Treatment of Familial Mediterranean Fever

First-Line Treatment: Colchicine

The American College of Rheumatology recommends that treatment with colchicine should begin immediately upon clinical diagnosis, even before genetic confirmation, to prevent inflammatory attacks and complications 1, 3
Colchicine dosing is weight-based and age-dependent, with the following recommended doses:
- Children <5 years: ≤0.5 mg/day
- Children 5-10 years: 0.5-1.0 mg/day
- Children >10 years and adults: 1.0-1.5 mg/day 2
Long-term colchicine prophylaxis is essential to control inflammation, prevent clinical attacks, and prevent the development of AA amyloidosis, with a strength of evidence supporting its effectiveness 3, 4

The primary treatment goal is to achieve minimal or no clinical activity and complete control of subclinical inflammation to prevent associated damage, as recommended by the European League Against Rheumatism 1, 2
Regular monitoring of acute phase reactants is necessary even in asymptomatic periods to detect subclinical inflammation, with a recommended frequency of monitoring 2, 5
Adherence to treatment is crucial and should be regularly assessed, especially in adolescents and adults, to ensure optimal treatment outcomes 3, 4

In adherent patients with persistent attacks or subclinical inflammation, colchicine dose should be increased within the recommended range, as suggested by the American College of Rheumatology 4

FMF requires lifelong management with regular follow-up visits and patient education, with a focus on promoting quality of life and supporting overall health and well-being, as recommended by the European League Against Rheumatism 3, 4
Patient-centered management is essential to promote quality of life and support overall health and well-being, with a strength of evidence supporting its importance 1

Regular colchicine treatment significantly reduces the risk of amyloidosis from 60% to less than 13%, highlighting the importance of adherence to treatment 6