Familial Mediterranean Fever: The Recurring Fever Condition That Strikes in Bouts — and How Treatment Keeps It in Check
Updated: 2 days ago
Medically reviewed by Dr. Baraa Alnahhal, MD · Last reviewed: October 2026
Quick Answer
Familial Mediterranean fever is a genetic autoinflammatory disorder causing recurrent fevers and painful inflammation of the abdomen, chest and joints, usually starting in childhood. There is no cure, but daily colchicine prevents most attacks and helps prevent kidney-damaging amyloidosis. If colchicine is not enough, interleukin-1 blocking medicines such as canakinumab may be prescribed. [3] [4]
What the research says
Interleukin-1 blockers can help when colchicine is not enough. A Cochrane review of 10 randomised trials with 312 participants found that canakinumab probably reduces the number of people having an attack at 16 weeks in colchicine-resistant FMF (risk ratio 0.41, 95% CI 0.26–0.65; one study, 63 participants; moderate-certainty evidence) (Yin et al., Cochrane Database of Systematic Reviews, 2022 [1]).
Current evidence supports these options. A systematic review of 42 studies (1,798 patients) that informed the EULAR/PReS recommendations concluded that interleukin-1 inhibitors are effective and relatively safe for people who do not respond to colchicine, and one randomised trial showed once-daily and twice-daily colchicine to be equivalent (Sag et al., Annals of the Rheumatic Diseases, 2025 [2]).
What is familial Mediterranean fever?
Familial Mediterranean fever (FMF) is a genetic autoinflammatory disorder that causes recurrent fevers and painful inflammation of your abdomen, chest, and joints [3].
FMF is an inherited disorder that usually occurs in people of Mediterranean origin, including those of Jewish, Arab, Armenian, Turkish, North African, Greek, or Italian ancestry. But it can affect people in any ethnic group [3].
FMF is typically diagnosed during childhood. While there is no cure for this disorder, you may be able to relieve or even prevent signs and symptoms by following your treatment plan [3].
How the attacks work
FMF symptoms occur in bouts called attacks that last 1 to 3 days. Arthritic attacks may last for weeks or months. The attacks generally resolve on their own after a few days. Between attacks, you will likely feel back to your typical health, and symptom-free periods may be as short as a few days or as long as several years [3].
What an attack looks like
Signs and symptoms of FMF attacks vary, but can include:
Symptom | Detail |
Fever | A sudden fever is the hallmark of an attack |
Abdominal pain | Painful inflammation of the abdomen |
Chest pain | Can make it hard to breathe deeply |
Painful, swollen joints | Usually in the knees, ankles, and hips |
Red rash | On the legs, especially below the knees |
Muscle aches | Aches in the muscles |
Swollen, tender scrotum | Possible in males |
When to see a doctor
See your health care provider if you or your child has a sudden fever accompanied by pain in the abdomen, chest, and joints [3].
What causes FMF?
Familial Mediterranean fever is caused by a gene change (mutation) that is passed from parents to children. The gene change affects the function of an immune system protein called pyrin, causing problems in regulating inflammation in the body [3].
In people with FMF, the change occurs in a gene called MEFV. Many different changes in MEFV are linked to FMF. Some changes may cause very severe cases, while others may result in milder signs and symptoms [3].
What triggers an attack?
It is unclear what exactly triggers attacks, but they may occur with the following [3].
Possible trigger | Type |
Emotional stress | Psychological |
Menstruation | Hormonal |
Exposure to cold | Environmental |
Physical stress such as illness or injury | Physical |
Risk factors
The risk of FMF is higher with a family history of the disorder and with Mediterranean ancestry. FMF may be more likely in people of Jewish, Arab, Armenian, Turkish, North African, Greek, or Italian descent, but it can affect people in any ethnic group [3].
Why untreated FMF is serious
Complications can occur if FMF is not treated. Inflammation can lead to the following [3].
Complication | What happens |
Amyloidosis | The protein amyloid A, which normally does not build up in organs, collects during repeated attacks, causing inflammation and organ damage, especially in the kidneys |
Kidney damage | Amyloidosis can damage the kidney filtering systems (glomeruli), causing nephrotic syndrome with large protein loss in urine; it can lead to blood clots in the kidneys or kidney failure |
Joint pain | Arthritis is common, most often affecting the knees, ankles, and hips |
Infertility | Untreated inflammation may affect the reproductive organs |
Other complications | Inflammation in the heart, lungs, spleen, brain, and superficial veins |
In some people, the first sign of FMF is amyloidosis, the buildup of amyloid A protein in organs, especially the kidneys [3].
