{"schema":"https://ver.cy/schemas/card/1.0.0","id":"vr.tr.periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis","code":"thing-q2044034","url":"https://ver.cy/models/thing/q2044034/","name":"periodic fever, aphthous stomatitis, pharyngitis and adenitis","alternateNames":[],"kind":"thing","status":"published","version":"0.1.0-research.1","language":"en","classifiers":{"family":"Thing Registry","category":"Cross-cutting context","entryKind":"thing","plane":"XCT","domain":["XCT.STA"],"industry":[],"navPath":"","tags":[],"facets":{}},"whatItIs":"Periodic fever, aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome is an autoinflammatory condition characterized by recurrent, stereotyped febrile episodes with aphthous oral ulcers, pharyngitis or cervical lymphadenitis, typically beginning in early childhood with normal growth and wellness between attacks.","purpose":"Enable an agent to represent suspected or established PFAPA syndrome, assess the evidence and episode pattern, and identify appropriate review or management questions without treating a symptom cluster as a confirmed diagnosis.","scope":{"in":["The relationship between PFAPA syndrome, a suspected diagnosis and individual fever episodes","Recurring fever patterns and health between episodes","Episode-associated aphthous stomatitis, pharyngitis and cervical adenitis","Versioned diagnostic or classification criteria and evidence concerning alternative explanations","Longitudinal burden, management response and reassessment triggers"],"out":["The patient's complete health record and identity","Individual consultations, admissions and episodes of care","Independent models of infectious illness, cyclic neutropenia and other recurrent fever disorders","Laboratory assay methods and specimen processing","Drug products, prescribing protocols and surgical procedure specifications"],"boundaries":[]},"distinguishingFeatures":["Evaluate whether repeated, documented fever episodes form a stereotyped pattern with recorded health between attacks; isolated fever or repeated unrelated illnesses do not establish PFAPA.","Evaluate how oral aphthae, pharyngitis and cervical node findings cluster with fever across episodes; do not infer that every named manifestation occurs in every attack.","Check whether infection evidence explains individual attacks or the recurring pattern before attributing all sore throats and fevers to PFAPA.","Record whether cyclic neutropenia and other recurrent fever syndromes have been assessed where indicated, including the timing and adequacy of the evidence.","Compare the phenotype with an explicitly identified diagnostic framework; treatment response or a coding label alone must not establish the syndrome."],"structure":{"bundles":[{"id":"syndrome-identity-and-diagnostic-standing","name":"Syndrome identity and diagnostic standing","description":"Establishes what the PFAPA designation represents and how securely it is supported.","layers":[{"id":"registered-concept","name":"Registered concept","description":"Connects the registry concept to terminology without implying diagnostic confirmation.","findings":[{"id":"pfapa-concept-boundary","name":"PFAPA concept boundary","description":"Records the intended syndrome meaning and separates it from the component symptoms.","questions":[{"text":"Does this record describe PFAPA syndrome, a suspected attribution, or an individual episode with some of its named symptoms?","id":"pfapa-concept-boundary-q01","kind":"boundary"},{"text":"Which verified terminology entry identifies this syndrome, and what coding system, jurisdiction and revision accompany it?","id":"pfapa-concept-boundary-q02","kind":"provenance"}]}]},{"id":"criteria-and-attribution","name":"Criteria and attribution","description":"Makes diagnostic reasoning traceable to its framework and assessor.","findings":[{"id":"versioned-criteria-assessment","name":"Versioned criteria assessment","description":"Preserves criterion-level support, contradictions and missing observations.","questions":[{"text":"Which diagnostic or classification criteria were used, who issued them, and which version and intended population apply?","id":"versioned-criteria-assessment-q01","kind":"provenance"},{"text":"Which criteria are supported, contradicted or unassessed, and who assigned the current diagnostic standing?","id":"versioned-criteria-assessment-q02","kind":"measurement"}]}]}]},{"id":"fever-pattern-and-interepisode-course","name":"Fever pattern and interepisode course","description":"Represents attacks as a time series and examines what happens between them.","layers":[{"id":"attack-timing","name":"Attack timing","description":"Records fever onset, duration and recurrence using explicit observation rules.","findings":[{"id":"documented-recurrence-pattern","name":"Documented recurrence pattern","description":"Assesses episode regularity without erasing missed observations or treatment effects.","questions":[{"text":"What measured temperatures, measurement methods and start or end rules define each recorded fever