Familial mediterranean fever (FMF) is a familial disease characterized by recurrent episodes of febrile serositis, peritonitis, arthritis and pleuritis. Many studies have been performed is an attempt to understand the basis of the inflammatory attacts in FMF. Ghrelin, a recently described orexigene peptide is predominantly produced by stomach. Ghrelin also exerts multiple regulatory effects on immune system. It has reported that grelin has anti-inflammatory effects. There is currently no published evidence demonstrating a role for anti-inflammatory effects of ghrelin in FMF. For this reason, we investigated the role of plasma ghrelin levels in patients with FMF. Thirty seven patients with FMF and 10 healthy controls (5 female, 5 male; mean age 35.4 ± 5.6 years) were enrolled in this study. Twenty-one patients were in active stage (10 female, 11 male, mean age; 31.0 ± 5.4 years, mean disease duration 7.2 ± 3.3 years) and 16 patients were in inactive stage (7 female,9 male, mean age; 33.0 ± 6.0 years, mean disease duration; 8.7 ± 3.2 years). Plasma ghrelin levels were determined by EIA. The mean plasma ghrelin levels were 158.4 ± 52.9 pg/ml in patients with FMF and 56.7 ± 7.5 pg/ml in healthy controls. The mean plasma ghrelin levels were 190.5 ±49.4 pg/ml in the active patients and 116.2 ± 11.7 pg/ml in the inactive patients. Plasma ghrelin levels were significantly high in patients with FMF compared to healthy controls (p < 0.001). Plasma ghrelin levels were significantly high in the active patients compared to in the inactive patients and healthy controls (p < 0.001 and p < 0.001 respectively). There was significantly difference between in active and inactive patients with FMF (p < 0.001). As a results; Plasma ghrelin levels were high both in active and inactive patients with FMF. It is showed that ghrelin may play significant role of the pathogenesis of FMF.