Ailevi Akdeniz Ateşi Tanısı ile İzlenen Prepubertal Çocuklarda Kemik Mineral Dansitesinin Değerlendirilmesi

Öz

Amaç: Ailevi Akdeniz Ateşi (AAA) otozomal ressesif kalıtılan tekrarlayan atateş, poliserözit ve cilt bulgularıyla karakterize atakler ve remisyonla seyreden kronik periyodik inflamatuvar bir hastalıktır. Bu çalışma, AAA tanısıyla izlenen prepubertal çocuklarda kemik mineral yoğunluğunu (BMD) araştırmak ve kemik yoğunluğu ve hastalığın laboratuvar ve demografik özelikleri arasındaki ilişkiyi saptamak amacıyla yapılmıştır.

Gereç ve Yöntem: Bu çalışmaya AAA tanısıyla takipli ve kolşisin tedavisi alan prepubertal 32 hasta alındı. Hastaların demografik ve klinik verileri, remisyon döneminde akut faz reaktanları, kemik döngüsünün biyokimyasal parametreleri, kemik yaşı, L1-L4 vertebra BMD ölçümleri değerlendirildi. Hastaların sonuçları sağlıklı Türk çocukları için belirlenmiş olan değerlerle karşılaştırıldı.

Bulgular: Hastaların tamamında z skorları -2’den büyüktü, akut faz değerleri, kemik metabolizma belirteçleri normal sınırlar içinde bulundu. aBMD Z-skor ile demografik veriler, akut fazlar ve kemik metabolizma belirteçleri arasında korelasyon saptanmadı.Tanıda gecikme süresi ve BMD arasın- da negatif korelasyon saptandı.

Sonuç: AAA’li çocuklarda aBMD Z-skorları normal olmakla birlikte tanıya geç başlanılan çocuklarda BMD daha düşük bulundu. Erken başlanan kolşisin tedavisi bu hastalarda optimal kemik sağlığı için önemlidir.

Anahtar Kelimeler

• Çocuk
• inflamasyon
• kemik mineral dansitesi

Evaluation of Bone Mineral Density in Prepubertal Children with Familial Mediterranean Fever

Öz

Objective: Familial Mediterranean Fever (FMF) is a hereditary autosomal recessive chronic periodic inflammatory disease, characterized by recurrent fever polyserositis and skin manifestations. The aim of this study was to investigate the bone mineral density (BMD) in prepubertal children with FMF and to determine the relationship between bone density and demographic, laboratory characteristics of the disease.

Material and Method: Thirty two previously diagnosed, attack-free, prepubertal FMF patients who were receiving regular colchicine treatment were included in the study. Demographic and clinical data of patients, acute phase reactants, biochemical parameters of bone turnover, bone age, and L1-L4 vertebral mineral density were evaluated. The results of the patients were compared with values determined for healthy Turkish children.

Results: All of the patients had z-scores which were greater than -2. Acute phase values and bone metabolism markers were within normal limits. No correlation was found between the aBMD Z-score and demographic data, acute phase reactants and bone metabolism markers. There was a negative correlation between delay in diagnosis and aBMD Z- score.

Conclusion: Although aBMD Z-scores were normal in children with FMF the aBMD Z score was found to be lower in children who had had a delay in treatment. Early initiated colchicine therapy is important for optimal bone health in these patients.