episode?","id":"documented-recurrence-pattern-q01","kind":"measurement"},{"text":"How do episode durations and onset-to-onset intervals vary, and which intervals include missing observations or interventions?","id":"documented-recurrence-pattern-q02","kind":"measurement"}]}]},{"id":"between-attack-course","name":"Between-attack course","description":"Tracks recovery, persistent findings and changes in the recurring pattern.","findings":[{"id":"baseline-recovery-and-pattern-change","name":"Baseline recovery and pattern change","description":"Distinguishes documented recovery from assumed wellness and temporary gaps from sustained resolution.","questions":[{"text":"Between episodes, what evidence documents symptom resolution, usual functioning and age-appropriate growth where relevant?","id":"baseline-recovery-and-pattern-change-q01","kind":"measurement"},{"text":"What observation period and follow-up evidence justify describing the course as ongoing, changed or in remission?","id":"baseline-recovery-and-pattern-change-q02","kind":"definition"}]}]}]},{"id":"attack-manifestations-and-inflammatory-evidence","name":"Attack manifestations and inflammatory evidence","description":"Captures the named manifestations and their relationship to fever and objective observations.","layers":[{"id":"oral-pharyngeal-and-node-findings","name":"Oral, pharyngeal and node findings","description":"Describes each manifestation with enough detail to check its meaning and recurrence.","findings":[{"id":"manifestation-co-occurrence","name":"Manifestation co-occurrence","description":"Records observed aphthae, pharyngitis and cervical adenitis without assuming completeness.","questions":[{"text":"Which oral lesions, pharyngeal findings and cervical node findings were observed, by whom, and with what descriptive evidence?","id":"manifestation-co-occurrence-q01","kind":"measurement"},{"text":"Do these findings coincide with fever, recur in similar combinations, or persist outside attacks?","id":"manifestation-co-occurrence-q02","kind":"boundary"}]}]},{"id":"timed-objective-evidence","name":"Timed objective evidence","description":"Links examination and laboratory observations to the episode phase.","findings":[{"id":"attack-and-baseline-comparison","name":"Attack and baseline comparison","description":"Preserves the temporal context needed to assess inflammatory findings.","questions":[{"text":"Which inflammatory markers and blood counts were obtained during attacks and between attacks, with what results and reference ranges?","id":"attack-and-baseline-comparison-q01","kind":"measurement"},{"text":"Which persistent or discordant findings require review before another episode is attributed to PFAPA?","id":"attack-and-baseline-comparison-q02","kind":"action"}]}]}]},{"id":"alternative-explanations-and-reassessment","name":"Alternative explanations and reassessment","description":"Tracks competing explanations and the limits of the evidence used to assess them.","layers":[{"id":"infection-and-neutropenia-assessment","name":"Infection and neutropenia assessment","description":"Examines two specific sources of overlap with recurrent fever and oral or pharyngeal symptoms.","findings":[{"id":"adequacy-of-alternative-assessment","name":"Adequacy of alternative assessment","description":"Distinguishes unassessed alternatives from alternatives evaluated with appropriately timed evidence.","questions":[{"text":"What clinical or microbiological evidence supports infection in particular attacks, and does it explain the recurring pattern?","id":"adequacy-of-alternative-assessment-q01","kind":"boundary"},{"text":"If cyclic neutropenia was considered, what serial neutrophil evidence and sampling schedule support the assessment?","id":"adequacy-of-alternative-assessment-q02","kind":"provenance"}]}]},{"id":"broader-recurrent-fever-differential","name":"Broader recurrent fever differential","description":"Records features that may shift interpretation toward another inflammatory or systemic condition.","findings":[{"id":"phenotype-driven-reassessment","name":"Phenotype-driven reassessment","description":"Connects additional symptoms and family history to a documented review decision.","questions":[{"text":"What family history, rash, abdominal or chest pain, joint findings, genital ulcers, ocular findings or other features broaden the differential?","id":"phenotype-driven-reassessment-q01","kind":"measurement"},{"text":"Which findings prompt specialist reassessment or consideration of genetic evaluation under the applicable clinical guidance?","id":"phenotype-driven-reassessment-q02","kind":"action"}]}]}]},{"id":"burden-management-and-follow-up","name":"Burden, management and follow-up","description":"Relates documented disease burden to clinician-directed management and subsequent outcomes.","layers":[{"id":"functional-burden","name":"Functional burden","description":"Measures disruption across a defined observation period.","findings":[{"id":"attack-impact-and-review-priorities","name":"Attack impact and review priorities","description":"Captures effects on daily life and the outcomes that matter