Medical Cannabis in Treatment of Resistant Familial Mediterranean Fever

Case series Patient: Male, 30 • Male, 23 Final Diagnosis: Familial Mediterranean fever Symptoms: Abdominal pain Medication: — Clinical Procedure: — Specialty: Rheumatology OBJECTIVE: Unusual setting of medical care BACKGROUND: Colchicine-resistant familial Mediterranean fever can be treated by anti-IL-1 biologic therapy; however, such treatment needs approval by the health insurance company, and many patients are denied such treatment or do not respond to it. CASE REPORTS: Two familial Mediterranean fever (FMF) patients, both homozygous for M694V mutation and resistant to colchicine treatment, were treated with medical cannabis. Prior to that, 1 patient was denied biologic treatment and the other had no significant response to anakinra. Under medical cannabis treatment, both patients had remarkable improvement in the severity of the attacks and also a decrease in the frequency of the attacks, from once every 2 weeks to 1 attack every month in 1 patient; this patient had also a remarkable reduction in the C-reactive protein level during the attacks. CONCLUSIONS: Cannabis is a therapeutic option for treating the most complex patients with FMF.