Familial Mediterranean fever (FMF) complicated by AA amyloidosis demands a higher level of inflammatory control than FMF alone. Persistent systemic inflammation drives ongoing amyloid deposition, threatening renal function. When standard first-line therapy can no longer achieve the required targets, escalation is indicated.
The presence of AA amyloidosis requires that FMF treatment be intensified. Controlling the underlying inflammatory activity is central to slowing progression and protecting glomerular function. Maximal tolerated colchicine is the established first step, but it is not always sufficient.
This protocol applies when maximal tolerated colchicine has not achieved the required targets: SAA protein has not been maintained below 10 mg/L, and proteinuria and glomerular filtration have not stabilised or improved. Failure to reach these inflammatory and renal endpoints is the trigger for escalation.
When colchicine at maximal tolerated dose is insufficient, the protocol introduces a biologic approach involving anti-IL-1 therapy — the full regimen, co-administration details, and monitoring schedule are contained in the structured protocol.
The therapeutic goals are SAA protein maintained below 10 mg/L, and stable or improving proteinuria and glomerular filtration rate.
DOI: 10.1136/annrheumdis-2015-208690