When Familial Mediterranean fever (FMF) is complicated by AA amyloidosis, standard management is not sufficient. The presence of amyloidosis signals that systemic inflammation has been inadequately controlled, with serious consequences for renal function. Treatment must be intensified accordingly.

Clinical scenario: FMF in a patient with established AA amyloidosis — a complication driven by sustained inflammatory activity that demands a more aggressive and closely monitored treatment strategy.

Treatment approach

The approach centres on maximising the tolerated dose of colchicine. Where this proves insufficient, further agents may be added. The complete escalation criteria, supplementary options, and monitoring schedule are set out in the full protocol.

Treatment goals

References

DOI: 10.1136/annrheumdis-2015-208690

FMF treatment needs to be intensified in AA amyloidosis using the maximal tolerated dose of colchicine and supplemented with biologics as required.

Colchicine must be given in doses that are sufficient to produce sustained control of the inflammatory disease in order to prevent ongoing abnormal production of SAA protein.

Therapeutic success is ideally monitored by frequent estimation of SAA protein with the target being maintenance below 10 mg/L and by assessment of proteinuria and glomerular filtration.

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Treatment of Familial Mediterranean Fever in AA Amyloidosis

Treatment approach

Treatment goals

References