Tumor Necrosis Factor (TNF) - Associated Periodic Syndrome (aka Familial Hibernian Fever)

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SAID group:
TNF-associated Autoinflammatory Diseases, Protein Folding


Autosomal dominant. Spontaneous mutations, with some familial groups. [1]

Affects all races. Second most common inherited SAID (after FMF). [1]

Unknown. TRAPS affects 0.01:10,000 people in the European Union. [51] >1000 patients worldwide. [52]

Timing of symptoms:
Days to weeks. An average flare lasts around three weeks. [1] [9]

Age of onset:
Most first attacks occur by 3 years of age, and almost all begin by 20 years of age. A few have symptoms start later in life. [9]

Skin cutaneous:
Migrating rash with deep pain under the areas with the rash. Severe pain follows the rash path from the trunk outwards to the limbs. [9]

Fevers lasting >3 days at over 38°C with flares. Some have headaches with flares of symptoms. [1] [9]

Uncommon–not believed to be caused by TRAPS. [1]

Conjunctivitis, and periorbital edema during flares. [1] [9]

Common, including pleurisy. [1]

Abdominal pain, peritonitis, diarrhea, and constipation with flares. Splenomegaly. [1]

Splenomegaly is common; some have lymphadeopathy. [1]

Joints bones muscles cartilage:
Intermittent or chronic arthritis in the large joints with muscle pain and swelling is common. [1]

Henoch-Schönlein purpura (HSP), lymphocytic vasculitis. [1]

10-20% occurrence. Higher risk with a cysteine mutation. [9]

Abnormal labs:
High: ESR, CRP, SAA. Polymorphonuclear neutrophils (PMNs), polyclonalgammopathy, leukocytosis. [1] Elevated serum IgD levels10% to 13% of patients with TRAPS (elevated in some with other autoinflammatory diseases too, such as HIDS, MA, FMF, PFAPA) [128]

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Photo credit:

Federici, S., Caorsi, R., & Gattorno, M. (2012). The autoinflammatory diseases. Swiss medical weekly, 142, 0.


Here is a helpful video overview on "Difficult to Treat TRAPS" by Dr Marco Gattorno, a leading expert on autoinflammatory diseases at the 2nd NIH-WRNMMC Symposium on Autoinflammatory and Immunedysregulatory Diseases that the Autoinflammatory Alliance co-sponsored and helped to organize in August 2019:

  • Our COVID-19 information for patients with autoinflammatory diseases

    NIH-WRNMMC 2nd Symposium on Autoinflammatory & Immunedysregulatory Diseases (co-sponsored by the Autoinflammatory Alliance)

  • Autoinflammatory Bootcamp lectures
    Full video archives from the symposium
  • August 22, 2019 (Day 1) August 23, 2019 (Day 2)
  • Autoinflammatory Patient & Family Program Archived Facebook LIvecast including talks by autoinflammatory disease experts.

  • Genetic Testing Our blog post and downloadable pdf of US genetic testing panels for autoinflammatory diseases.

  • saidsupport.org Our blog with the latest news,& helpful information for thriving with an autoinflammatory diseases.

  • Healthier Ever After Our book/program to help kids with injectable medications.

    Our Autoinflammatory Alliance website TRAPS Syndrome page.

    Find periodic fever syndrome panels, which test for TRAPS and syndromes with similar symptoms at the same time, at the Genetic Testing Registry (GTR)

    Updated May 2020 by Karen Durrant RN. BSN

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