1. Familial Mediterranean Fever (FMF) In Iranian Traditional Medicine
Majid Avijgan
Professor of Infectious Diseases,
Neda Pari Zangeneh
Resident of Infectious Diseases,
Mahtab Avijgan
Biomedical Science student at UoN,
Shiva Shabani
Resident of Infectious Diseases,

2. Abstract Hereditary disease Mutation in gene MEFV
180 mutations in exon 10
Treatment: Colchicine
Iranian Traditional Medicine and FMF
Trigger agents : physical or emotional exertion, the menstrual cycle, and bleeding in women

3. Theory about FMF Racial and ethic disease Mostly seen in Jews
Sephardi Jews come from western Asia and Africa – Muslim/Arabic countries
Ashkenazi Jews come from Armenia, Germany and France – Christian countries
ITM ancientness

4. Fever overview What is fever? Heat is assigned for animals :
Innate heat
Natural heat
Exogenic heat
Layers in human body :
Main organs
humors
Rouh (Energy movement)

5. Fever overview
Types of fever :
Deghiyeh fever
Kheltiyeh fever
Youmiyeh fever
Regarding the fact that FMF conforms to some characteristics of Youmiyeh fever, thus this type of of fever is explained here. (Youmiyeh fever in most cases will be removed in 24 hours, unless it transforms to another type of fever, but in very rare cases this can last for 3 days.)

6. Daily fever
Youmiyeh fever basis:
Dehydration → exercise, pain, inflammation, dyspepsia, fluid loss, obstruction, hunger and thirst
Reduction in natural heat excretion → sun exposure, cold exposure, filthy skin or swimming in mineral water containing ZAJ and sulfur
High heat production → anger, sadness, overthinking and fear (mental emotional status)

7. Daily fever 9 major symptoms and overview on Daily fever treatment:
Weakness, malaise, sleepiness before fever
Fever without chilly sensation
No high fever
Insidious attack of fever
Cold extremities
Natural face complexion
Fast and large pulse
Normal morning urine
Maximum 24 hours of fever duration

8. Reasons of daily fever Sever sadness (Gham) Faint Worriedness (Hamm)
Excess thirst
Sever fear (Tars)
Excess hunger
Overthinking
Micro-emboly and obstruction
Sever anger (Khashm)
Thickness of skin, filthy skin and obstruction of skin pores
Excess joy (Shadi)
Dyspepsia
Sever insomnia
Inflammation
Long sleeping, no bath/exercise
Hot nature food
Fatigue and pain
Postnasal discharge and rhinorrhea
Body fluid loss
Muscle spasm and twitching
Pain

9. Epidemiology
Epidemic in Mediterranean region (Sephardic Jews, Turks, Arabs, and Armenians)
Prevalence of FMF:
Turkey 1/1000
non-Ashkenazi Jews 1/256 to 1/500
Sephardic and Iraqi Jews 1/250 to 1/1000
Ashkenazi Jews 1/73,000
Armenia 1/500
North African countries, Greece, Germany, France, Italy, the USA, Australia, Canada, India and Japan

10. Molecular genetics and maternal transmission of FMF
Mono gene autosomal recessive disease → mutation in MEFV gene
MEFV is on short section of chromosome of 16p 13.3
5 common mutations for FMF happen in genes:
M694V → Jewish, Turkish, Armenian (sever form)
M680I → Armenian
M694I → Arab
E148Q → European, Turkish (mild form)
V726A → (mild form)
More sever in Armenians in the USA and Turkish kids in Germany
} (as sever as M694V)

11. Theoretical conclusion
Some patients with mutation but no clinical manifestations
Some patients without mutation but with clinical manifestations
Environmental factors (physical or emotional, Diet, Menstruation and 21 factors of ITM) lead to fever
Innate system in conventional medicine and PVS in traditional medicine are main factors for triggering and self-limiting the fever
ITM for decreasing fever temperature recommends Diet, Bath and herbal medicine
Theory: FMF is a type of daily fever in ITM and can be treated too

12. Clinical manifestations
Attack length
1–3 days
Serosa
Pleurisy, peritonitis; asymptomatic pericardial effusions
Skin
Erysipeloid erythema
Joints
Acute monoarthritis; chronic hip arthritis (rare)
Muscle
Exercise-induced myalgia (common); protracted febrile myalgia( rare) GI
Abdominal pain. Some individuals have constipation lasting all the attack length, while diarrhea is more frequent in children. In a small percentage of patients the attacks are characterized by afebrile recurrent abdominal pain.
Eyes, ears
heart
genitourinary
Uncommon
asymptomatic pericardial effusions
Self-limited orchitis, Renal amyloidosis, proteinuria
CNS
Other clinical manifestations
Aseptic meningitis ,headache
protracted febrile myalgia, Relapsing polychondritis

13. Şahru Yüksel1, Lilit Ayvazyan and Armen Yuri Gasparyan
Şahru Yüksel1, Lilit Ayvazyan and Armen Yuri Gasparyan. 3Familial Mediterranean Fever as an Emerging Clinical Model of Atherogenesis Associated with Low-Grade Inflammation. The Open Cardiovascular Medicine Journal, 2010, 4, 51-56

14. Conclusion Duration of fever is less than 3 days
Fever as a major clinical symptom
No complications after relieving
No chills accompanied with fever
No high fever
Self limited of any attack
Geographical distribution

15. Thank you for your attention