PFAPA syndrome and Behçet’s disease: a comparison of two medical entities based on the clinical interviews performed by three different specialists

Luca Cantarini, Antonio Vitale, Giulia Bersani, Laura Martin Nieves, Marco Cattalini, Giuseppe Lopalco, Francesco Caso, Luisa Costa, Florenzo Iannone, Giovanni Lapadula, Mauro Galeazzi, Angela Ceribelli, Enrico Brunetta, Carlo Selmi, Donato Rigante

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

The pediatric syndrome characterized by periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) and adult Behçet’s disease share some clinical manifestations and are both polygenic autoinflammatory disorders with interleukin-1β showing to play a pivotal role. However, the diagnosis is mostly clinical and we hypothesize that specific criteria may be addressed differently by different physicians. To determine the diagnostic variability, we compared the answers of 80 patients with a definite diagnosis of Behçet’s disease (age 42.1 ± 13.7 years) obtained by separate telephone interviews conducted by a rheumatologist, a pediatrician, and an internist working largely in the field of autoinflammatory disorders. Questions were related to the age of symptom onset, the occurrence of recurrent fevers during childhood, and the association with oral aphthosis, cervical adenitis and/or pharyngitis, previous treatments, possible growth impairment, the time lapse between PFAPA-like symptoms and the onset of Behçet’s disease, and the occurrence of Behçet-related manifestation during childhood. The rheumatologist identified 30 % of patients with Behçet’s disease fulfilling PFAPA syndrome diagnostic criteria, compared to the pediatrician and the internist identifying 10 and 7.5 %, respectively. Most of the patients suffered from recurrent oral aphthosis in childhood also without fever (50, 39, and 48 % with each interviewer), yet no patient fulfilled the Behçet’s disease diagnostic criteria. Our data suggest that physician awareness and expertise are central to the diagnosis of autoinflammatory disorders through an accurate collection of the medical history.

Original languageEnglish (US)
Pages (from-to)501-505
Number of pages5
JournalClinical Rheumatology
Volume35
Issue number2
DOIs
StatePublished - Feb 1 2016

Keywords

  • Autoinflammation
  • Behçet’s disease
  • Interleukin-1
  • PFAPA syndrome

ASJC Scopus subject areas

  • Rheumatology

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    Cantarini, L., Vitale, A., Bersani, G., Nieves, L. M., Cattalini, M., Lopalco, G., Caso, F., Costa, L., Iannone, F., Lapadula, G., Galeazzi, M., Ceribelli, A., Brunetta, E., Selmi, C., & Rigante, D. (2016). PFAPA syndrome and Behçet’s disease: a comparison of two medical entities based on the clinical interviews performed by three different specialists. Clinical Rheumatology, 35(2), 501-505. https://doi.org/10.1007/s10067-015-2890-5