Independent risk factors for resolution of periodic fever, aphthous stomatitis, pharyngitis, and adenitis syndrome within 4 years after the disease onset

Background/Objective Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is a polygenic disease with unknown etiology. In this retrospective cohort study, we aimed to evaluate the risk factors for the resolution of PFAPA syndrome within 4 years after the onset. Methods In total, 466 patients with PFAPA syndrome that are being followed up our department were included into the study. Between May 2020 and September 2020, medical charts of the patients were reviewed retrospectively. Results The median age of the patients at the time of the study and at disease onset were 8.6 (2.9–20.5; IQR 6.9–10.6) years and 18 (1–84; IQR 11-31) months. On univariate analysis age at disease onset ( p = 0.003), positive family history of PFAPA syndrome ( p = 0.04), absence of myalgia ( p = 0.04), and absence of headache ( p = 0.003) were all associated with the resolution of PFAPA syndrome within 4 years after the onset. Multivariate logistic regression analysis revealed that age at disease onset (OR 1.04, 95% CI 1.01–1.07, p = 0.002), positive family history of PFAPA syndrome (OR 2.69, 95% CI 1.12–6.48, p = 0.02), and absence of headache (OR 0.2, 95% CI 0.05–0.74, p = 0.01) were independent risk factors for the resolution of PFAPA syndrome within 4 years after the onset. Conclusion We report later age of disease onset, positive family history of PFAPA syndrome, and absence of headache as independent risk factors for resolution of PFAPA syndrome within 4 years after the onset. Key points: • Periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome is a multifactorial disease with unknown etiology. • Although, PFAPA syndrome usually resolves within 3–5 years after the disease onset, it can persist for years and even continue into adulthood. With our current knowledge, there is no clue to predict which patients will have a long disease course and which patients will not. • Later age of disease onset, positive family history of PFAPA syndrome and absence of headache as independent risk factors for resolution of PFAPA syndrome within 4 years after the onset.