to the affected person or caregivers.","questions":[{"text":"Over what period were attack frequency, impaired oral intake and missed school, work or usual activities recorded?","id":"attack-impact-and-review-priorities-q01","kind":"measurement"},{"text":"Which documented burdens and patient or caregiver priorities should the next management review address?","id":"attack-impact-and-review-priorities-q02","kind":"action"}]}]},{"id":"intervention-response-and-review","name":"Intervention response and review","description":"Tracks clinician-selected episode treatment, preventive treatment or surgical management and their outcomes.","findings":[{"id":"attributable-benefit-harm-and-recurrence","name":"Attributable benefit, harm and recurrence","description":"Separates observed response from proof of diagnosis or proof of treatment causation.","questions":[{"text":"For each intervention, what timing, symptom-resolution trajectory, subsequent attack interval and adverse effects were documented?","id":"attributable-benefit-harm-and-recurrence-q01","kind":"measurement"},{"text":"What agreed follow-up criteria trigger continuation, reconsideration or renewed diagnostic assessment?","id":"attributable-benefit-harm-and-recurrence-q02","kind":"action"}]}]}]},{"id":"evidence-and-external-alignment","name":"Evidence and external alignment","description":"What the world already says about this thing, gathered so the model can be checked against it.","layers":[{"id":"reported-evidence","name":"Reported evidence","description":"Findings from the breadth pass, kept separate from the structural claims.","findings":[{"id":"evidence-confidence-notes","name":"Check these first","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these check these first hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-confidence-notes-q01","kind":"provenance"}]},{"id":"evidence-kinds","name":"Kinds and varieties","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these kinds and varieties hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-kinds-q01","kind":"provenance"}]},{"id":"evidence-identifiers","name":"Identifiers and schemes","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these identifiers and schemes hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-identifiers-q01","kind":"provenance"}]},{"id":"evidence-standards-and-regulation","name":"Standards and regulation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these standards and regulation hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-standards-and-regulation-q01","kind":"provenance"}]},{"id":"evidence-real-world-use","name":"Real-world use","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these real-world use hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-real-world-use-q01","kind":"provenance"}]},{"id":"evidence-measurements","name":"Typical measurements","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these typical measurements hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-measurements-q01","kind":"provenance"}]},{"id":"evidence-failure-modes-and-hazards","name":"Failure modes and hazards","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these failure modes and hazards hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-failure-modes-and-hazards-q01","kind":"provenance"}]},{"id":"evidence-regional-variation","name":"Regional variation","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these regional variation hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-regional-variation-q01","kind":"provenance"}]},{"id":"evidence-neighbours","name":"Neighbouring kinds and how to tell them apart","description":"Recalled without web access and unsourced; every item is a lead to verify.","questions":[{"text":"Which of these neighbouring kinds and how to tell them apart hold for the sense of periodic fever, aphthous stomatitis, pharyngitis and adenitis this model covers, and on what evidence?","id":"evidence-neighbours-q01","kind":"provenance"}]}]}]}]},"agentConduct":{"may":["Explain PFAPA in general terms from reputable medical sources.","Help parents keep a symptom diary to share with their child's doctor."],"mustNot":["Diagnose PFAPA or rule out other causes of fever in a child.","Recommend medicines or tonsil removal for a specific child.","Disclose a child's health records without the parents' consent.","Dismiss repeated fevers as harmless without medical review."],"requiresHuman":["Treatment decisions, including surgery."]