Practical considerations for monitoring patients with familial Mediterranean fever: review of evidence and expert opinion.

Introduction: Effective monitoring is critical in familial Mediterranean fever (FMF), to guide a treat-to-target approach to management and to prevent long-term complications. Here we review current evidence and guidance on monitoring patients with FMF in clinical practice, and propose flexible recommendations for long-term monitoring in FMF, that can be tailored to the needs and setting of the individual clinic. Methods: In this expert-informed narrative review based on a systematic literature search, published evidence was used to inform and augment the clinical experience and expert opinion of a group of international experts in FMF. Results: A total of 42 publications were included for review, including several treatment guidelines for FMF as well as publications relating to clinical biomarkers (primarily acute phase reactants), patient-reported outcomes and various disease scales and scores. While much of the guidance from these publications is broadly consistent, with agreement on core monitoring principles and parameters, the lack of validated, evidence-based recommendations highlights the need for flexibility in clinical practice. Conclusion: This review provides a comprehensive schedule of parameters with suggested monitoring frequencies, centred around three key principles of FMF monitoring: assessing disease characteristics, monitoring for subclinical inflammation, and assessing the tolerability of current medication and possible side effects. It is our hope that this will prove a useful starting point for creation of tailored monitoring schedules by clinics based on their specific resources, patient needs, and clinical priorities.