Multicentre cohort study on the course of paediatric familial Mediterranean fever in the aftermath of the 2023 earthquake

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.