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  1. Article: Reply to: More erroneous statements about the use of frequentist statistical methods in medical research.

    Livneh, Avi

    Clinical and experimental rheumatology

    2017  Volume 37 Suppl 122, Issue 6, Page(s) 5

    MeSH term(s) Bayes Theorem ; Biomedical Research ; Data Interpretation, Statistical
    Language English
    Publishing date 2017-10-26
    Publishing country Italy
    Document type Letter ; Comment
    ZDB-ID 605886-3
    ISSN 1593-098X ; 0392-856X
    ISSN (online) 1593-098X
    ISSN 0392-856X
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  2. Article ; Online: The Preferential Use of Anakinra in Various Settings of FMF: A Review Applied to an Updated Treatment-Related Perspective of the Disease.

    Giat, Eitan / Ben-Zvi, Ilan / Lidar, Merav / Livneh, Avi

    International journal of molecular sciences

    2022  Volume 23, Issue 7

    Abstract: Familial Mediterranean fever (FMF), the most frequent monogenic autoinflammatory disease, is manifested with recurrent and chronic inflammation and amyloid A (AA) amyloidosis, driven by overproduction of interleukin 1 (IL-1) through an activated pyrin ... ...

    Abstract Familial Mediterranean fever (FMF), the most frequent monogenic autoinflammatory disease, is manifested with recurrent and chronic inflammation and amyloid A (AA) amyloidosis, driven by overproduction of interleukin 1 (IL-1) through an activated pyrin inflammasome. Consequently, non-responsiveness to colchicine, the cornerstone of FMF treatment, is nowadays addressed by IL-1- blockers. Each of the two IL-1 blockers currently used in FMF, anakinra and canakinumab, has its own merits for FMF care. Here we focus on anakinra, a recombinant form of the naturally occurring IL-1 receptor antagonist, and explore the literature by using PubMed regarding the utility of anakinra in certain conditions of FMF. Occasionally we enrich published data with our own experience. To facilitate insights to anakinra role, the paper briefs some clinical, genetic, pathogenetic, and management aspects of FMF. The clinical settings of FMF covered in this review include colchicine resistance, AA amyloidosis, renal transplantation, protracted febrile myalgia, on- demand use, leg pain, arthritis, temporary suspension of colchicine, pediatric patients, and pregnancy and lactation. In many of these instances, either because of safety concerns or a necessity for only transient and short-term use, anakinra, due to its short half-life, is the preferred IL-1 blocker.
    MeSH term(s) Amyloidosis/etiology ; Child ; Colchicine/therapeutic use ; Familial Mediterranean Fever/drug therapy ; Female ; Humans ; Interleukin 1 Receptor Antagonist Protein/therapeutic use ; Interleukin-1 ; Serum Amyloid A Protein
    Chemical Substances Interleukin 1 Receptor Antagonist Protein ; Interleukin-1 ; Serum Amyloid A Protein ; Colchicine (SML2Y3J35T)
    Language English
    Publishing date 2022-04-02
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms23073956
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Screening for Fabry's disease in a high-risk subpopulation of FMF.

    Maller, Tomer / Ben-Zvi, Ilan / Lidar, Merav / Livneh, Avi

    European journal of medical research

    2022  Volume 27, Issue 1, Page(s) 210

    Abstract: Background: Familial Mediterranean fever (FMF) is an autosomal recessive disease associated with mutations in the Mediterranean fever gene (MEFV) that manifests with recurrent episodes of febrile serositis. Fabry's disease (FD) is an X-linked lysosomal ... ...

