Familial Mediterranean fever (FMF) is characterised by unprovoked attacks and subclinical inflammation that persists between episodes. The treatment goal is to suppress both — confirmed by normalisation of inflammatory markers between attacks.
The first-line approach centres on an oral daily agent — colchicine — initiated as soon as the clinical diagnosis is confirmed, with dosing individualised by age group and adjusted upward if attacks or subclinical inflammation persist.
Complete control of unprovoked attacks and minimisation of subclinical inflammation between episodes — with normal serum amyloid A (SAA) protein and C-reactive protein (CRP) levels between attacks as measurable targets.
DOI: 10.1136/annrheumdis-2015-208690
Treatment with colchicine should be started as soon as a clinical diagnosis is made.
A starting dose of ≤0.5 mg/day for children <5 years of age, 0.5–1.0 mg/day for children 5–10 years of age, 1.0–1.5 mg/day in children >10 years of age and in adults is recommended.
Dosing can be in single or divided doses, depending on tolerance and compliance.
If inflammation persists despite adherence to the advised initial dose of colchicine, as defined by continuing attacks or elevated APR between attacks, colchicine dose may be increased by 0.5 mg/day with careful monitoring of side effects.
Colchicine may be increased up to a daily dose of 2 mg in children and 3 mg in adults, or the maximum tolerated dose if this cannot be appropriate.
The ultimate goal of treatment in FMF is to obtain complete control of unprovoked attacks and minimise subclinical inflammation in between attacks.
The development of AA amyloidosis can be prevented when treatment substantially maintains normal SAA protein concentration between attacks.
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