To the Editor.
—Bodel and Dillard (131:189, 1973) report a great improvement of symptoms in four of five patients with periodic fever after they received therapy with conjugated estrogens. These authors refer to many forms of therapy that have been tried. To those can be added the fat-free diet, recommended by Melinkoff et al.1 Recently, indomethacin has been reported to alleviate symptoms.2What constitutes a significant improvement is a question of statistical analysis. This, as the authors point out, could not be done due to the small sample size. A serious pitfall in evaluating the effects of treatment in patients with periodic fever is the unpredictability of this disorder. Frequency, duration, and intensity may vary from attack to attack. Often a series of attacks is followed by an asymptomatic interval lasting years. This makes prediction impossible, at least for familial mediterranean fever (FMF).3 Cases that occur
Kats BA. Estrogen Therapy for Periodic Fever. Arch Intern Med. 1974;133(5):868-869. doi:10.1001/archinte.1974.00320170144014