Intramuscular gold for the treatment of seronegative spondyloarthropathy associated with familial Mediterranean fever

Articular attack is a common feature of familial Mediterranean fever (FMF). FMF arthritis commonly resolves without any sequale within a few weeks. However, approximately 10% of the patients develop protracted arthritis persisting for months to years. Treatment with colchicine may not be effective and nonsteroidal antiinflammatory drugs or second line agents may be needed for the management of protracted arthritis. In this paper, we describe a 22-year-old patient with FMF who was complicated with protracted arthritis in the knee and shoulder joints and bilateral sacroiliitis. He was successfully treated by intramuscular gold 50 mg weekly. However, gold treatment was discontinued 8 months later because of the development of asymptomatic proteinuria. In conclusion, FMF should be considered in the evaluation of peripheric oligoarthritis, particularly in patients with Mediterranean origin. Intramuscular gold might be an effective agent. However, care should be taken regarding the development of proteinuria.