{
  "abstract": "Objectives Türkiye was struck by earthquakes on 6 February 2023. Emerging evidence links psychosocial stress and environmental insults to inflammasome activation. This multicentre study investigated whether the earthquake was associated with changes in the disease course among paediatric patients with familial Mediterranean fever (FMF).Methods Data were collected from 963 paediatric FMF patients (<18 years) across fifteen centres, including three located in the earthquake zone. Monthly attack counts were analysed over an 18-month period (February 2022–August 2023). Analyses were stratified by earthquake exposure and colchicine access (outside the earthquake area; earthquake area with sufficient access; earthquake area with limited access for the first 2 weeks). Primary analyses used multilevel interrupted time-series and difference-in-differences Poisson models for monthly attack counts, and secondary analyses used mixed-effects logistic regression for monthly attack presence (≥1 attack). Both models were stratified by colchicine access and adjusted for clinical covariates.Results In the overall cohort, the February 2023 earthquake was associated with a 35% immediate rise in monthly FMF attack frequency (incidence rate ratio (IRR)=1.35, 95% CI 1.15 to 1.59). This effect was markedly amplified within the earthquake zone: attack frequency increased 2.16-fold in regions with adequate colchicine access (IRR=2.16, 95% CI 1.49 to 3.12) and 3.56-fold in regions with limited access (IRR=3.56, 95% CI 2.79 to 4.55). A significant post-earthquake decline in attacks followed (monthly trend IRR=0.93, 95% CI 0.89 to 0.98), with the fastest recovery in limited-access regions (IRR=0.83, 95% CI 0.78 to 0.89). Findings were consistent in the secondary logistic model.Conclusion FMF patients in the earthquake zone experienced a marked but transient escalation in disease activity after the disaster, with the strongest impact in regions with limited medication access. These findings suggest that not just access to treatment but also psychosocial stress or possibly environmental factors may cause activation of such diseases through the trigger of pyrin-inflammasome.",
  "authors": [
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University, Ankara, Turkey"
      ],
      "name": "Veysel Cam"
    },
    {
      "affiliations": [
        "Social Paediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey"
      ],
      "name": "Siddika Songul Yalcin"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University, Ankara, Turkey"
      ],
      "name": "Ezgi Deniz Batu"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey"
      ],
      "name": "Hatice Melisa Kacmaz"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Nesibe Gökçe Kocamaz"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Marmara University Faculty of Medicine, Istanbul, Turkey"
      ],
      "name": "Özge Günal"
    },
    {
      "affiliations": [
        "Faculty of Medicine, Department of Paediatrics, Division of Rheumatology, Erciyes University, Kayseri, Turkey"
      ],
      "name": "Eda Kayhan"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, TC Sağlık Bakanlığı Samsun Eğitim ve Araştırma Hastanesi, Samsun, Turkey"
      ],
      "name": "Burcu Bozkaya"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Diyarbakir Egitim ve Arastirma Hastanesi, Diyarbakır, Turkey"
      ],
      "name": "Semanur Taşkın"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, TC Sağlık Bakanlığı Ankara Gülhane Eğitim ve Araştırma Hastanesi, Ankara, Turkey"
      ],
      "name": "Vildan Gungorer"
    },
    {
      "affiliations": [
        "Cerrahpaşa Faculty of Medicine, Paediatric Rheumatology, Istanbul University-Cerrahpasa, İstanbul, Turkey"
      ],
      "name": "Elif Kılıç Konte"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Gulsah Pirim"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey"
      ],
      "name": "Dilara Ünal"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Ministry of Health Ankara Etlik City Hospital, Ankara, Turkey"
      ],
      "name": "Semanur Ozdel"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Marmara University Faculty of Medicine, Istanbul, Turkey"
      ],
      "name": "Oya Koker"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Erciyes Universitesi, Kayseri, Turkey"
      ],
      "name": "Aysenur Pac Kısaarslan"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Çukurova Universitesi, Adana, Turkey"
      ],
      "name": "Rabia Miray Kisla Ekinci"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, TC Sağlık Bakanlığ Başakşehir Çam ve Sakura Şehir Hastanesi, İstanbul, Turkey"
      ],
      "name": "Şeyda Dogantan"
    },
    {
      "affiliations": [
        "Facult of Medicine, Department of Paediatrics, Division of Rheumatology, Eskisehir Osmangazi University, Eskişehir, Turkey"
      ],
      "name": "Selcan Demir"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Istanbul Medeniyet University, Istanbul, Turkey"
      ],
      "name": "Kubra Ozturk"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, TC Sağlık Bakanlığı SBÜ Dr Behçet Uz Çocuk Hastalıkları Ve Cerrahisi Eğitim Ve Araştırma Hastanesi, Izmir, Turkey"
      ],
      "name": "Hatice Adıgüzel Dundar"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey"
      ],
      "name": "Ozge Basaran"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Gaziantep University Faculty of Medicine, Gaziantep, Turkey"
      ],
      "name": "Ayşe Balat"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Umraniye Training and Research Hospital, Istanbul, Turkey"
      ],
      "name": "Betul Sozeri"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Istanbul University-Cerrahpasa Cerrahpasa Faculty of Medicine, Istanbul, Turkey"
      ],
      "name": "Ozgur Kasapcopur"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey"
      ],
      "name": "Yelda Bilginer"
    },
    {
      "affiliations": [
        "Department of Paediatrics, Division of Rheumatology, Hacettepe University Faculty of Medicine, Ankara, Turkey"
      ],
      "name": "Seza Ozen"
    }
  ],
  "title": "Multicentre cohort study on the course of paediatric familial Mediterranean fever in the aftermath of the 2023 earthquake",
  "uid": "13ffe24f-fe51-5e58-ba24-c62c3a852449"
}