},"ethics":{"considerations":["Repeated fevers disrupt children's schooling and parents' work.","Children cannot consent for themselves; decisions need care and parents' involvement."],"affectedParties":["Affected children","Parents and carers","Schools"]},"owners":{"steward":"Nobody owns the condition; families and clinicians answer for care.","roles":[],"masterSystems":[]},"relations":[{"target":"Q55785287","type":"parent","note":"registry parent class"}],"interaction":{"identity":{"applicability":"required","items":["Vercy registry: vr.tr.periodic-fever-aphthous-stomatitis-pharyngitis-and-adenitis","Wikidata: Q2044034 (https://www.wikidata.org/wiki/Q2044034)"]},"properties":{"applicability":"not-applicable","items":["Diagnostic standing: suspected | clinician-established | under reassessment | alternative explanation established","Age at first compatible episode: months or years, with date precision and information source","Fever episode duration: hours or days per episode, with the onset and resolution rule","Interval between fever onsets: days, retaining individual intervals and observation gaps","Episode manifestation profile: aphthous stomatitis, pharyngitis and cervical adenitis each recorded as present | absent | not assessed","Interepisode health: returned to documented baseline | persistent symptoms | uncertain","Inflammatory and blood-count evidence: links to results with assay units, reference ranges, dates and attack or interepisode timing","Diagnostic framework: named criteria, issuing authors or body, publication or revision date, intended use and item-level assessment","Episode burden: episodes and days of disrupted usual activity per stated observation period","Management response: intervention linked to timing, symptom trajectory, subsequent recurrence and adverse events"]},"recognition":{"applicability":"optional","items":["Fever episodes recurring every few weeks with mouth ulcers, sore throat and swollen neck glands.","The child is well between episodes."]},"capabilities":{"applicability":"required","items":["Construct a longitudinal episode profile from dated observations and identify missing evidence.","Compare recorded features with a named, versioned diagnostic framework without autonomously confirming the diagnosis.","Flag changes in the usual episode pattern or persistent interepisode abnormalities for clinical review.","Track which alternative explanations were considered and whether their supporting evidence remains adequate.","Summarize episode burden and observed management outcomes for shared clinical review."]},"hazards":{"applicability":"required","items":["Other serious causes of recurrent fever can be missed if assumed to be PFAPA.","Repeated missed school and family strain."]},"interfaces":{"applicability":"required","items":["The Orphanet rare disease nomenclature, maintained by Orphanet under the coordination of the French National Institute of Health and Medical Research, includes PFAPA syndrome."]},"context":{"applicability":"required","items":["PFAPA syndrome is encountered mainly in pediatric care when recurrent fever episodes occur with oral ulcers, throat inflammation or enlarged cervical lymph nodes.","Representing the syndrome helps clinicians compare episode patterns and symptom-free intervals while considering alternative explanations."]}},"sources":[{"title":"Wikidata item Q2044034: periodic fever, aphthous stomatitis, pharyngitis and adenitis","url":"https://www.wikidata.org/wiki/Q2044034","note":"identity and sense of the item"},{"title":"Wikipedia: Periodic fever, aphthous stomatitis, pharyngitis and adenitis","url":"https://en.wikipedia.org/wiki/Periodic_fever%2C_aphthous_stomatitis%2C_pharyngitis_and_adenitis","note":"general description of the item"}],"openQuestions":["Which diagnostic and classification frameworks should this model support, and how do their requirements and validation populations differ for childhood-onset, persistent adult and adult-onset presentations?","What exact ICD-10, ICD-11 and SNOMED CT mappings are verified for PFAPA in the relevant editions and jurisdictions?","Which population-based estimates of prevalence, age at onset and long-term course are sufficiently supported, with population, ascertainment method and study year recorded?","What evidence supports the proposed aetiology and inflammatory mechanisms, and which uncertainties prevent a definitive causal account or diagnostic biomarker?","What current guidance supports differential investigation, treatment selection and follow-up thresholds, and how strong is the evidence for each management option?"],"resources":{"spec":"/models/things/publications/thing-q2044034/spec.json"},"provenance":{"origin":"thing registry research (pass 2)","builtFrom":["models/things/publications/thing-q2044034/spec.json"],"providers":["Codex"],"researchStatus":"unreviewed","generatedAt":"2026-09-12T12:01:22Z","builder":"tools/build_cards.py@1.0.0"},"completeness":{"sections":{"classifiers":"filled","whatItIs":"filled","purpose":"filled","distinguishingFeatures":"filled","structure":"filled","agentConduct":"filled","ethics":"filled","owners":"filled","relations":"filled","interaction.identity":"filled","interaction.properties":"not-applicable","interaction.recognition":"filled","interaction.capabilities":"filled","interaction.hazards":"filled","interaction.interfaces":"filled","interaction.context":"filled","sources":"filled"},"notes":{"_gate":"Published through the thing publication gate 1.0 on 2026-10-07T10:10:28+00:00: completeness 1.00; sense: Wikidata description; 2 live sources; review by codex: pass","interaction.properties":"Plane XCT: no invented physical properties."},"score":1.0}}