New recommendations for the treatment of familial Mediterranean fever

In 2016, EULAR - The European Alliance of Associations for Rheumatology - published recommendations on the treatment of familial Mediterranean fever (FMF). Since then, new evidence has become available, so the recommendations have been reviewed and updated.

FMF is an autoinflammatory disease caused by a single gene. It is characterised by repeated attacks of fever and inflammation, and causes pain in the joints, lungs, and abdomen - which can have negative effects if left untreated. Although it is the most common of the monogenic autoinflammatory diseases, it is still rare - resulting in low awareness around the disease for both patients and healthcare professionals, and limited knowledge about its management options.

The last recommendations for FMF were published in 2016, but since then there have been new treatments developed, and new evidence collected. To address this, EULAR and PReS - the Paediatric Rheumatology European Society - have worked together to review and update the recommendations. Researchers, healthcare professionals, and patients worked together to develop this new advice.

The new work, published in the April 2025 issue of the Annals of the Rheumatic Diseases, includes 12 individual recommendations and four overarching principles. These principles emphasise that FMF has a complex clinical presentation, which requires expertise in both diagnosis and management. They also stress that the treatment goal is to achieve at least minimal activity and control of subclinical inflammation to prevent damage - and that this will require lifetime management and prophylaxis. Good adherence is therefore important for people with FMF, and patient-centred management is useful to support patients in achieving good health and well-being.

The 12 new recommendations focus on key management steps, from first-line treatment with colchicine and dosing considerations through to second-line options and the biologic therapies that may be considered. Specific recommendations also deal with issues such as amyloidosis, pregnancy, symptomatic treatment during attacks, and measures of disease activity.

EULAR and PReS are confident that this revised set of recommendations will support rheumatologists and other healthcare professionals in managing FMF in patients of all ages. They note that the updates highlight the need for a holistic approach and attention to compliance - but there is still much to find out about this disease, and ongoing research will help to support continued updates in the future.