    Abstract Background: Familial Mediterranean fever (FMF) is an autosomal recessive disease associated with mutations in the Mediterranean fever gene (MEFV) that manifests with recurrent episodes of febrile serositis. Fabry's disease (FD) is an X-linked lysosomal storage disease caused by mutations in the alpha-galactosidase A gene and presents with a wide range of gastrointestinal, skin, vascular, renal and neurological manifestations. FMF and FD share similar manifestations, which may lead to misdiagnosis of one as the other; mostly FD is misdiagnosed as FMF. Moreover, various overlapping manifestations may stem from comorbidities, commonly coupled to FMF (such as Behcet's disease, inflammatory bowel disease, glomerulonephritis, fibromyalgia, and multiple sclerosis), as well as from colchicine adverse effects, which may add to the diagnostic confusion. Thus, we postulated that screening FMF for FD will lead to the identification of patients falsely diagnosed with FMF or who, in addition to FMF, suffer from FD that was previously missed.
    Methods: To identify missed FD among the FMF population, we performed chemical and genetic analyses for FD in blood samples obtained from a cohort of FMF patients followed in the specialized FMF center of our institution. To increase the likelihood of detecting patients with FD, we enriched the surveyed FMF population with patients exhibiting manifestations shared by patients with FD or who deviate from the typical FMF presentation.
    Results and conclusions: Of 172 surveyed FMF patients in a cohort derived from a clinic dedicated to FMF, none had FD. Thus, the postulation of increased odds for detecting FD in patients with FMF was not confirmed. Further exploration for FD in FMF population, is nevertheless recommended.
    MeSH term(s) Humans ; Familial Mediterranean Fever/complications ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/genetics ; Pyrin/genetics ; Fabry Disease/diagnosis ; Fabry Disease/genetics ; Fabry Disease/complications ; alpha-Galactosidase/genetics ; Colchicine ; Mutation
    Chemical Substances Pyrin ; alpha-Galactosidase (EC 3.2.1.22) ; Colchicine (SML2Y3J35T) ; MEFV protein, human
    Language English
    Publishing date 2022-10-21
    Publishing country England
    Document type Journal Article
    ZDB-ID 1329381-3
    ISSN 2047-783X ; 0949-2321
    ISSN (online) 2047-783X
    ISSN 0949-2321
    DOI 10.1186/s40001-022-00846-1
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Diagnosis. Severity scoring system for paediatric FMF.

    Livneh, Avi

    Nature reviews. Rheumatology

    2012  Volume 8, Issue 6, Page(s) 309–310

    Abstract: Severity scoring systems for adult familial Mediterranean fever (FMF) are established and used as important clinical and analytical tools in disease management and research. A recent paper highlights the need for a paediatric FMF severity measure. How ... ...

    Abstract Severity scoring systems for adult familial Mediterranean fever (FMF) are established and used as important clinical and analytical tools in disease management and research. A recent paper highlights the need for a paediatric FMF severity measure. How should such a score be built and what challenges might be faced?
    MeSH term(s) Age of Onset ; Child ; Child, Preschool ; Colchicine/therapeutic use ; Comorbidity ; Disease Progression ; Erysipelas/epidemiology ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/drug therapy ; Familial Mediterranean Fever/epidemiology ; Humans ; Pleurisy/epidemiology ; Prognosis ; Severity of Illness Index
    Chemical Substances Colchicine (SML2Y3J35T)
    Language English
    Publishing date 2012-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2491532-4
    ISSN 1759-4804 ; 1759-4790
    ISSN (online) 1759-4804
    ISSN 1759-4790
    DOI 10.1038/nrrheum.2012.54
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Evaluation of a Proarrhythmic Repolarization Marker (Total Cosine R to T) in Patients With Uncomplicated Familial Mediterranean Fever.

    Nussinovitch, Udi / Stahi, Tomer / Livneh, Avi

    Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases

    2020  Volume 26, Issue 8, Page(s) 334–337

    Abstract: Familial Mediterranean fever (FMF) is a systemic autoinflammatory disorder characterized by recurrent attacks of fever and serous inflammation. The association between FMF and risk of cardiac arrhythmia is continuously questioned; some studies report ... ...

