{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T01:04:06Z","timestamp":1778202246754,"version":"3.51.4"},"reference-count":36,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T00:00:00Z","timestamp":1758844800000},"content-version":"unspecified","delay-in-days":87,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000921","name":"COST","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000921","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2025,9,10]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although colchicine is the mainstay of familial Mediterranean fever (FMF) treatment, 5\u201310% of patients are considered to have colchicine resistance (CR). However, there is no globally agreed CR definition or indications for biological disease-modifying anti-rheumatic drugs (bDMARDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A survey on \u2018Biologics in Monogenic Autoinflammatory Diseases\u2019, part of the \u2018Clinical Practice Strategies\u2019 (CLiPS) initiative, was conducted by a JIR cohort-initiated eCOST network among expert participants worldwide. Our primary aim was to provide a flowchart reflecting the different CR definitions and present data regarding bDMARD indications. The secondary aim was to determine how specific biases influence clinical approaches. We analysed the CliPS according to the experience levels of physicians, country-specific FMF prevalence, countries\u2019 gross domestic product, bDMARD availability and reimbursement policies of the countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 223 responses from 46 countries were included in the study. Almost half of the respondents (73\/160, 45.6%) indicated that three to four attacks within the preceding 6 months were necessary for their CR definition. The most frequently used acute-phase reactant was C-reactive protein (157\/164, 95.7%). Almost three-fourths of the respondents (74%, n=165) considered that supplementary factors, including complications of FMF, attack severity, elevated activity scores, patient-reported outcome and quality of life scales, influenced their CR definition.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>We present a novel flowchart describing physicians\u2019 general attitudes and unique findings regarding management strategies for colchicine-resistant FMF and shifting trends influenced by epidemiological and socioeconomic factors.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/rmdopen-2025-006097","type":"journal-article","created":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T10:15:16Z","timestamp":1758881716000},"page":"e006097","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Comparative 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Moussaoui","sequence":"additional","affiliation":[{"name":"Infectious Diseases and General Internal Medicine, University Hospital of Li\u00e8ge GIGA-Inflammation, Infection & Immunity | University of Li\u00e8ge, Li\u00e8ge, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meri","family":"Kirijas","sequence":"additional","affiliation":[{"name":"Institute of Immunobiology and Human Genetics, Faculty of Medicine, Ss. 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