Protracted febrile myalgia is a severe manifestation of Familial Mediterranean fever (FMF) that requires a specific therapeutic approach. This page describes the clinical criteria that define this sub-population and outlines the treatment direction for achieving symptom resolution.

Clinical Scenario

This protocol applies to patients with FMF who develop protracted febrile myalgia — defined as severe, disabling myalgia of at least 5 days' duration, accompanied by fever and elevated inflammatory markers, in a patient carrying at least one M694V mutation.

Treatment Approach

Management centres on an anti-inflammatory strategy led by glucocorticoids, which can produce prompt resolution of symptoms. Alternative approaches exist for cases where the principal option is not used. The therapeutic goal is full resolution of symptoms with rapid clinical improvement.

The complete regimen, agent selection, and sequencing are available in the full structured protocol.

References

Protracted febrile myalgia is defined as severe disabling myalgia of at least 5 days duration in a patient with FMF associated with fever, elevated levels of inflammatory markers and the presence of at least one M694V mutation.
In protracted febrile myalgia, glucocorticoids lead to the resolution of symptoms; NSAID and IL-1-blockade might also be a treatment option.
Steroid treatment leads to prompt improvement.
NSAID might also be beneficial.
Two cases successfully treated by IL-1 blockade have been reported.

DOI: 10.1136/annrheumdis-2015-208690

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Treatment of Familial Mediterranean Fever in Protracted Febrile Myalgia

References