An unusual case of coexistence of Familial Mediterranean Fever with rheumatoid arthritis and Sjögren’s syndrome

We report a rare case of a female patient with multiple rheumatological conditions. The patient initially presented with periodic, diffuse abdominal pain. This complaint was not fully investigated because polyarthritic symptoms became the predominant ones. This led to the diagnosis of rheumatoid arthritis. Afterward, the patient complained of xerostomia, xerophthalmia, and diffuse rash. After investigations, she was diagnosed with Sjögren’s syndrome. Suspecting a case of methotrexate-induced vasculitis, her initial prescription was changed to azathioprine and then to etanercept. Eventually, her persistent abdominal pain, combined with her Armenian origin, prompted her physician to order a genetic analysis of the MEFV gene, which revealed the V726A/P369S mutation, giving rise to the diagnosis of Familial Mediterranean Fever. In her routine follow-up, the patient was in a stable condition, adherent to the medications, and showed improvement in her symptoms. Therefore, this case shows the importance of early genetic testing in similar cases, which in turn will allow timely diagnosis and treatment.