Association of PANDAS/PANS and psychological disorders in patients with PFAPA syndrome

Objective: PFAPA syndrome is a disease in which viral and autoimmune mechanisms are implicated in its etiology. PANS is known to be primarily driven by neuroinflammation in its etiology. PANDAS, on the other hand, is defined as a neuropsychiatric disorder known to occur due to immune response following a GABHS infection. In recent years, numerous new pieces of evidence have emerged indicating a relationship between inflammation and psychiatric disorders. The episodic nature of PANS/PANDAS, accompanied by behavioral symptoms, suggests the presence of shared psychiatric and clinical symptoms mediated by autoimmunity in PFAPA patients. The psychosocial dimension of the chronic inflammatory disease, which is characterized by episodic attacks and can adversely affect quality of life, will be explored in our study. The aim of our study is to investigate the frequency of PANDAS/PANS and psychiatric diagnoses in the PFAPA group compared to the control group. Materials and Methods: The study was conducted at the Child and Adolescent Psychiatry, Child Allergy, and Child Rheumatology clinics of Çukurova University School of Medicine. Our study is a cross-sectional, descriptive case-control study. Our sample consisted of 30 cases with PFAPA history between the ages of 5-16 and 30 cases in the control group, selected through convenience sampling. Results: When comparing the frequency of PANS/PANDAS between the control group and PFAPA patients, PANS/PANDAS was found in 3.3% (n=1) of the control group and in 30% (n=9) of the PFAPA group (p=0.01). None of the cases in the control group had a history of psychiatric medication use prior to the study. In PFAPA patients, this rate was 20% (p=0.01). The rate of psychiatric disorder detection was 40% in the control group and 80% in PFAPA patients (p=0.002). When examining the frequency of psychiatric comorbidity between the two groups, multiple psychiatric disorders were found in 53.3% of PFAPA cases (p<0.001). Conclusion: The incidence of PANS/PANDAS and psychiatric disorders is increased in children with PFAPA syndrome. This suggests a shared immune mechanism and inflammation; however, larger case numbers and prospective randomized studies are needed to establish a causal relationship and provide conclusive evidence of a shared etiology. Keywords: Inflammation, PANDAS, PANS, PFAPA, Psychiatric Disorder.