Familial Mediterranean Fever (FMF)
حمى البحر الأبيض المتوسط العائلية
A hereditary autoinflammatory disorder that causes recurring episodes of fever along with abdominal, chest, or joint pain, each usually lasting one to three days. It is notably more common among people of Mediterranean and Middle Eastern ancestry, including Arab populations, due to specific inherited gene variants. Long-term daily colchicine treatment is highly effective at preventing attacks and the serious kidney complications that can occur if the condition goes untreated.
This information is for general awareness only and does not replace professional medical advice. Consult a doctor for diagnosis and treatment.
Quick answer
Familial Mediterranean fever (FMF) is an inherited autoinflammatory condition that causes recurrent episodes of fever with abdominal, chest or joint pain, usually lasting one to three days. It is most common in people from Mediterranean and Middle Eastern backgrounds.
It is caused by changes (mutations) in the MEFV gene and is usually inherited from both parents. Attacks often begin in childhood.
Diagnosis is based on the pattern of attacks and, often, genetic testing. Daily colchicine prevents attacks in most people and protects against the serious long-term complication of amyloidosis, which can damage the kidneys. Treatment is lifelong and guided by a specialist.
Symptoms
Recurrent fever
Episodes usually last 12 hours to 3 days, then settle completely.
Abdominal pain
Sometimes severe and mimicking appendicitis or peritonitis.
Chest pain
Sharp, often worse on breathing — from inflammation around the lungs.
Joint pain and swelling
Often in the knees, ankles or hips; usually short-lived.
Skin rash
A tender red patch on the lower leg (erysipelas-like) in some people.
Muscle pain, especially in the legs
Symptom-free periods between attacks
Symptom guides
Causes and risk factors
Causes
- Mutations in the MEFV gene — The gene encodes a protein (pyrin) that helps regulate inflammation; changes lead to episodes of unprovoked inflammation.
- Autosomal recessive inheritance — Usually a person inherits a changed gene from each parent, although exceptions occur.
- Attack triggers — Stress, infection, physical exertion or menstruation can bring on an attack in some people.
Risk factors
- Ancestry — More common in people of Turkish, Arab, Armenian, Jewish and other Mediterranean and Middle Eastern origins.
- Family history of FMF
- Parents who are carriers of an MEFV mutation
How is it diagnosed?
FMF is diagnosed by a specialist from the typical pattern of attacks, supported by tests.
Clinical history
Duration, frequency and features of attacks, ethnicity and family history.
Blood tests during attacks
Inflammatory markers such as CRP and ESR rise during attacks and usually fall between them.
Genetic testing for MEFV mutations
Supports the diagnosis but is not always conclusive on its own.
Response to colchicine
A good response supports the diagnosis.
Excluding other causes
Infections, appendicitis and other autoinflammatory or rheumatic conditions.
Related tests
Treatment
Colchicine is the cornerstone of treatment. The dose is set by the treating specialist according to age, weight and response, and treatment is continued long term.
Daily colchicine
Prevents attacks in most people and helps prevent amyloidosis; usually taken lifelong and adjusted by the specialist.
Treatment for colchicine-resistant or intolerant patients
Biologic medicines that block interleukin-1 are used under specialist care.
Managing attacks
Pain relief and anti-inflammatory medicines as advised.
Regular monitoring
Blood and urine tests (including urine protein) to check the kidneys and treatment safety.
Family screening and counselling
Genetic advice for relatives and family planning.
Do not stop colchicine without medical advice, even when you feel well; missing doses can lead to attacks and long-term complications.
When should you see a doctor?
Arrange a medical assessment if
- Recurrent episodes of fever with abdominal, chest or joint pain
- Attacks that continue despite colchicine
- Side effects from colchicine, such as persistent diarrhoea or muscle weakness
- Swelling of the legs or foamy urine (possible kidney involvement)
- Planning pregnancy while on treatment
Seek urgent care if
- Severe abdominal pain that isn't typical for your attacks, especially with vomiting or a rigid abdomen
- Chest pain with breathlessness
- Very high fever with a stiff neck or confusion
- Signs of colchicine toxicity — severe vomiting, diarrhoea, muscle pain or weakness — especially with kidney disease or taking interacting medicines
Prevention
Take colchicine regularly as prescribed
This is the main way to prevent attacks and complications.
Keep follow-up appointments and tests
Including kidney and urine checks.
Genetic counselling
For families who have FMF or carry MEFV mutations.
Check with a doctor about new medicines
Some medicines interact with colchicine.
Frequently asked questions
What is familial Mediterranean fever?
An inherited condition causing recurrent fever and painful inflammation of the abdomen, chest or joints.
Who gets FMF?
It is most common in people of Mediterranean and Middle Eastern origin, and usually begins in childhood.
Is FMF contagious?
No. It is a genetic condition that is inherited, not an infection.
How is FMF treated?
With daily colchicine, which prevents attacks in most people and protects the kidneys from amyloidosis.
Is FMF dangerous?
With treatment the outlook is good. The main serious risk is amyloidosis, which colchicine helps prevent.
Can FMF be cured?
It cannot be cured, but it can usually be controlled very well with lifelong treatment.
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Medical sources
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