Colchicine is appropriate for this patient who has familial Mediterranean fever (FMF), an autosomal recessive disease characterized by episodes of fever, polyserositis, arthritis, erysipeloid rash around the ankles, and elevated acute phase reactants. Attacks last 1 to 3 days and are self-limited but can be dramatic. FMF is associated with mutation of the MEFV₁ gene; testing for MEFV mutations is available and should be considered as an aid to diagnosis, although not all mutations have been identified. AA amyloidosis is a potential long-term consequence of FMF due to the production and accumulation of serum amyloid A. Colchicine affects the function of various inflammatory cells that are thought to play a role in the cytokine overproduction seen in FMF. A response to colchicine is useful in the clinical diagnosis of FMF because it can prevent attacks as well as AA amyloidosis. Treatment with colchicine is therefore indicated for this patient who most likely has FMF, as manifested by her history of febrile attacks of abdominal serositis, erysipelas-like skin lesions that mimic cellulitis, and inflammatory arthritis occurring independently of the febrile episodes.

FMF genetic mutations affect the function of pyrin that results in overactivation of the inflammasome. The inflammasome is an important constituent of the innate immune system that is responsible for production of interleukin (IL)-1; dysregulation of the inflammasome, as in FMF, results in overproduction of IL-1. The IL-1 inhibitor anakinra can be used in patients with FMF who are unresponsive to colchicine; however, this agent is not first-line therapy.

NSAIDs and prednisone have not been shown to have a significant impact on the disease progression or symptoms associated with FMF.