Do you suddenly get a fever without warning? Do you also have a stomach ache, a feeling of tightness in your chest, or joint pain? Sometimes these symptoms go away after a few days, only to reappear after a while? It's normal to feel very scared when this happens. Today we're going to talk about a disease that causes these symptoms, which is a bit strange, but very important to know about.
What is `Familial Mediterranean Fever (FMF)`?
Simply put, Familial Mediterranean Fever, or FMF for short, is a lifelong condition that comes from our genes. What happens in this is that, for no apparent reason, we suddenly get a fever, and at the same time, there is inflammation in various parts of the body. To be precise, this is something that happens due to a small problem in our own immune system. That is why it is also called an autoinflammatory disease .
It mainly affects people living in Mediterranean countries. It causes inflammation of the thin membranes called `serous membranes` (these cover areas such as the chest cavity and abdominal cavity), called `serositis`. It can also cause inflammation of the `synovial membranes` that cover our joints, called `synovitis`. Symptoms usually last for a few days and then subside.
What are the symptoms of FMF?
FMF symptoms usually begin in childhood, before the age of 20. These symptoms may be severe at first, but they may gradually improve as you get older. Once you have the disease, you may not have any symptoms for weeks, months, or even years. However , early detection and treatment can help reduce symptoms and prevent long-term complications such as amyloidosis.
Now let's see what these symptoms are:
- A high fever of up to 40.6 degrees Celsius (105 Fahrenheit), sometimes accompanied by chills and shivering.
- It may come with a headache and stiff neck.
- Stomach pain and bloating (bloating).
- The stomach muscles become tight and constipation may occur.
- Chest pain , which increases when breathing.
- Joint pain and swelling (often in one joint).
- Swelling and pain in the testicles in men.
- Muscle aches , especially in the lower body.
- A red, raised skin lesion may develop on the legs .
These symptoms can appear suddenly within a few hours. However, not everyone will have all of these symptoms . Fever is the most common. In childhood, a fever may be the only symptom. The illness usually lasts for a few days.
Prodromal Symptoms of FMF
Some people start to feel small symptoms a few days before the onset of this fever. Just like some people feel it before a ``migraine`` or women feel it before their ``menstruation``. We call these ``prodromal symptoms`` . When you feel these, you get a hint that ''Ah... now that trouble is coming''.
What are these telltale signs?
- Anxiety, restlessness
- Irritability
- Headache
- Nausea
- Body pain
- Malaise ( lack of enthusiasm, lifelessness )
Why does this `FMF` occur?
This is due to changes in the `MEFV` gene in our body. This `MEFV` gene helps to make a very important protein, namely a protein called `pyrin`. Our innate immune system – that is, the part of the immune system that works against threats such as sudden infections – relies on this `pyrin` protein. So, when the `MEFV` gene cannot make `pyrin` properly, that protein cannot work properly within the immune system. That is when this problem occurs.
About 30 genetic mutations (`variations`) that cause `FMF` have been identified. Of these, the most common are `V726A`, `M680I`, `E148Q`, `M694V` and `M694I`. These are most common in populations of Mediterranean and Middle Eastern origin. For example:
- Arabs
- Armenians
- Greeks
- Iranians
- Italians
- Jewish people
- Kurds
- Turks
Triggers for FMF
Although FMF often seems to come on suddenly and without any apparent reason, for some people it is triggered by certain things. For some people, the condition can be triggered by physical or mental stress. People say that FMF can be triggered by things like:
- Exposure to cold
- Exercise or excessive fatigue
- A recent infection
- A recent injury or surgery
- Severe stress (like a major life problem)
- The time when women have their monthly period or ovulation
Possible complications of FMF
Although the fever of FMF subsides after a few days, the continuous inflammation in the body can affect our body over time. That is why doctors recommend continuous treatment for this. When there is a continuous inflammatory process like this, our immune system is put under great pressure, and other diseases can also occur.
The most serious complication of this is a condition called `secondary amyloidosis` . This can even lead to kidney failure. That's why it's very important to be careful about this.
Other complications can also include:
- Splenomegaly (splenomegaly)
- Infertility
- Other autoimmune diseases (`Secondary autoimmune disease`)
How is FMF diagnosed?
How does a doctor diagnose FMF? They do things like:
- They will carefully listen to your symptoms, how often they occur, and how long they have been present .
- They will ask if anyone in your family has had this disease and what your genetic heritage is like .
- When you are sick, they will examine you to see if there is any inflammation or irritation in your body .
- During illness , blood tests are done to see if there are any signs of inflammation .
- Genetic testing is recommended to check for mutations in the MEFV gene, which most commonly causes FMF.
- They will also look at how you respond to the treatments for FMF.
Treatment for `FMF`
The main treatment for FMF is the anti-inflammatory drug colchicine. This works by reducing the activity of a type of white blood cell called neutrophils, which are involved in inflammation. Colchicine can help prevent or reduce the frequency of FMF flares, and reduce the risk of complications. More than 90% of people with FMF are cured . Most people have to take this medication every day for the rest of their lives.
However, a very small number of people do not get the desired results from colchicine, or they may not be able to take this medicine due to other health reasons. For such people, doctors suggest other types of medication. Some of them are:
- `Anakinra` (`Anakinra`)
- `Rilonacept`
- `Canakinumab`
What happens if you have `FMF`?
Although there is no cure for FMF, it can be managed well with medication . For many people, the fever and body aches stop completely when they start taking medication. For others, the frequency of flare-ups decreases and the frequency of flare-ups decreases. However, for these medications to work properly, they must be taken regularly, even when they are not symptomatic . Taking these medications when the disease is already present will not stop the disease immediately. These medications only prevent the disease from occurring.
Can FMF be prevented?
Many people don't even know they have the gene variant that causes FMF. To get FMF, you need to get two copies of the gene variant from both your mother and father. If you only have one copy, you won't have symptoms of FMF. But you can pass that gene variant on to your children. If your partner also has that gene variant, your children may have FMF. Genetic testing can help you find out if you are a carrier of the gene variant.
There have been reports of such frequent fevers since ancient times. Perhaps this disease called `FMF` is just as old. Some researchers think that this condition may have arisen as a way to help fight off major infections like `tuberculosis` that were widespread at the time. In fact, there are some benefits to having inflammation in the body, but it is only when it becomes too much that it becomes problematic. Fortunately, there are now good drugs to control this condition. So even if you have `FMF`, you can live a normal life.
The most important thing for you to remember! (Take-Home Message)
Okay, so now you have a better understanding of what we talked about today, `FMF`. The most important thing is that if you or someone in your family has a fever for no reason, stomach ache, joint pain, etc., do not dismiss it as just a cold, but see a doctor to find out exactly what is going on. If you recognize the disease and start treatment early, you can prevent many complications and live a normal life. Remember, it is also very important to use the medicine your doctor prescribes exactly, as directed. Don't forget to talk to your doctor about any questions or concerns you may have.
` FMF, familial fever syndrome, frequent fevers, stomach aches, joint pain, genetic diseases, colchicine, amyloidosis
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