{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:58:05Z","timestamp":1791208685905,"version":"4.1.0"},"reference-count":0,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"Abstract<\/jats:title>\n \n Objectives<\/jats:title>\n In our study, we aimed to determine the frequency of attack-triggering factors in pediatric patients with colchicine-resistant familial Mediterranean fever (FMF), to examine their relationship with genotype, and to evaluate changes in these factors following treatment with an IL-1 antagonist.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Between January 2024 and February 2025, 86 pediatric FMF patients (36 colchicine-resistant, 50 colchicine-responsive) who met the Eurofever criteria were included in this study. Patients were questioned for the presence of potential attack-triggering factors, including psychological stress, cold exposure, seasonal changes, physical activity, infections, fatigue, prolonged standing, long-distance travel, menstruation, starvation, sleeplessness, and the consumption of high-fat foods. In the colchicine-resistant group, triggering factors were assessed before and after anti-IL-1 treatment.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n At least one triggering factor was identified in 82.6% of patients, which was more common in colchicine-resistant patients than in colchicine-responsive patients (94.4% vs. 74%, p=0.014). The most common triggers in resistant patients were cold exposure (88.2%), stress (70.6%), physical activity (67.6%), seasonal changes (65.6%), and infection (58.8%). Following IL-1 antagonist treatment, the frequency of patient-reported attacks associated with triggering factors decreased significantly (mean 29% to 14%, p&lt;0.001). M694V homozygosity was associated with a higher frequency of specific triggering factors, including cold exposure, physical activity, and fatigue. Multivariable analysis revealed that severe disease activity (ISSF) (OR: 6.23) and longer disease duration (OR: 1.22) were independent predictors of the presence of triggering factors.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although triggering factors were more frequently reported in patients with colchicine-resistant pediatric FMF, disease severity and disease duration were independently associated with their presence. IL-1 antagonist therapy substantially reduced both trigger-associated attacks and triggering factors. Recognition of modifiable triggers and their genetic associations may support personalized management and improved disease control.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/mr\/roag086","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:46:48Z","timestamp":1790941608000},"source":"Crossref","is-referenced-by-count":0,"title":["Triggering Factors in Pediatric Familial Mediterranean Fever: A New Perspective on Colchicine Resistance"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8178-8386","authenticated-orcid":false,"given":"Hatice Kubra","family":"Zora","sequence":"first","affiliation":[{"name":"Division of Pediatric Rheumatology, Department of Pediatrics, Uludag University , Bursa ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5284-5238","authenticated-orcid":false,"given":"Osman","family":"Donmez","sequence":"additional","affiliation":[{"name":"Division of Pediatric Rheumatology, Department of Pediatrics, Uludag University , Bursa ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1199-1706","authenticated-orcid":false,"given":"Hatice","family":"Ortac","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Uludag University , Bursa ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6753-9584","authenticated-orcid":false,"given":"Berkant","family":"Ersoy","sequence":"additional","affiliation":[{"name":"Division of Pediatric Rheumatology, Department of Pediatrics, Uludag University , Bursa ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8571-2581","authenticated-orcid":false,"given":"Sara Sebnem","family":"Kilic","sequence":"additional","affiliation":[{"name":"Division of Pediatric Rheumatology, Department of Pediatrics, Uludag University , Bursa ,","place":["Turkey"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,5]]},"container-title":["Modern Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roag086\/71603298\/roag086.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/mr\/advance-article-pdf\/doi\/10.1093\/mr\/roag086\/71603298\/roag086.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T13:11:14Z","timestamp":1791205874000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/mr\/advance-article\/doi\/10.1093\/mr\/roag086\/8864917"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":0,"URL":"https:\/\/doi.org\/10.1093\/mr\/roag086","relation":{},"ISSN":["1439-7595","1439-7609"],"issn-type":[{"value":"1439-7595","type":"print"},{"value":"1439-7609","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"article-number":"roag086"}}