Date:
Patient:
MRN:
Clinician: (Rheumatologist, Internist)
Reason for Visit:
Follow-up for FMF
Evaluation of disease activity (frequency and severity of attacks)
Medication adjustment or response assessment
Management of complications (amyloidosis)
History of Present Illness:
Briefly describe the patient’s current status:
Frequency and severity of FMF attacks (fever, abdominal pain, chest pain, joint pain)
Response to current colchicine therapy (if applicable)
Presence of any new symptoms or complications
Past Medical History:
Include any relevant past medical conditions, such as:
Previous hospitalizations for FMF attacks
History of abdominal or joint surgery (related to FMF complications)
Family History:
Presence of FMF in first-degree relatives
Social History:
Adherence to colchicine medication (if prescribed)
Labs:
Acute phase reactants (inflammatory markers) may be elevated during attacks (e.g., ESR, CRP).
Consider mentioning other labs as relevant, such as:
Complete blood count (CBC) – may show signs of inflammation during attacks
Liver function tests – may be abnormal in some patients with amyloidosis
Imaging:
Imaging studies are not diagnostic for FMF, but may be performed to rule out other diagnoses or assess complications (e.g., abdominal X-ray for suspected bowel perforation).
Consider mentioning any imaging performed for specific concerns.
Genetics:
Mention FMF gene mutation(s) identified (if known).
Assessment:
Confirm the diagnosis of FMF based on clinical features, family history, and possible genetic testing results.
Assess disease activity based on attack frequency and severity.
Evaluate for potential complications of FMF, such as amyloidosis (protein deposition in organs).
Plan:
Outline the treatment plan based on disease activity and potential complications:
Colchicine: The mainstay of FMF therapy, taken daily to prevent attacks. Discuss dosage adjustments if needed.
Other medications: Consideration of additional medications (corticosteroids, biologic agents) in severe cases or those with colchicine intolerance.
Management of complications: Address specific needs related to amyloidosis or other complications.
Prognosis:
Briefly discuss the prognosis. Early diagnosis and consistent colchicine use can significantly reduce the frequency and severity of attacks and prevent complications.
Education:
Document any education provided to the patient regarding:
The nature of FMF and its symptoms
Importance of daily colchicine adherence
Warning signs and symptoms of complications
The importance of regular follow-up
Notes:
Include any additional relevant information not covered above, such as the patient’s understanding of the disease and adherence to recommendations.
Consider mentioning the emotional impact of chronic illness and potential support groups available.
Disclaimer: This is a template and should be adapted to the specific needs of each patient. It is important to consult with a healthcare professional for diagnosis and treatment recommendations.