| Context. The etiology of the recurrent attacks of peritonitis, arthritis, and pleuritis in Familial Mediterranean fever (FMF) is not completely understood. Clinical series reported that emotional, physiological or physical stress precedes the attacks. Unpredictability, different duration and intensity of attacks in the same individual suggest a role of triggers in their etiology.;Objective. To assess and quantify the effect of the reported factors on FMF attacks in Armenian patients.;Design. Case-crossover design with bi-directional sampling of control times. Baseline interviews collected information on personal, medical and family history characteristics. Patients were actively followed-up to ascertain FMF attacks and collect data on exposures. Exposure data prior to the FMF attacks (case windows) were compared to attack-free, random days (control windows). The odds ratio estimates were adjusted for colchicine using conditional logistic regression.;Setting. Patients were recruited from the Center of Medical Genetics, Armenia where molecular testing for FMF is performed.;Participants. A sample of 167 patients, median age 26 years (ranged 9 to 66), 53% male, 71% with genetic diagnosis within a week of enrollment. Genotype was available in 86% of the patients. Majority of patients (72%) did not have any close relative with FMF.;Main outcome measure. FMF attack as self-assessed by the patients.;Exposures. Data on stressful events, strenuous physical activity, menstruation, and high-fat food items (e.g. pork, butter, milk, pastry, etc.) and their occurrence prior to the FMF attacks and control interviews were recorded.;Results. The number of stressful events predicted FMF attacks on the second day after the event. After adjustment for colchicine use, at least one stressful event was associated with estimated 1.94 higher odds of FMF attack on the second day (95%CI: 0.88 to 4.32, p-value = 0.102). An additional stressful event was associated with 70% increase in the odds of FMF attack on the second day (95%CI: 1.04 to 2.79, p-value = 0.035). No positive associations of physical exertion, menstruation, and high-fat diet with increased likelihood of FMF attacks were found.;Conclusion. Stress has a delayed effect on FMF attacks. Preventive efforts need to take place within 2-3 days after stressful events. |