    Abstract Familial Mediterranean fever (FMF) is a systemic autoinflammatory disorder characterized by recurrent attacks of fever and serous inflammation. The association between FMF and risk of cardiac arrhythmia is continuously questioned; some studies report abnormal cardiac repolarization, while others do not. Considering this controversy, we aim to perform in a large cohort of FMF patients a total cosine R to T (TCRT) analysis, a previously unexplored repolarization marker in this disorder.
    Methods: The study group included 56 FMF patients without amyloidosis, diagnosed with FMF according to published criteria and 131 control subjects, unaffected with FMF. A 12-lead electrocardiogram (ECG) was performed according to strict standards. Electrocardiogram files were processed with Python-based computer software. Patients were followed for 10 to 12 years, and the rate of cardiac complications was evaluated.
    Results: Other than FMF and prescription of colchicine, both groups had similar medical and demographic background. TCRT results were similar for a randomly selected beat (0.40 ± 0.06 vs 0.50 ± 0.04, p > 0.05) and for an averaged beat (0.39 ± 0.06 vs 0.50 ± 0.04, p > 0.05) in FMF patients and control subjects, respectively. Correction of average TCRT for heart rate also resulted in similar TCRTc values in patients and control groups (0.42 ± 0.07 s vs 0.51 ± 0.05 s, respectively, p > 0.05). During the follow-up period, none of the patients died, and no patient developed clinical symptoms suggestive of ventricular arrhythmias.
    Conclusions: Colchicine treated uncomplicated FMF patients have normal TCRT and TCRTc values, implying low risk for cardiac arrhythmias in this population. Future studies should evaluate the sensitivity and specificity of this marker in high-risk FMF populations, such as those who developed AA amyloidosis.
    MeSH term(s) Amyloidosis ; Arrhythmias, Cardiac/diagnosis ; Arrhythmias, Cardiac/epidemiology ; Arrhythmias, Cardiac/etiology ; Colchicine ; Electrocardiography ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/drug therapy ; Familial Mediterranean Fever/epidemiology ; Humans
    Chemical Substances Colchicine (SML2Y3J35T)
    Language English
    Publishing date 2020-07-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1283266-2
    ISSN 1536-7355 ; 1076-1608
    ISSN (online) 1536-7355
    ISSN 1076-1608
    DOI 10.1097/RHU.0000000000001465
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article: Familial mediterranean fever: a continuously challenging disease.

    Livneh, Avi

    The Israel Medical Association journal : IMAJ

    2011  Volume 13, Issue 4, Page(s) 197–198

    MeSH term(s) Familial Mediterranean Fever/complications ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/genetics ; Genetic Association Studies ; Humans
    Language English
    Publishing date 2011-04
    Publishing country Israel
    Document type Introductory Journal Article
    ZDB-ID 2008291-5
    ISSN 1565-1088 ; 0021-2180
    ISSN 1565-1088 ; 0021-2180
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Familial Mediterranean fever (FMF)-response to TNF-blockers used for treatment of FMF patients with concurrent inflammatory diseases.

    Haj-Yahia, Soad / Ben-Zvi, Ilan / Lidar, Merav / Livneh, Avi

    Joint bone spine

    2021  Volume 88, Issue 5, Page(s) 105201

    Abstract: Objective: Familial Mediterranean fever (FMF) is the most common interleukin 1 (IL-1)-driven monogenic autoinflammatory disease. Yet published data also suggest that tumor necrosis factor (TNF) may have a role in the pathogenesis of FMF and may serve as ...

