American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a common characteristic of acute phase reactants in familial Mediterranean fever?

1. Typically normal levels

2. Elevated levels during episodes of fever

3. Decreased levels during episodes of fever

4. Only elevated during treatment

The correct answer is: Elevated levels during episodes of fever

In familial Mediterranean fever, a distinctive characteristic of acute phase reactants is that their levels are elevated during episodes of fever. This is due to the inflammatory nature of the condition, which triggers a systemic inflammatory response manifesting as fever, serositis, and other symptoms. Acute phase reactants, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), are proteins whose concentrations increase in response to inflammation. When an individual with familial Mediterranean fever experiences an attack, these reactants rise as part of the body's immune response. The immune system's activation signifies that cytokines, primarily interleukin-6, are being produced, leading to the synthesis of these proteins in the liver. This is why measuring the levels of acute phase reactants can be an important part of monitoring the disease and understanding the patient's inflammatory state during acute episodes.