The role of adalimumab in the treatment of colchicine-resistant familial mediterranean fever: a case report

Abstract

Familial Mediterranean fever (FMF) is an autosomal recessive inherited disorder. Articular manifestations are the second most common presentation in FMF patients after abdominal pain. Colchicine remains the gold standard of therapy for the different aspects of the disease. However, about 5-15% of patients experience resistance to colchicine. Therefore, physicians were encouraged to try different medications and treatment modalities. Biologic agents were used in several FMF patients with various clinical presentations including articular involvement. In the majority of those, there was a good clinical response with improvement in the quality of life. Adalimumab is an anti-TNF alpha agent used conventionally in inflammatory bowel disease and rheumatologic disorders. To date only five cases were reported in the literature using adalimumab for severe refractory FMF.Our case report details a young female with severe disabling colchicine-resistant FMF associated with significant articular inflammation. She was treated with adalimumab with remarkable clinical improvement and complete response.