Characteristics of familial Mediterranean fever after 65 years of age.

First Author : Rodrigues François

Journal : Eur J Intern Med

Refererence : Eur J Intern Med 2024 Oct 29:S0953-6205(24)00429-1.

Pubmed link : https://pubmed.ncbi.nlm.nih.gov/39477705/

Summary :

Familial Mediterranean fever (FMF) is the most common monogenic auto-inflammatory disease, associated with mutations in the MEFV gene. It leads to recurrent febrile abdominal pain and is treated with colchicine, which significantly improves life expectancy. As more FMF patients reach 65 or older, there is a lack of data on its course in elderly patients. This study aimed to explore the phenotype and comorbidities of FMF patients over 65, all of whom were treated with colchicine.

Among 638 FMF patients followed in French adult JIR cohort centers, 59 were over 65 (32 women, 27 men), with 48% referred after 65. The majority carried the M694V MEFV mutation. Nine patients had died by the time of analysis, most due to complications like amyloidosis, infections, or liver cirrhosis. Common comorbidities included cardiometabolic disorders (59%), liver disease (37%), and cancers (15%). Kidney disease, particularly from amyloidosis, was also prevalent.

Treatment with colchicine began at a median age of 35.5, but there was a 28-year delay in initiation. While 55% responded well to colchicine, 18% showed poor adherence, and some experienced secondary treatment failure. Interleukin-1 inhibitors were also used with good results.

This study highlights the need for lifelong follow-up and individualized treatment for elderly FMF patients, considering the impact of aging and comorbidities. Further research is needed to understand the relationship between FMF and conditions like liver cirrhosis.