How FMF is diagnosed
Tests and procedures used to diagnose FMF include the following [4].
Test | What it shows |
Physical exam | The provider asks about signs and symptoms and examines you |
Family medical history review | A family history of FMF raises the likelihood |
Lab tests | During an attack, blood and urine tests may show raised inflammatory markers (for example, an elevated white blood cell count); protein in the urine may indicate amyloidosis |
Genetic testing | May confirm an FMF-associated change in the MEFV gene, but it is not used alone |
Genetic testing may determine whether your MEFV gene contains a change associated with FMF. However, tests are not advanced enough to detect every gene change linked to FMF, so false-negative results are possible. For this reason, health care providers typically do not use genetic tests as the sole method of diagnosing FMF [4].
Genetic testing for FMF may be recommended for your first-degree relatives (parents, siblings, or children) or other relatives who may be at risk. Genetic counseling can help you understand gene changes and their effects [4].
Treatment: what actually works
There is no cure for familial Mediterranean fever. However, treatment can help relieve symptoms, prevent attacks, and prevent complications caused by inflammation [4].
Medications
Medicine | How it works | Key notes |
Colchicine (Colcrys) | A pill that reduces inflammation and helps prevent attacks and the development of amyloidosis | Effective in preventing attacks for most people; dosing varies (one daily dose versus smaller, more frequent doses); common side effects include abdominal pain, nausea, and diarrhea; treatment is generally lifelong |
Interleukin-1 blockers | Block the inflammation-involved protein interleukin-1 | For symptoms not controlled with colchicine; canakinumab (Ilaris) is FDA-approved for FMF; other options include rilonacept (Arcalyst) and anakinra (Kineret), which are not FDA-approved specifically for FMF |
Colchicine is effective in preventing attacks for most people. To lessen the severity of symptoms during an attack, your health care provider may recommend intravenous fluids and medications to reduce fever and inflammation and control pain [4].
Regular appointments with your health care provider are important to monitor your medications and your health.
Coping and support
Learning that you or your child has a chronic illness such as FMF can be upsetting and frustrating. Here are some tips that may help you cope [4].
Tip | Why it helps |
Learn about FMF | Knowing enough to feel comfortable making care decisions; ask your provider for good starting sources |
Find someone to talk with | A family member, trusted friend, counselor, or therapist lets you express fears and frustrations |
Consider a support group | Members truly understand what you are going through; ask your provider if a local FMF support group exists |
Preparing for your appointment
If you have signs and symptoms of FMF, you may begin by seeing your family health care provider, who may refer you to a specialist in inflammatory diseases called a rheumatologist. Because appointments can be brief and there is often a lot to discuss, arrive prepared [4].
What you can do
Preparation step | Details |
Ask about pre-appointment restrictions | For example, diet restrictions before testing |
List your symptoms | Including any that seem unrelated |
Note key personal info | Major stresses or recent life changes |
List all medications | Including vitamins, supplements, and doses |
Bring a family member or friend | Someone who may remember details you miss |
Write questions in priority order | List from most to least important in case time runs out |
Questions you might ask
Question | Category |
What do you think is causing my or my child's symptoms? | Diagnosis |
What caused this condition? | Cause |
What treatments are available, and what are the side effects? | Treatment |
Are there any other possible treatments? | Alternatives |
If other health problems are present, how can they be treated as well? | Co-management |
Are there any restrictions on activity? | Daily life |
Should my family members be tested? | Family screening |
If I want to have more children, can I protect them from this disorder? | Future planning |
What to expect from your doctor
Your health care provider is likely to ask when you first began experiencing symptoms; whether symptoms are continuous or come and go; how long they last; what seems to trigger them and what warning signs help predict them; whether anything you do stops or lessens their severity; whether symptoms follow a pattern; and whether blood relatives have FMF [4].
