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National Pediatric Center of FMF 
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National Pediatric Center of FMF 

 

Periodic Disease or Familial Mediterranean Fever is considered an ethnic disease for the Armenian population and has a high frequency of carrying MEFV gene mutations (1 : 3 - 4). The FMF usually manifests in childhood. 

 

In Armenia, starting from 80s, the Department of Pediatrics of the Yerevan State Medical University has been engaged in the study of FMF in children under the leadership of the head of the department, corresponding member of the USSR Academy of Medical Sciences, Professor V. A. Astvatsatryan. Later, in 1998, by the decision of the Ministry of Health of the RA, the National Pediatric Center of FMF was formed as a part of “Arabkir” MC-ICAH. 

 

The NPC of FMF aims at prevention of FMF complications in children by organizing early diagnosis, dispensary monitoring and continuous treatment. Since 2003, the NPC of FMF has been implementing the “Early diagnosis and treatment of FMF in children” long-running project under the patronage of the MOH of the RA, cooperating with YSMU and the Center of Medical Genetics /CMG/. In 2003-2015 the program was also sponsored by the “Howard Karagheusian” Medical Benevolent Public Organization. Within the framework of the project, more than 3400 children with FMF are being monitored at the dispensary and treated continuously with colchicine until they reach the age of 18 (under the state order).

 

Fields of activity of NPC of FMF 

 

NPC of FMF carries out professional work in the following directions:
 

    Medical`

  • inpatient - at the General Pediatric Department of “Arabkir” MC-ICAH the final diagnosis of FMF patients is determined and colchicine treatment is started.

  • outpatient, where following services are provided:

    1. Dispensary monitoring of FMF 

The dispensary care of FMF patients is carried out in the dispensary of the NPC of FMF, under the state order. Currently, 3450 patients with FMF under 18 are registered at the dispensary. The latter includes medical counseling (2-3 times a year), examination and continuous colchicine treatment until the age of 18. The Ministry of Health of the RA provides quality colchicine of Armenian production /ArpiMed Pharmaceutical Company/ to FMF patients under 18 registered at the dispensary. 

2. Outpatient counseling of patient with suspected FMF and visits to the regions of Armenia for preliminary detection of children with suspected FMF and for referral to “Arabkir” MC final diagnosis

 

    Scientific`  

  • scientific research related to FMF (in particular, research of FMF cases with atypical course, combined with other autoimmune diseases, the epidemiology of cases, study of complications, such as kidney amyloidosis, adhesion-related disorder)

  • implementation of FMF scientific projects and cooperation with international organizations (ISSAIDs, PRINTO, PReS, ESPGHAN), as well as YSMU and CMG. In particular, since 2013, the “FMF in children: atypical type, clinical and genetic features of complicated FMF cases and cases combined with immune diseases” project has been implemented jointly

  • participation in international congresses and conferences related to FMF and autoimmune diseases

  • publication of scientific articles

  • defense of scientific theses
     

    Educational, methodical, organizational 

  • regular visits to the regions of the RA and the Republic of Artsakh (together with the Armenian Pediatric Association, APA), lectures and practical training for medical personnel (together with YSMU), talks with parents, open-days (examination of suspected FMF patients) 

  • participation in APA pediatric schools and YSMU conferences (lectures, FMF case discussions).

  • development and publication of guidelines, manuals, fact-sheets

               1. for doctors, nurses, clinical residents (in Armenian, Russian)

               2. for patients and their parents

 

Achievements of the NPC of FMF thanks to the “Early diagnosis of FMF in children and regular treatment with colchicine” long-running project.

 

  • A significant decrease of kidney amyloidosis, the main complication of FMF, over the past 17 years. From 2003 to 2020, only 0.075% of patients had kidney amyloidosis as a complication. In the recent past, in the absence of colchicine treatment and monitoring of the disease, amyloidosis occurred in 16.2% of FMF patients under 15. 

  • Improvement of FMF early diagnosis: since 2003, the total number of FMF patients under 18 monitored at the dispensary has increased 6-7 times (from 500 up to 3400 children), and the number of new cases registered annually reaches about 300-350.

  • Improving the information and applicability of FMF of the national population.

  • Regular continuous monitoring of FMF patients according to international guidelines and provision of free treatment with colchicine (>1 000 000 tab/year; 1mg).

  • Improvement of physical growth and development of children with FMF registered in dispensary care.

  • Regular genetic tests at the Center of Medical Genetics.

  • Cooperation with international organizations (PRINTO, ISSAID, PRES, ESPGHAN) and countries (Italy, France, Israel). 

  • Diagnosis and monitoring of FMF with atypical course and/or with other autoimmune disorders (rheumatoid arthritis, PFAPA, inflammatory bowel disease, celiac disease , non-amyloid glomerulopathy, etc).

 

The implementation of the program to improve diagnosis, management and monitoring of FMF in children is a result and an example of effective cooperation between the Government of the RA (MOH), the Diaspora community (’Howard Karagheusian” Foundation) and educational (YSMU), scientific-research (Center of Medical Genetics), clinical (“Arabkir” MC-ICAH NPC of FMF) organizations. 

