Statement (e) is NOT true: Signs of peritonitis are NOT observed in all patients with FMF
The claim that peritonitis signs occur in all FMF patients is false—while peritonitis is the most common manifestation of FMF, it does not occur universally in every patient. 1
Analysis of Each Statement:
a) Gene location on chromosome 16p13.3 (NOT chromosome 18)
This statement is INCORRECT as written, making it a candidate for the false statement. The MEFV gene responsible for FMF is actually located on chromosome 16p13.3, not on the short arm of chromosome 18. 2 However, the question asks which statement is NOT true, and this statement about chromosome 18 is indeed false.
b) Sudden episodes of acute aseptic inflammation of serous membranes
This is TRUE. FMF is definitively characterized by recurrent bouts of fever and inflammatory symptoms involving serosal membranes (peritoneum, pleura, synovium). 2 The inflammation is aseptic and episodic in nature.
c) Symptoms become more severe over time
This statement is FALSE and represents a common misconception. With appropriate colchicine treatment, FMF can be well controlled and does not inherently worsen over time. 1 In fact, the 2024 EULAR guidelines emphasize that the goal of treatment is to obtain complete control of attacks and minimize subclinical inflammation. 3 Untreated patients may develop complications like amyloidosis, but the disease itself does not follow a progressive worsening pattern when properly managed.
d) Amyloidosis is a complication
This is TRUE. AA amyloidosis is a well-recognized and serious complication of FMF, particularly in untreated or inadequately controlled patients. 1, 3 This is why monitoring for subclinical inflammation and preventing complications is a cornerstone of FMF management.
e) Signs of peritonitis observed in all patients
This is FALSE. While peritonitis is the most common manifestation of FMF, it does not occur in every single patient. FMF has variable clinical presentations including:
- Isolated fever episodes 4
- Arthritis without peritonitis
- Pleuritis as the predominant feature 5
- Atypical presentations with only fever and arthralgia 6
The disease shows significant phenotypic heterogeneity, and not all patients experience peritoneal involvement.
Answer to the Question:
Both statements (c) and (e) are NOT true. However, if forced to choose the single MOST incorrect statement, statement (e) is the clearest false claim because it uses the absolute term "all patients," which is demonstrably incorrect given the documented clinical heterogeneity of FMF presentations.
Statement (c) is also false but requires more nuanced interpretation—symptoms don't inherently worsen over time with proper treatment, though complications can develop if the disease is poorly controlled.