Is it possible to predict the need for tonsillectomy in children with PFAPA?

Introduction: Periodic fever, aphthous stomatitis, pharyngitis, andcervical adenitis syndrome (PFAPA) is the most common periodic feverdisorder in children. Tonsillectomy is considered an important optiondue to its positive effects on the resolution of attacks.Objectives: This study aims to identify clinical and laboratory predictors for recommending tonsillectomy in PFAPA patients.Methods: This retrospective, multicenter, cross-sectional studyincluded 20 pediatric rheumatology centers in Turkey. Patients diagnosed with PFAPA according to the Eurofever/PRINTO classificationcriteria between January 2019 and January 2024 were included.Demographic, clinical, and laboratory data were recorded. Surgicaloutcomes and satisfaction were evaluated in operated patients.Results: This study included 1205 PFAPA patients. Tonsillectomy wasrecommended for 332 patients, and 167 underwent the procedure.After tonsillectomy, 69.5% of patients experienced complete resolution of symptoms, while 26% had partial recovery. Overall, 89.2% ofpatients were satisfied with the procedure. The absence of exudativetonsillitis during attacks, along with the presence of pharyngitis orabdominal pain, were significant factors influencing a decision to recommend tonsillectomy. Multivariate analysis showed exudative tonsillitis was a negative predictor (p=0.012), while pharyngitis (p<0.001)and abdominal pain (p<0.001) were positive predictors. Longer attackduration was also associated with tonsillectomy (p=0.043).Conclusion: Identifying which PFAPA patients would benefit from tonsillectomy may contribute to more effective disease management. Inparticular, patients with prolonged attack duration, absence of exudative tonsillitis, and the presence of pharyngitis or abdominal painmay be appropriate candidates for surgical intervention. Given its significant impact on quality of life, tonsillectomy is associated with highpatient satisfaction.