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EULAR/PReS endorsed recommendations for the management of familial Mediterranean fever (FMF): 2024 update

First author : Ozen S

Review: Annals of the Rheumatic Diseases

Reference: Ann Rheum Dis. 2025 Apr 9:S0003-4967(25)00084-6

Link to pubmed: EULAR/PReS endorsed recommendations for the management of familial Mediterranean fever (FMF): 2024 update - PubMed

Recommandations approuvées par l’EULAR et la PReS pour la FMF

2024 European Recommendations on Familial Mediterranean Fever (FMF) – Summary:


Familial Mediterranean Fever (FMF) is the most common monogenic autoinflammatory disease worldwide. Due to its clinical and genetic variability, specialized management is essential. In 2024, the EULAR and PReS societies updated their guidelines.


General Principles:

  • FMF requires specialist expertise for both diagnosis and management.

  • The primary goal is complete control of inflammation, including subclinical inflammation, to prevent complications such as AA amyloidosis.

  • Lifelong treatment is necessary, with strict adherence, primarily based on daily colchicine therapy.

  • Care should be patient-centered, aiming to preserve quality of life.


Key Recommendations:

  • Colchicine should be initiated as soon as a clinical diagnosis is made.

  • The dosage must be tailored to tolerance and adherence (single or divided daily doses).

  • If symptoms persist or subclinical inflammation remains, the dose should be increased within recommended limits (maximum 2 mg/day in children, 3 mg/day in adults).

  • If colchicine fails despite good adherence, interleukin-1 blockers (anakinra, canakinumab) are recommended.

  • Chronic musculoskeletal manifestations may require additional treatments (DMARDs, biologics).

  • Regular monitoring (clinical, biological, toxicity, adherence) is essential.

  • Colchicine should be continued during pregnancy and breastfeeding.

  • During acute attacks, colchicine should be maintained at the same dose, with symptomatic treatment added (e.g., NSAIDs).

  • A minimum core set of assessment criteria is proposed: attack frequency, quality of life, biological markers (CRP, SAA).


Quality indicators, clinical priorities (especially adherence), and implementation strategies are provided to harmonize care across centers.



Characteristics of familial Mediterranean fever after 65 years of age

First author: François Rodrigues et al.


Caractéristiques de la fièvre méditerranéenne familiale après 65 ans

              Familial Mediterranean Fever (FMF) is an autosomal recessive disease caused by mutations in MEFV, characterized by recurrent febrile attacks. The natural history of the disease, which began in children and had a high mortality rate in the last century, is unknown in people over 65.


        This retrospective study included the records of 59 patients with FMF followed at Hôpital Tenon (Paris, France), representing 9% of the total number of patients followed for FMF. The median age was 73 years. Although all patients were treated with colchicine, the study population, born in the 1940s-1950s, had a late diagnosis (median age 28 years) and a delayed initiation of colchicine (35 years, median year of introduction 1980). 73% of patients had an elevated intercritical CRP on colchicine, and 37% had to receive an inteleukin-1 inhibitor, with good tolerability. The prevalence of AA amyloidosis was 10%. The most frequent comorbidities were cardiovascular (59% of patients) and, unexpectedly, hepatic (37%), with a high frequency of non-alcoholic, non-viral cirrhosis (27%) and no associated diabetes, suggesting a link with FMF. Nine patients (15%) had died at the time of collection, two from complications of FMF, two from hepatic cirrhosis, and five from infections.


             In conclusion, the study indicates that FMF can remain active after the age of 65, motivating specialized lifelong follow-up with CRP monitoring between attacks, as well as the prescription of biotherapy in the event of unsatisfactory disease control.




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