Assessing Disease Severity and Activity in Patients with Familial Mediterranean Fever
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Assessing Disease Severity and Activity in Patients with Familial Mediterranean Fever S. Kapoor1,2 To The Editor: Ahsen et al. have provided interesting data in their recent article in your esteemed journal [1]. Interestingly, the past few years have seen the identification of other sensitive markers to assess disease severity and activity in patients with familial Mediterranean fever (FMF). For instance, serum “S100A12” is emerging as a sensitive new marker of disease severity in patients with FMF [2]. Serum S100A12 appears to be a more sensitive marker of subclinical inflammation in patients with FMF, as it is markedly elevated in clinically unaffected homozygous MEFV gene mutation carriers also [3]. For instance, patients with active FMF demonstrate S100A12 levels almost 290 times the levels noted in non-FMF individuals [4]. Addition of colchicine in the form of therapeutic intervention results in a significant decline in serum S100A12 levels [5]. For instance, Kallinich et al. in a recent study reported that the serum S100A12 level in patients with successful response to colchicine therapy was 440 ng/ml in contrast to almost 6,260 ng/ml in patients with persistent symptomatology [6, 7]. Another promising marker to assess disease activity is serum “MRP 8/14” (calprotectin). For instance, serum calprotectin levels are significantly accentuated in individuals with FMF [8]. Dzhndoian has recently demonstrated that the response to therapy with agents such as colchicine can be closely assessed by using serum calprotectin, as levels in general decrease significantly, following successful therapy [9]. Another new and sensitive marker of the disease activity is serum “fetuin-A” [10]. For instance, Oncu et al. in a recent study have demonstrated that serum fetuin-A levels during FMF attacks are markedly lower than serum fetuin-A levels noted in the attack-free period [11]. In fact, a negative association 1 2
Schaumburg, IL, USA To whom correspondence should be addressed at Schaumburg, IL, USA. E-mail: [email protected]
exists between serum fetuin-A levels and serum CRP as well as ESR. A similar negative association exists between serum fetuin-A levels and serum ceruloplasmin levels [12]. Another marker that is increasingly being used to assess disease severity in FMF is serum cystatin-C [13]. For instance, patients with FMF and renal involvement tend to exhibit accentuated serum cystatin-C levels [14]. A recent study has suggested that patients with serum cystatin-C levels greater than 876.5 pg/ml should be routinely screened for renal involvement [15]. In fact, serum cystatin-C is a better and more sensitive than GFR for diagnosing and assessing renal involvement in patients with FMF. The above markers have shown considerable promise so far. Hopefully, the coming few years will see their increased application to assess the disease severity and activity in patients with FMF.
REFERENCES
1. Ahsen A, Ulu MS, Yuksel S, et al. 2014. As a new inflammatory marker for familial Mediterranean fever: neutrophil-to-lymp
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