Anahtar Kelimeler

• Bone mineral density
• children
• familial mediterranean fever

Kaynakça

1. 1. Kucuk A, Albayrak Gezer I, Ucar R, Karahan AY. Familial mediterranean fever. Acta Medica 2014;57(3):97-104. google scholar
2. 2. Cobankara V, Balkarli A. Ailesel Akdeniz Ateşi. Pam Med J 2011;4(2):86-98. google scholar
3. 3. Duzova A, Bakkaloglu A, Besbas N, Topaloglu R, Ozen S, Ozaltin F, Bassoy Y, Yilmaz E. Role of serum amyloid A (SAA) in monitoring subclinical inflammation and in colchicine dosage in familial Mediterranean fever. Clin Exp Rheumatol 2003;21:509-14. google scholar
4. 4. Siverekli NB, Sahin O, Senel S, Hayta E, Kaptanoglu E, Elden H. Bone mineral density in familial Mediterranean fever. Rheumatol Int 2012;32:2453-7. google scholar
5. 5. Burnham JM. Inflammatory diseases and bone health in children. Curr Opin Rheumatol 2012;24(5):548-53. google scholar
6. 6. Williams KM. Update on Bone Health in Pediatric Chronic Disease. Endocrinol Metab Clin North Am 2016;45(2):433-41. google scholar
7. 7. Specker BL, Schoenau E. Quantitative bone analysis in children: current methods and recommendations. J Pediatr 2005;146(6):726-31. google scholar
8. 8. Pras E, Livneh A, Balow JE Jr, Pras E, Kastner DL, Pras M, Langevitz P. Clinical differences between North African and Iraqi Jews with familial Mediterranean fever. Am J Med Genet 1998;75(2):216-9. google scholar

9. 9. Goksen D, Darcan Ş, Coker M, Kose T. bone mineral density of healthy turkish children and adolescents. Journal of Clinical Densitometry 2006;9(1)84-90. google scholar
10. 10. Slobodnick A, Shah B, Pillinger MH, Krasnokutsky S. Colchicine: old and new. Am J Med 2015;128(5):461-70. google scholar
11. 11. Duzova A, Ozaltın F, Ozon A, Besbas N, Topaloglu R, Ozen S, et al. Bone mineral density in children with familial Mediterranean fever. Clin Rheumatol 2004;23(3):230-4. google scholar
12. 12. Yıldırım K, Karatay S, Çetinkaya R, Uzkeser H, Erdal A, Çapoğlu İ, et al. Bone mineral density in patients with familial Mediterranean fever. Rheumatol Int 2010;30:305-8. google scholar
13. 13. Suyani E, Ozturk MA, Deger SM, Demirag MD, Goker B, Haznedaroglu S. Decreased bone mineral density in adult familial Mediterranean fever patients: a pilot study. Clin Rheumatol 2008;27(9):1171-5. google scholar
14. 14. Yuksel S, Samli H, Colbay M, Dundar U, Acarturk G, Demir S, et al. Increased serum osteoprotegerin levels associated with decreased bone mineral density in familial Mediterranean fever. Tohoku J Exp Med 2009;217(4):321-7. google scholar
15. 15. Koşan C, Sepetçigil O, Çayır A, Kaya A, Özkan B. Evulation bone metabolism in children with familial Mediterranean fever. Turkish J Pediatr Dis 2012;6:139-45. google scholar
16. 16. Bishop N, Arundel P, Clark E, Dimitri P, Farr J, Jones G, et al. International Society of Clinical Densitometry. Fracture prediction and the definition of osteoporosis in children and adolescents: the ISCD 2013 Pediatric Official Positions. J Clin Densitom 2014;17(2):275-80. google scholar
17. 17. Sopher AB, Fennoy I, Oberfield SE. An update on childhood bone health: mineral accrual, assessment and treatment. Curr Opin Endocrinol Diabetes Obes 2015;22:35-40. google scholar
18. 18. Zhang Y, Milojevic D. Protecting Bone Health in Pediatric Rheumatic Diseases: Pharmacological Considerations. Pediatr Drugs 2017;19(3):193-211. google scholar
19. 19. Devogelaer JP, Boutsen Y, Gruson D, Manicourt D. Is there a place for bone turnover markers in the assessment of osteoporosis and its treatment? Rheum Dis Clin N Am 2011;37:365-86. google scholar
20. 20. Dey S, Jahan A, Yadav TP, Bhagwani DK, Sachdev N. Measurement of bone mineral density by dual energy X-ray absorptiometry in juvenile idiopathic arthritis. Indian J Pediatr 2014;81(2):126-32. google scholar
21. 21. Aydın T, Taspınar O, Akbal Y, Peru C, Guler M, Uysal O, et al. Serum bone markers levels and bone mineral density in familial Mediterranean fever. J Phys Ther Sci 2014;26(9):1459-63. google scholar