Treatment of familial Mediterranean fever: colchicine and beyond.

F amilial Mediterranean fever, the most common form of hereditary autoinflammatory disorders, is characterized by recurrent episodes of fever and sterile inflammation resulting in peritonitis, pleuritis, arthritis, and/or erysipelas-like erythema. In addition to these self-limited inflammatory episodes that last 1–3 days and mainly affect serosal membranes, FMF has also been associated with an increased risk for reactive (AA type) amyloidosis [1]. FMF is considerably common in eastern Mediterranean countries and exerts a significant disease burden. Colchicine has been accepted as the standard of care for prophylactic treatment of inflammatory episodes and prevention of reactive amyloidosis in FMF patients long before the elucidation of the genetic basis of FMF [2-5]. Identification of the pathogenic mechanisms of FMF, after the MEFV gene variations were found to be the cause of the autosomal recessively inherited disease, enables the optimum use of colchicine as well as the development of more targeted therapies for patients with inadequate response to colchicine. This review updates the treatment options for patients with FMF by summarizing the available data on colchicine and its current alternatives.