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Adult-onset Still disease — SCE Rheumatology MCQ

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HardPregnancy and rare rheumatic diseaseAdult-onset Still diseaseSCE Rheumatology

A patient with genetically confirmed familial Mediterranean fever has monthly attacks and persistently raised serum amyloid A despite adherence to maximally tolerated colchicine. What escalation is appropriate?

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Correct answer: E — Add interleukin-1 blockade while continuing the tolerated colchicine dose

This is colchicine-resistant FMF with ongoing inflammatory and amyloid risk. Specialist IL-1 blockade can be added through the commissioned periodic-fever pathway while tolerated colchicine is continued, rather than escalating toxic colchicine exposure or substituting chronic glucocorticoid.

Reference: EULAR/PReS recommendations for familial Mediterranean fever — 2024 update (Published April 2025): https://ard.bmj.com/content/84/6/899; NHS England: canakinumab for TRAPS, HIDS/MKD and FMF (Published March 2020): https://www.england.nhs.uk/publication/canakinumab-for-treating-periodic-fever-syndromes-traps-hids-mkd-and-fmf-ages-2-years-and-older/