For clinicians
Familial Mediterranean fever and autoinflammatory syndromes
FMF, familial Mediterranean fever, autoinflammatory disease, periodic fever
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Bottom lineBottom line: continue colchicine throughout pregnancy and lactation; discontinuation risks flares and long-term amyloidosis. Outcomes on colchicine are generally good. FMF attacks (serositis) can mimic obstetric or surgical emergencies. IL-1 inhibitors (e.g. anakinra) are increasingly used for colchicine-resistant disease and considered compatible.
By domain
Colchicine: keep taking it ●●●○moderate evidencestrong
Continue colchicine; it is compatible and its continuation reduces flares and amyloidosis risk. Do not stop for pregnancy.[1]
Attacks that mimic emergencies ●●○○low evidenceconditional
Serositis attacks can mimic appendicitis, cholecystitis, or obstetric emergencies; ensure the diagnosis is flagged to avoid unnecessary intervention.[1]
If colchicine is not enough ●●○○low evidenceconditional
For colchicine-resistant disease, IL-1 inhibitors (anakinra, and canakinumab) are increasingly used and considered compatible; individualise.[1]
Pregnancy outcomes ●●○○low evidenceconditional
Outcomes on colchicine are generally favourable; uncontrolled disease and amyloidosis-related organ involvement increase risk.[1]
Key points
| Point | Evidence |
|---|---|
| Colchicine continuation is the central, evidence-supported recommendation.[1] | ●●●○moderate evidencestrong |
References
- Ruegg L, et al. EULAR recommendations for antirheumatic drugs in reproduction, pregnancy, and lactation: 2024 update. Ann Rheum Dis. 2025;84(6):910-926. https://ard.eular.org/article/S0003-4967(25)00818-0/fulltext