The aim of the present study was to determine whether intima-media thickness (IMT) of the common (CCA) and internal carotid arteries (ICA) was increased due to chronic inflammation occurring in familial Mediterranean fever (FMF) patients compared to healthy controls. Erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP), serum amyloid A protein (SAA), lipid profile and homocysteine levels were examined in 70 FMF patients [median age 14 years (range 4-24)] in an attack free period and in 50 healthy controls [median age 14 years (range 4-18)]. All the patients were homozygous or compound heterozygous for MEFV mutations. IMT of both CCA and ICA was evaluated with a high resolution B-mode ultrasonography. ESR, CRP, fibrinogen and SAA levels were significantly higher in FMF patients as compared to healthy controls (P < 0.05). Intima media thickness of the common carotid artery was found to be significantly higher in FMF patients when compared to those in healthy controls [0.37 mm (0.26-0.61) vs. 0.28 mm (0.21-0.35), P < 0.001]. The median ICA-IMT was significantly increased in the patients when compared to those in the controls [0.25 mm (0.18-0.44) vs. 0.22 mm (0.10-0.26), P < 0.001]. A positive correlation between CCA-IMT and SAA levels (r = 0.24, P = 0.04) was found while ICA-IMT positively correlated with ESR (r = 0.31, P = 0.008) and fibrinogen levels (r = 0.30, P = 0.012). Intima media thickness, an early predictor of atherosclerosis, may be associated with subclinical inflammation in children with FMF. Further studies will enlighten whether these patients will be predisposed more to coronary artery disease.