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Tumor necrosis factor receptor-associated periodic syndrome


Other Names:
FPF; Familial Hibernian fever; FHF; FPF; Familial Hibernian fever; FHF; TRAPS; Hibernian fever, familial; TNF receptor-associated periodic syndrome; Periodic fever, familial, autosomal dominant; TNF receptor-associated periodic fever syndrome See More
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Tumor necrosis factor receptor-associated periodic syndrome (TRAPS) is an inherited condition characterized by recurrent episodes of fever. Episodes can begin at any age but most often begin in early childhood. Fevers typically last about 3 weeks but can last from a few days to a few months. The amount of time between episodes may vary from weeks to years. Episodes usually occur spontaneously, but are sometimes brought on by a variety of triggers (such as injury, infection, or stress). Symptoms during fever episodes may include abdominal, muscle or joint pains; skin rashes (usually on the limbs); puffiness around the eyes; and inflammation in various areas of the body. Some people develop amyloidosis.[1] TRAPS is caused by mutations in the TNFRSF1A gene and is inherited in an autosomal dominant manner.[1][2] Treatment may include systemic corticosteroids at the beginning of an episode to reduce its severity and duration.[2]
Last updated: 6/24/2015
The characteristic feature of TRAPS is recurrent episodes of fever. Episodes may begin at any age, but most often begin in early childhood. Fevers usually last around 3 weeks but can last from days to months. The time between episodes can vary considerably from weeks to years. Fevers are often associated with other symptoms, which may include muscle, joint, and/or abdominal pain; a spreading rash; puffiness and/or swelling around the eyes; and/or inflammation in various other areas of the body including the heart muscle, joints, throat, or mucous membranes.[3][1] About 25% of people with TRAPS develop amyloidosis, which can lead to kidney or liver failure.[1][2]
Last updated: 6/24/2015

This table lists symptoms that people with this disease may have. For most diseases, symptoms will vary from person to person. People with the same disease may not have all the symptoms listed. This information comes from a database called the Human Phenotype Ontology (HPO) . The HPO collects information on symptoms that have been described in medical resources. The HPO is updated regularly. Use the HPO ID to access more in-depth information about a symptom.

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Medical Terms Other Names
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HPO ID
80%-99% of people have these symptoms
Abdominal pain
Pain in stomach
Stomach pain
[ more ] 		0002027
Diarrhea
Watery stool
0002014
Elevated C-reactive protein level 0011227
Elevated erythrocyte sedimentation rate
High ESR
0003565
Erysipelas 0001055
Myalgia
Muscle ache
Muscle pain
[ more ] 		0003326
Pericarditis
Swelling or irritation of membrane around heart
0001701
Recurrent fever
Episodic fever
Increased body temperature, episodic
Intermittent fever
[ more ] 		0001954
Skin rash 0000988
30%-79% of people have these symptoms
Arthritis
Joint inflammation
0001369
Constipation 0002019
Erythema 0010783
Intestinal obstruction
Bowel obstruction
Intestinal blockage
[ more ] 		0005214
Leukocytosis
Elevated white blood count
High white blood count
Increased blood leukocyte number
[ more ] 		0001974
Lymphadenopathy
Swollen lymph nodes
0002716
Orchitis
Inflammation of testicles
0100796
Pleuritis
Inflammation of tissues lining lungs and chest
0002102
Splenomegaly
Increased spleen size
0001744
Vomiting
Throwing up
0002013
5%-29% of people have these symptoms
Abnormal myocardium morphology 0001637
Abnormality of the sacroiliac joint 0100781
Arthralgia
Joint pain
0002829
Behavioral abnormality
Behavioral changes
Behavioral disorders
Behavioral disturbances
Behavioral problems
Behavioral/psychiatric abnormalities
Behavioural/Psychiatric abnormality
Psychiatric disorders
Psychiatric disturbances
[ more ] 		0000708
Bruising susceptibility
Bruise easily
Easy bruisability
Easy bruising
[ more ] 		0000978
Cellulitis
Bacterial infection of skin
Skin infection
[ more ] 		0100658
Chest pain 0100749
Conjunctivitis
Pink eye
0000509
Cranial nerve paralysis 0006824
Fasciitis
Inflammation of the fascia
0100537
Hypermelanotic macule
Hyperpigmented spots
0001034
Migraine
Intermittent migraine headaches
Migraine headache
Migraine headaches
[ more ] 		0002076
Myositis
Muscle inflammation
0100614
Paresthesia
Pins and needles feeling
Tingling
[ more ] 		0003401
Periorbital edema 0100539
Peritonitis 0002586
Recurrent pharyngitis
Recurrent sore throat
0100776
Uveitis 0000554
Vasculitis
Inflammation of blood vessel
0002633
Vertigo
Dizzy spell
0002321
Percent of people who have these symptoms is not available through HPO
Amyloidosis 0011034
Autosomal dominant inheritance 0000006
Conjunctival hyperemia 0030953
Edema
Fluid retention
Water retention
[ more ] 		0000969
Hepatic amyloidosis 0012280
Muscle stiffness 0003552
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Last updated: 7/1/2020
TRAPS is a genetic condition caused by mutations in a gene called TNFRSF1A. This gene gives the body instructions to make a protein called tumor necrosis factor receptor 1 (TNFR1). This protein exists in cell membranes where it binds to another protein called tumor necrosis factor (TNF). The binding sends signals that tell the cells to trigger inflammation (producing immune system proteins) or self-destruct.