 

NPC of FMF plans to:

1. continue the project of early diagnosis and treatment with colchicine of children with FMF, because the number of patients continues to increase

2. continue scientific research works
    - atypical FMF cases, including clinical and genetic features of MEFV heterozygotes  

     - FMF cases with other autoimmune disorders (rheumatoid arthritis, PFAPA, inflammatory bowel disease, celiac disease , vasculitis, nephritis, etc) 

3. update the children’s register of FMF

 

NPC of FMF provides services to:

  • citizens of the RA under 18 within the framework of the state order approved by the Ministry of Health

  • citizens of CIS countries are served on a paid basis or within the framework of existing humanitarian projects

  • FMF patients with renal complications, who are monitored together with a nephrologist 

 

Our personnel

  • G. G. Amaryan, head of the NPC of FMF, Professor, MD of the Department of Pediatrics N2, YSMU, 

  • N. G. Mkrtchyan, coordinator of the NPC of FMF Dispensary service, Assistant Professor of the Department of Pediatrics N2, YSMU

  • H. G. Sargsyan, Assistant Professor of the Department of Pediatrics N2, YSMU

  • S. G. Sargsyan, Assistant Professor of the Department of Pediatrics N2, YSMU, head of the Institute of Child and Adolescent Health of “Arabkir” MC

  • K. G. Mirzabekyan, PhD, head of the General Pediatric Department of the ”Arabkir” MC-ICAH

  • R. Y. Davtyan, physician at the General Pediatric Department of the ”Arabkir” MC-ICAH

  • M. M. Papazyan, PhD, physician at the Nephrology Department of “Arabkir” MC-ICAH

  • L. Galstyan, A. Babayan, nurses at the FMF Dispensary

 

 Cooperation  

  • Ministry of Health of the RA (provided free of charge outpatient (dispensary) follow up service of children of NPC FMF until age of 18 y. within the state of beneficial package)

  • “Howard Karagheusian” Medical Benevolent Public Organization, 2003 – 2015

  • Yerevan State Medical University after M. Heratsi

  • Armenian Pediatric Association 

  • Center of Medical Genetics and Primary Health Care 

  • Consortium of Armenian Physicians Researching FMF

  • “ArpiMed” Pharmaceutical Company

International organizations
-    PRINTO (Pediatric  rheumatology international trials organization ) 
-    ISSAID (International Society of Auto inflammatory Diseases)
-    PReS (Pediatric Rheumatology European Society)
-    ESPGHAN (European Society of Pediatric Gastroenterology, Hepatology, Nutrition)

Staff
Media
Contacts
Ruzan Davtyan
Ruzan Davtyan
Pediatrician, gastroenterologist
NUNE MKRTCHYAN
NUNE MKRTCHYAN
Karine Mirzabekyan
Karine Mirzabekyan
Hasmik Sargsyan
Hasmik Sargsyan
Pediatrician
FMF: No Cases of Kidney Amyloidosis
16 January 24
  Pediatrician Sergey Sargsyan, the head of the Institute of Children and Adolescent Health at the "Arabkir" Medical Complex, addressed questions from the Public Television Company "News" regarding Periodic disease / Familial Mediterranean Fever (FMF), a genetic condition prevalent among Armenians and relatively common in our population. Thanks to the dispensary control service established decades ago, cases of complications related to the disease and its consequential kidney failure have significantly decreased from 16% to 0 among children under the age of 18 with FMF.   Approximately 3600 children diagnosed with FMF are currently undergoing treatment in Armenia, including compatriots under the age of 18 residing in other countries with the same diagnosis. The doctor emphasizes that approximately 400 children receive this diagnosis annually, with a noticeable upward trend in recent years.   According to pediatrician Sergey Sargsyan, the head of the “Arabkir” Medical Center-ICAH “Periodic disease” is a hereditary disorder. Although some may refer to it as the “Yerevanian disease”, it is unrelated to the city of Yerevan. In the international classification, it is known as “familial Mediterranean fever”, affecting people from this region, including Armenians, Sephardic Jews, Arabs, and Turks, who naturally inherited the gene through centuries of mixing with different populations.   The disease can manifest with recurrent fever, abdominal pain, and may even lead to kidney failure. It is prevalent among the Armenian population, with most cases developing before the age of 20, depending on the type of gene.   Dr. Sargsyan explains, “One in five individuals has one gene, but a single gene is insufficient. For the disease to develop, two genes—maternal and paternal—must combine, in most cases.”   While in the 1990s, approximately 16% of children in our country experienced kidney complications before reaching adulthood, the current scenario has changed.    Sargsyan details, “The discovery of the gene, conducted by the Center of Genetics in Armenia, along with subsequent organizational efforts and the implementation of a unique ambassadorial model, where patients visit the center for treatment and check-ups, has led to a remarkable reduction. Today, I can report that the initial 16% has decreased a hundredfold. We now have unique cases where children develop kidney complications, at least in infancy.   The Children's Republican Center for Periodic Diseases at the “Arabkir” Medical Center provides treatment for children aged 0-18 years under the state order. Sergey Sargsyan adds, “People over the age of 18 can also receive appropriate medication and undergo monitoring at the regional health center. Various treatment and control models are available. The crucial aspect is to diagnose the disease promptly and at its earliest stage.
Gayane Amaryan about FMF
01 December 23
Dear parents, You often ask us about various diseases, their symptoms, how they’re diagnosed, and treatment options and prevention methods. Among the topics that come up frequently is Familial Mediterranean Fever, which is very common among us.  Professor Gayane Amaryan has stepped up to answer the questions on the “Novosti Armenia” website. Get the lowdown on this condition and find the answers to your questions. 
Պարբերական հիվանդություն, մաս 2
19 January 22
Ներկայացնում է Ռուզան Դավթյանը: https://www.youtube.com/watch?v=IP8nhQYdtts
Պարբերական հիվանդություն, մաս 1
19 January 22
Պարբերական հիվանդության հանրապետական մանկական կենտրոնի բժիշկ Ռուզան Դավթյանը ներկայացնում է մանրամասներ պարբերական հիվանդության ախտանշանների, ախտորոշման եւ բուժման մասին: 
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