Conclusion: a chronic condition with a real plan behind it
Familial Mediterranean fever is a genetic condition that arrives in unpredictable bursts, such as a sudden fever, abdominal pain, or swollen joints, and then disappears as quickly as it came. Left untreated, those recurring attacks can quietly damage the kidneys and other organs. But the treatment story is encouraging: for most people, a daily medicine prevents the attacks and the complications they cause, so children and adults can feel like themselves between episodes.
If you or your child keeps having unexplained fever attacks, especially if your family traces its roots to the Mediterranean region, it is worth raising FMF with your health care provider. And if you are diagnosed, the most important next steps are starting treatment early, keeping up with regular appointments, and asking whether your family members should be tested too.
Want more practical, evidence-based guides like this one? Explore our collection of autoinflammatory and genetics explainers, and tell us what to cover next in the comments.
Learn more from trusted organizations
National Human Genome Research Institute: About Familial Mediterranean Fever
NIH Genetic and Rare Diseases Information Center: Familial Mediterranean fever
Frequently Asked Questions
What is familial Mediterranean fever?
Familial Mediterranean fever is a genetic autoinflammatory disorder that causes recurrent fevers and painful inflammation of the abdomen, chest, and joints. It is inherited and typically diagnosed during childhood.
Is FMF genetic?
Yes. It is caused by a gene change in the MEFV gene that is passed from parents to children. The change affects an immune protein called pyrin, disrupting the body's ability to regulate inflammation.
Who is most likely to get FMF?
People with a family history of FMF and those of Mediterranean ancestry, including Jewish, Arab, Armenian, Turkish, North African, Greek, or Italian descent. But it can affect people in any ethnic group.
How long do FMF attacks last?
Attacks last 1 to 3 days. Arthritic attacks may last for weeks or months. Between attacks, people typically feel back to their normal health, with symptom-free periods lasting from a few days to several years.
What does an FMF attack feel like?
A sudden fever accompanied by abdominal pain, chest pain that makes deep breathing hard, painful swollen joints (usually knees, ankles, and hips), a red rash on the legs below the knees, muscle aches, and sometimes a swollen, tender scrotum.
What triggers FMF attacks?
It is unclear exactly, but attacks may occur with emotional stress, menstruation, exposure to cold, and physical stress such as illness or injury.
Can FMF be cured?
No, there is no cure. But daily colchicine, generally taken for life, prevents most attacks and helps prevent the dangerous complication of amyloidosis, and interleukin-1 blocking medicines may be prescribed when colchicine is not enough.
What is amyloidosis, and why does FMF cause it?
Amyloidosis is a buildup in organs of a protein called amyloid A, which the body makes during inflammation. It accumulates during FMF attacks and damages organs, especially the kidneys. Untreated, it can lead to kidney failure.
Why is genetic testing not used alone to diagnose FMF?
Current tests cannot detect every MEFV gene change linked to FMF, so false negatives are possible. Providers rely on symptoms, family history, lab tests, and, when available, genetic testing together.
Should my family be tested if I have FMF?
Genetic testing may be recommended for first-degree relatives (parents, siblings, and children) or other at-risk relatives. Genetic counseling can help families understand the gene changes and their effects.
References
Yin X, Tian F, Wu B, et al. Interventions for reducing inflammation in familial Mediterranean fever. Cochrane Database of Systematic Reviews. 2022;3(3):CD010893. PMID 35349164. https://doi.org/10.1002/14651858.CD010893.pub4
Sag E, Otón T, Carmona L, et al. Efficacy and safety of treatments in familial Mediterranean fever and its complications: a systematic review informing the EULAR/PReS recommendations for familial Mediterranean fever. Annals of the Rheumatic Diseases. 2025;84(11):1909-1927. PMID 40562663. https://doi.org/10.1016/j.ard.2025.05.020
Mayo Clinic Staff. Familial Mediterranean fever: symptoms and causes. Mayo Clinic. November 11, 2021. https://www.mayoclinic.org/diseases-conditions/familial-mediterranean-fever/symptoms-causes/syc-20372470
Mayo Clinic Staff. Familial Mediterranean fever: diagnosis and treatment. Mayo Clinic. November 11, 2021. https://www.mayoclinic.org/diseases-conditions/familial-mediterranean-fever/diagnosis-treatment/drc-20372475
Medical disclaimer
This article was prepared for general information only and is not a substitute for professional medical advice.
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