Clinical features of patients with familial Mediterranean fever over 50 years of age: a single-center experience

Familial Mediterranean Fever (FMF) is the most common hereditary monogenic autoinflammatory syndrome, with disease activity potentially influenced by aging. This study aimed to evaluate the clinical features, genetic background, treatment patterns, and disease course of FMF in older patients. This retrospective observational cohort study included 343 FMF patients aged 50 years or older. Demographic data, MEFV mutations, attack characteristics, and treatments were analyzed. Attack frequency and visual analog scale (VAS) scores were compared across three time points: before colchicine treatment, after treatment, and in the past year. Patients were stratified by recent attack status, and multivariate logistic regression was used to identify independent predictors of attack activity. The median number of attacks per year decreased from 12 (IQR: 4-24) before treatment to 1 (IQR: 0-4) after treatment, and 0 (IQR: 0-3) in the past year (p < 0.001). Patients with attacks in the past year had higher current and maximum colchicine doses (p = 0.002 and p = 0.02), while those without recent attacks were significantly older (p = 0.005). Multivariate analysis showed that age ≥ 60 years remained associated with a lower likelihood of attacks (OR = 0.60, 95% CI: 0.37-0.98, p = 0.042), as was male sex (p = 0.003). Attack frequency and colchicine requirements were lower in older FMF patients, suggesting milder disease activity in older individuals. These findings highlight the need for additional research into aging-related mechanisms in FMF and may help guide treatment strategies for older patients.