Most TNFRSF1A gene mutations that cause TRAPS result in incorrectly-shaped TNFR1 proteins, which become trapped in cells and cannot reach the surface to bind with TNF. The trapped proteins then clump together and are thought to trigger other pathways involved in causing inflammation. Affected people typically have a mutation in only one of their 2 copies of the TNFRSF1A gene, so some normal TNFR1 proteins are still produced, leading to even more inflammation. This is what leads to excess inflammation in people with TRAPS. It is unclear if abnormalities in the cells' ability to self-destruct also plays a role in causing the features of TRAPS.[1]
Last updated: 6/25/2015
TRAPS is inherited in an autosomal dominant manner. This means that having a mutation in only one of the 2 copies of the responsible gene is enough to cause signs and symptoms of the condition. When a person with an autosomal dominant condition has children, each child has a 50% (1 in 2) chance to inherit the mutated copy of the gene. In many cases, a person with TRAPS inherits the condition from an affected parent. In other cases, the mutation occurs for the first time in the affected person and is not inherited from a parent. For unknown reasons, some people who inherit the mutated gene never develop features of TRAPS. When this occurs, a condition is said to have reduced penetrance.[1]
Last updated: 6/25/2015
While there is no proven treatment for TRAPS, non steroidal anti-inflammatory drugs (NSAIDS) may be used to relieve symptoms of fever, and corticosteroids may be used to reduce severity of symptoms in most people. However, these medications typically don't decrease the frequency of attacks. Etanercept, a TNF inhibitor, has been shown to be effective but its efficacy tends to wane over time. Standard doses of etanercept twice a week have been shown to decrease the frequency, duration, and severity of attacks in some people and it may also reverse or slow the progression of amyloidosis. More studies are needed to evaluate this medication for TRAPS.[4][5]

Additional information about the treatment of TRAPS can be viewed on Medscape's Web site.
Last updated: 6/25/2015

FDA-Approved Treatments

The medication(s) listed below have been approved by the Food and Drug Administration (FDA) as orphan products for treatment of this condition. Learn more orphan products.

  • Canakinumab (Brand name: Ilaris) - Manufactured by Novartis Pharmaceuticals Corporation
    FDA-approved indication: Treatment for Familial Mediterranean Fever (FMF) in adult and pediatric patients; for Tumor Necrosis Factor Receptor Associated Periodic Syndrome (TRAPS) in adult and pediatric patients; and for Hyperimmunoglobulin D Syndrome (HIDS)/Mevalonate Kinase Deficiency (MKD) in adult and pediatric patients.
    National Library of Medicine Drug Information Portal
The long-term outlook (prognosis) for people with TRAPS depends largely on the development of amyloidosis, which happens in a minority of affected people.[3][5] The risk to develop amyloidosis depends on the specific mutation an affected person has, as well as possible environmental factors.[3] Without amyloidosis, life expectancy is normal.[5] In general, people with TRAPS continue to have episodes of fevers and symptoms throughout life.[3] However, with age, fever attacks may decrease in intensity and a more chronic and fluctuating course may continue.[4]
Last updated: 6/25/2015

If you need medical advice, you can look for doctors or other healthcare professionals who have experience with this disease. You may find these specialists through advocacy organizations, clinical trials, or articles published in medical journals. You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments.

If you can’t find a specialist in your local area, try contacting national or international specialists. They may be able to refer you to someone they know through conferences or research efforts. Some specialists may be willing to consult with you or your local doctors over the phone or by email if you can't travel to them for care.

