Guidelines for the management and treatment of periodic fever syndromes familial Mediterranean fever

Maria Teresa R.A. Terreri Wanderley Marques Bernardo Claudio Arnaldo Len Clovis Artur Almeida da Silva Cristina Medeiros Ribeiro de Magalhães Silvana B. Sacchetti Virgínia Paes Leme Ferriani Daniela Gerent Petry Piotto André de Souza Cavalcanti Ana Júlia Pantoja de Moraes Flavio Roberto Sztajnbok Sheila Knupp Feitosa de Oliveira Lucia Maria Arruda Campos Marcia Bandeira Flávia Patricia Sena Teixeira Santos Claudia Saad Magalhães About the authors

Abstract

Objective:

To establish guidelines based on scientific evidence for the management of familial Mediterranean fever.

Description of the evidence collection method:

The Guideline was prepared from 5 clinical questions that were structured through PICO (Patient, Intervention or indicator, Comparison and Outcome), to search in key primary scientific information databases. After defining the potential studies to support the recommendations, these were graduated considering their strength of evidence and grade of recommendation.

Results:

10,341 articles were retrieved and evaluated by title and abstract; from these, 46 articles were selected to support the recommendations.

Recommendations:

1. The diagnosis of FMF is based on clinical manifestations, characterized by recurrent febrile episodes associated with abdominal pain, chest or arthritis of large joints; 2. FMF is a genetic disease presenting an autosomal recessive trait, caused by mutation in the MEFV gene; 3. Laboratory tests are not specific, demonstrating high serum levels of inflammatory proteins in the acute phase of the disease, but also often showing high levels even between attacks. SAA serum levels may be especially useful in monitoring the effectiveness of treatment; 4. The therapy of choice is colchicine; this drug has proven effectiveness in preventing acute inflammatory episodes and progression towards amyloidosis in adults; 5. Based on the available information, the use of biological drugs appears to be an alternative for patients with FMF who do not respond or are intolerant to therapy with colchicine.

Keywords:
Familial Mediterranean fever; Guidelines; Childhood; Fever; Autoinflammatory syndromes

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