Chronic synovitis of the shoulder in familial Mediterranean fever: a disease of symptoms not signs.

Severe shoulder pain in a 41 year old Arab woman persisted for three months despite non-steroidal anti-inflammatory drug treatment. Isotope bone scanning and computed tomography showed inflammation of the glenohumeral joint and a large effusion, which needle aspiration had initially failed to reveal. A diagnosis of familial Mediterranean fever was made on the basis of a strongly suggestive past personal and family history, sterility of the joint effusion, and a good response to colchicine.