Anti-TNF agents in familial Mediterranean fever: report of three cases and review of the literature

Abstract

Familial Mediterranean fever (FMF) is an autoinflammatory disease characterized by recurrent fever, peritonitis/pleuritis, or arthritis attacks. Patients may have FMF-associated mutations of pyrin. The role of biologics such as anti-tumor necrosis factor (TNF) agents (infliximab, etanercept, adalimumab, golimumab) and anakinra, canakinumab, or rilonacept in the treatment of FMF needs to be clarified. Herein we present reports of three patients (all were positive for HLA B27) with typical spondylitis associated with FMF who were successfully managed with anti-TNF agents, along with a literature review. The patients were a 37-year-old man with concomitant Crohn's disease and amyloidosis who was treated with infliximab (INF, 5 mg/kg for 3 years) and switched to adalimumab (ADA), and two female patients (a 24-year-old and a 31-year-old) with FMF who developed severe spondylitis and who were also treated with ADA. Anti-TNF agents can control FMF attacks quite effectively and they reveal a promising role in the treatment of FMF-associated amyloidosis and spondylitis.

Autoinflammatory Skin Disorders: The Inflammasome in Focus

“…Anti-TNF treatment in 10 FMF patients non-responsive to colchicine significantly reduces disease episodes with 7 patients showing complete remission of episodes and FMF-associated factors [68]. Similar positive effects of anti-TNF therapy have been observed in FMF patients with amyloidosis and spondylitis [69, 70]. In a recent study, 13 FMF patients received IL-1 blockade (7 due to colchicine resistance, and 6 due to FMF-related amyloidosis) [71].…”

Rheumatoid Arthritis and Familial Mediterranean Fever or Sacroiliitis Accompanied by FMF

“…Nevertheless, phenotypical variations may be seen among patients having the same genotypes [2, 3]. Spinal (i.e., sacroiliitis) and peripheral joint (i.e., knee arthritis) involvements of FMF can be resembling spondyloarthropathies (SpA) features [4]. In addition, it has been notified that sacroiliitis could be seen in 7% of Turkish FMF patients [4].…”

“…Spinal (i.e., sacroiliitis) and peripheral joint (i.e., knee arthritis) involvements of FMF can be resembling spondyloarthropathies (SpA) features [4]. In addition, it has been notified that sacroiliitis could be seen in 7% of Turkish FMF patients [4]. M694V mutation can be encountered significantly higher frequencies in FMF patients with sacroiliitis [4].…”

“…In addition, it has been notified that sacroiliitis could be seen in 7% of Turkish FMF patients [4]. M694V mutation can be encountered significantly higher frequencies in FMF patients with sacroiliitis [4]. Recently, antitumor necrosis factor (TNF) agents have been frequently used to produce a clinical response in patients with resistance to colchicine therapy [4–6].…”

Familial Mediterranean fever with onset in the 70s showing various neutrophilic dermatosis

“…

clinical improvement of psoriasis, could support the hypothesis that IL-17 tear levels constitute the result of IL-17-driven skin inflammation, providing further evidence of the systemic inflammation occurring in psoriasis.However, this study had some limitations including the small number of patients and the enrolled population mainly affected by psoriatic arthritis (62.3% vs. 37.7% by plaque-type psoriasis).The central role of IL-17 has been proven not only in psoriasis but also in dry eye disease, as (i) IL-17 pathway was found upregulated in dry eye patients; (ii) IL-17 disrupted corneal epithelial barrier stimulating metalloproteinase production in human cultured corneal epithelial cells; (iii) desiccating stress-induced dry eye disease in mice models through a T helper 17 response; (iv) corneal epithelial barrier dysfunction in mice models was ameliorated by 10 Because of IL-17 centrality in the pathogenesis of both psoriasis and dry eye disease, this study could provide relevant evidence linking these disorders and, thus, substantiating their epidemiological association.

…”