Colchicine-Tolerant vs. Resistant Familial Mediterranean Fever: Comparative Analysis of Clinical, Psychosocial Characteristics and Quality of Life

<b>Background/Objectives</b>: Familial Mediterranean Fever (FMF) is a chronic autoinflammatory disease in which some patients develop resistance to colchicine, resulting in persistent attacks and increased disease burden. This study aimed to compare clinical characteristics, disease activity, psychological status, and quality of life between colchicine-tolerant and colchicine-resistant FMF patients, and to identify clinical factors independently associated with colchicine resistance. <b>Methods</b>: This exploratory cross-sectional observational study was conducted in 120 FMF patients followed at a tertiary rheumatology center. Patients were classified as colchicine-tolerant or colchicine-resistant. Disease activity and damage were assessed using the International Severity Scoring System for FMF (ISSF) and the Autoinflammatory Disease Damage Index (ADDI). Quality of life was evaluated using the FMF-Health-Related Quality of Life (FMF-HQL) and WHO Quality of Life-BREF (WHOQoL-BREF) questionnaires. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale (HADS). <b>Results</b>: Colchicine-resistant patients had significantly higher attack frequency and disease activity scores (<i>p</i> < 0.001). Quality of life was impaired, with higher FMF-HQL and lower WHOQoL-BREF scores across all domains (<i>p</i> < 0.001). Anxiety and depression scores were also higher. ISSF and Doctor Global Assessment (DGA) were independently associated with colchicine resistance. <b>Conclusions</b>: Colchicine resistance in FMF was associated with increased disease activity, impaired quality of life, and greater psychological burden.