    Abstract Objective: Familial Mediterranean fever (FMF) is the most common interleukin 1 (IL-1)-driven monogenic autoinflammatory disease. Yet published data also suggest that tumor necrosis factor (TNF) may have a role in the pathogenesis of FMF and may serve as a target for treatment. In the present study we evaluate this hypothesis.
    Methods: To this goal, we studied the incidental effect on FMF of TNF-directed treatment, administered to colchicine-refractory FMF patients for the management of a concurrent inflammatory disease. The rates of FMF patients and of treatments with complete or nearly complete FMF response were determined, based on the number of FMF attacks during TNF-blocker exposures. The possible effect of various FMF and non-FMF features on the outcome was determined using comparative analysis. Patients were identified and data were retrieved using electronic files from the FMF clinic.
    Results: Twenty-six patients were identified, each receiving ≥1 of four TNF-blockers for a mean duration of 27.6±16.4months. The TNF-blockers were found to induce complete or nearly complete FMF response in 10 (38.5%) of the patients, and in 13 of 50 (26%) exposures. No clinical, genetic, demographic, or therapeutic feature could predict which FMF patient would respond favorably to TNF-blocker therapy.
    Conclusion: This study suggests that TNF-blockers may be beneficial for a small proportion of colchicine-resistant FMF patients.
    MeSH term(s) Colchicine/therapeutic use ; Familial Mediterranean Fever/complications ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/drug therapy ; Humans ; Interleukin-1 ; Tumor Necrosis Factor Inhibitors ; Tumor Necrosis Factor-alpha
    Chemical Substances Interleukin-1 ; Tumor Necrosis Factor Inhibitors ; Tumor Necrosis Factor-alpha ; Colchicine (SML2Y3J35T)
    Language English
    Publishing date 2021-04-28
    Publishing country France
    Document type Journal Article
    ZDB-ID 2020487-5
    ISSN 1778-7254 ; 1297-319X
    ISSN (online) 1778-7254
    ISSN 1297-319X
    DOI 10.1016/j.jbspin.2021.105201
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  8. Article ; Online: Diagnostic Challenges and Solutions in Systemic Amyloidosis.

    Goldis, Rivka / Kaplan, Batia / Kukuy, Olga Lesya / Arad, Michael / Magen, Hila / Shavit-Stein, Efrat / Dori, Amir / Livneh, Avi

    International journal of molecular sciences

    2023  Volume 24, Issue 5

    Abstract: Amyloidosis refers to a clinically heterogeneous group of disorders characterized by the extracellular deposition of amyloid proteins in various tissues of the body. To date, 42 different amyloid proteins that originate from normal precursor proteins and ...

    Abstract Amyloidosis refers to a clinically heterogeneous group of disorders characterized by the extracellular deposition of amyloid proteins in various tissues of the body. To date, 42 different amyloid proteins that originate from normal precursor proteins and are associated with distinct clinical forms of amyloidosis have been described. Identification of the amyloid type is essential in clinical practice, since prognosis and treatment regimens both vary according to the particular amyloid disease. However, typing of amyloid protein is often challenging, especially in the two most common forms of amyloidosis, i.e., the immunoglobulin light chain amyloidosis and transthyretin amyloidosis. Diagnostic methodology is based on tissue examinations as well as on noninvasive techniques including serological and imaging studies. Tissue examinations vary depending on the tissue preparation mode, i.e., whether it is fresh-frozen or fixed, and they can be carried out by ample methodologies including immunohistochemistry, immunofluorescence, immunoelectron microscopy, Western blotting, and proteomic analysis. In this review, we summarize current methodological approaches used for the diagnosis of amyloidosis and discusses their utility, advantages, and limitations. Special attention is paid to the simplicity of the procedures and their availability in clinical diagnostic laboratories. Finally, we describe new methods recently developed by our team to overcome limitations existing in the standard assays used in common practice.
    MeSH term(s) Humans ; Immunoglobulin Light-chain Amyloidosis ; Proteomics/methods ; Amyloid/metabolism ; Amyloid Neuropathies, Familial ; Amyloidogenic Proteins
    Chemical Substances Amyloid ; Amyloidogenic Proteins
    Language English
    Publishing date 2023-02-28
    Publishing country Switzerland
    Document type Journal Article ; Review
    ZDB-ID 2019364-6
    ISSN 1422-0067 ; 1422-0067 ; 1661-6596
    ISSN (online) 1422-0067
    ISSN 1422-0067 ; 1661-6596
    DOI 10.3390/ijms24054655
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  9. Article: Late ventricular potentials in familial Mediterranean fever with and without AA amyloidosis.

    Nussinovitch, Udi / Livneh, Avi

    European journal of rheumatology

    2017  Volume 4, Issue 3, Page(s) 184–188

    Abstract: Objective: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by episodic and chronic inflammation that may lead to both accelerated coronary atherosclerosis and cardiac AA amyloidosis. We hypothesized that late ... ...