You can find more tips in our guide, How to Find a Disease Specialist. We also encourage you to explore the rest of this page to find resources that can help you find specialists.

Healthcare Resources

Related diseases are conditions that have similar signs and symptoms. A health care provider may consider these conditions in the table below when making a diagnosis. Please note that the table may not include all the possible conditions related to this disease.

Conditions with similar signs and symptoms from Orphanet
Differential diagnosis includes other diseases characterized by periodic fever such as familial cold urticaria, juvenile idiopathic arthritis, Behçet disease, PFAPA syndrome, and Muckle-Wells syndrome (see these terms).
Visit the Orphanet disease page for more information.

Support and advocacy groups can help you connect with other patients and families, and they can provide valuable services. Many develop patient-centered information and are the driving force behind research for better treatments and possible cures. They can direct you to research, resources, and services. Many organizations also have experts who serve as medical advisors or provide lists of doctors/clinics. Visit the group’s website or contact them to learn about the services they offer. Inclusion on this list is not an endorsement by GARD.

Organizations Supporting this Disease

Social Networking Websites

  • RareConnect has an online community for patients and families with this condition so they can connect with others and share their experiences living with a rare disease. The project is a joint collaboration between EURORDIS (European Rare Disease Organisation) and NORD (National Organization for Rare Disorders).

These resources provide more information about this condition or associated symptoms. The in-depth resources contain medical and scientific language that may be hard to understand. You may want to review these resources with a medical professional.

Where to Start

  • The Cleveland Clinic provides an overview of the different types of periodic fever syndromes.
  • DermNet NZ is an online resource about skin diseases developed by the New Zealand Dermatological Society Incorporated. DermNet NZ provides information about this condition.
  • Genetics Home Reference (GHR) contains information on Tumor necrosis factor receptor-associated periodic syndrome. This website is maintained by the National Library of Medicine.
  • The Merck Manuals Online Medical Library provides information on this condition for patients and caregivers. 
  • The National Organization for Rare Disorders (NORD) has a report for patients and families about this condition. NORD is a patient advocacy organization for individuals with rare diseases and the organizations that serve them.

In-Depth Information

  • Medscape Reference provides information on this topic. You may need to register to view the medical textbook, but registration is free.
  • The Monarch Initiative brings together data about this condition from humans and other species to help physicians and biomedical researchers. Monarch’s tools are designed to make it easier to compare the signs and symptoms (phenotypes) of different diseases and discover common features. This initiative is a collaboration between several academic institutions across the world and is funded by the National Institutes of Health. Visit the website to explore the biology of this condition.
  • Online Mendelian Inheritance in Man (OMIM) is a catalog of human genes and genetic disorders. Each entry has a summary of related medical articles. It is meant for health care professionals and researchers. OMIM is maintained by Johns Hopkins University School of Medicine. 
  • Orphanet is a European reference portal for information on rare diseases and orphan drugs. Access to this database is free of charge.
  • PubMed is a searchable database of medical literature and lists journal articles that discuss Tumor necrosis factor receptor-associated periodic syndrome. Click on the link to view a sample search on this topic.

Questions sent to GARD may be posted here if the information could be helpful to others. We remove all identifying information when posting a question to protect your privacy. If you do not want your question posted, please let us know.

  1. Tumor necrosis factor receptor-associated periodic syndrome. Genetics Home Reference. August, 2011; http://ghr.nlm.nih.gov/condition/tumor-necrosis-factor-receptor-associated-periodic-syndrome.
  2. Delwyn Dyall-Smith. Tumour necrosis factor receptor-associated periodic syndrome. DermNet NZ. December 15, 2014; http://dermnetnz.org/systemic/traps.html.
  3. Periodic Fever Syndromes. Cleveland Clinic Department of Rheumatic and Immunologic Diseases. 2009; http://my.clevelandclinic.org/disorders/periodic_fever_syndrome/rheumatology_overview.aspx. Accessed 1/9/2009.
  4. Marco Gattorno. Tumor necrosis factor receptor 1 associated periodic syndrome. Orphanet. September, 2014; http://www.orpha.net/consor/cgi-bin/OC_Exp.php?lng=en&Expert=32960.
  5. Shinawi M. Hereditary Periodic Fever Syndromes. Medscape. January 11, 2013; http://emedicine.medscape.com/article/952254-overview#a4.