In a subset of patients with Familial Mediterranean fever, chronic joint involvement develops as an ongoing complication — distinct from the typical periodic attack pattern and requiring dedicated treatment beyond standard management.
Approximately 5% of FMF patients develop chronic joint involvement, most commonly resembling spondyloarthritis with sacroiliitis and peripheral monoarthritis or oligoarthritis. Standard colchicine therapy is not always effective for this chronic arthritis presentation, and cases that do not respond require additional intervention.
When chronic arthritis persists in FMF, the protocol involves additional therapeutic agents — including disease-modifying antirheumatic drugs, intra-articular steroid injections, or biological agents. The specific selection criteria, sequencing, and decision points are set out in the full protocol.