (63.4%) (group I) and colchicine-resistant cases (group II) were 38 (36.5%). The fever duration after colchicine, number of attacks before/after colchicine, skin rash/erysipelas-like erythema, myalgia/protracted febrile myalgia, AIDAI before/after treatment, FMF severity score, and the maximum colchicine dose were higher in group II. Furthermore, high C-reactive protein and neutropenia were frequent in group II. However, different MEFV mutations, including M694V were similar between the two groups. Eight variables were detected in the regression analysis model, and independent predictors were utilized to generate a scoring model.
This study constructed a prediction model for colchicine nonresponse based on clinical and laboratory profiles. This model will be valuable for the treatment decisions of FMF children.
探讨家族性地中海热（FMF）患者对秋水仙碱耐药的早期预测特征。
纳入符合 Yalcinkaya-Ozen 标准且至少服用秋水仙碱 6 个月的 FMF 病例。从病历中收集数据，并根据临床参数（包括自身炎症性疾病活动指数（AIDAI）和 FMF 严重程度评分）进行解释。采用 FMF50 评分评估治疗反应。根据标准技术评估实验室发现和地中海热（MEFV）突变的基因分析。根据对秋水仙碱的反应将患者分为两组。比较两组，将有意义的变量纳入逻辑回归模型，以检测独立预测因子。使用受试者工作特征曲线评估这些预测因子的诊断准确性。
共纳入 120 例 FMF 儿童。排除 16 例不依从患者（13.3%）后，秋水仙碱反应者 66 例（63.4%）（组 I），秋水仙碱耐药者 38 例（36.5%）（组 II）。秋水仙碱后发热持续时间、秋水仙碱前/后发作次数、皮疹/类丹毒样红斑、肌痛/发热性肌痛、治疗前后 AIDAI、FMF 严重程度评分和最大秋水仙碱剂量在组 II 中更高。此外，组 II 中 C 反应蛋白升高和中性粒细胞减少更为常见。然而，两组之间不同的 MEFV 突变，包括 M694V，相似。回归分析模型检测到 8 个变量，利用独立预测因子生成评分模型。
本研究基于临床和实验室特征构建了秋水仙碱无反应预测模型。该模型将对 FMF 儿童的治疗决策具有重要价值。