    Abstract Objective: Familial Mediterranean fever (FMF) is an autosomal recessive disease characterized by episodic and chronic inflammation that may lead to both accelerated coronary atherosclerosis and cardiac AA amyloidosis. We hypothesized that late ventricular potentials (LPs), an established electrocardiographic susceptibility marker of ventricular arrhythmias, will be more common in FMF than in the adjusted normal population due to these two types of inflammation-associated cardiac effects. Therefore, we aimed to evaluate the occurrence of LPs in FMF patients with and without amyloidosis.
    Material and methods: Signal-averaged electrocardiography was performed in consecutive patients with FMF using the Frank corrected orthogonal lead system. At least 200 consecutive beats were digitally recorded and averaged, and the presence of LPs was determined according to acceptable thresholds.
    Results: There were 54 patients with colchicine-treated FMF, of whom 14 had biopsy-proven AA amyloidosis. None of the uncomplicated FMF patients and 2 of the 14 FMF amyloidosis patients had abnormal or borderline LPs.
    Conclusion: Based on LPs as a susceptibility marker for arrhythmia, FMF patients, including the large majority of FMF patients with amyloidosis, are seemingly not at an increased risk to develop arrhythmias.
    Language English
    Publishing date 2017-09-01
    Publishing country Turkey
    Document type Journal Article
    ZDB-ID 2873727-1
    ISSN 2148-4279 ; 2147-9720
    ISSN (online) 2148-4279
    ISSN 2147-9720
    DOI 10.5152/eurjrheum.2017.16113
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  10. Article: Effect of interleukin-1 inhibition in a cohort of patients with colchicine-resistant familial Mediterranean fever treated consecutively with anakinra and canakinumab.

    Druyan, Amit / Giat, Eitan / Livneh, Avi / Grossman, Chagai / Ben-Zvi, Ilan / Lidar, Merav

    Clinical and experimental rheumatology

    2021  Volume 39 Suppl 132, Issue 5, Page(s) 75–79

    Abstract: Objectives: To evaluate the efficacy of IL-1 blockers in a cohort of patients with colchicine-resistant familial Mediterranean fever (crFMF) treated consecutively with anakinra and canakinumab.: Methods: Patients with crFMF treated with anakinra and ... ...

    Abstract Objectives: To evaluate the efficacy of IL-1 blockers in a cohort of patients with colchicine-resistant familial Mediterranean fever (crFMF) treated consecutively with anakinra and canakinumab.
    Methods: Patients with crFMF treated with anakinra and canakinumab in any order were identified using the computerised database of Sheba Medical Centre. Background characteristics of the patients, reason for switching IL-1 inhibitor, and frequency of attacks under colchicine only, anakinra, and canakinumab were extracted from the computerised patient files. Patients were then interviewed for patient-reported outcomes.
    Results: A total of 46 patients in our clinic were prescribed canakinumab for crFMF after previous anakinra treatment, whereas no patients who switched treatment from canakinumab to anakinra were identified. Of those, 23/46 patients (50%) discontinued anakinra due to inadequate response (11 of them with secondary failure after a good initial response). Frequency of flares was significantly decreased following switch to canakinumab from anakinra treatment (p<0.01). After the switch to canakinumab, the median duration of flares, the severity of pain during a flare, and the patient's global assessment of disease activity were all significantly decreased (p≤0.01), according to the reports from the patients.
    Conclusions: Canakinumab is an effective treatment for FMF after failure of anakinra due to any cause.
    MeSH term(s) Antibodies, Monoclonal, Humanized ; Colchicine ; Familial Mediterranean Fever/diagnosis ; Familial Mediterranean Fever/drug therapy ; Humans ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1 ; Treatment Outcome
    Chemical Substances Antibodies, Monoclonal, Humanized ; Interleukin 1 Receptor Antagonist Protein ; Interleukin-1 ; canakinumab (37CQ2C7X93) ; Colchicine (SML2Y3J35T)
    Language English
    Publishing date 2021-07-22
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 605886-3
    ISSN 1593-098X ; 0392-856X
    ISSN (online) 1593-098X
    ISSN 0392-856X
    DOI 10.55563/clinexprheumatol/rrr9zd
    Database MEDical Literature Analysis and Retrieval System OnLINE

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