Aim: Familial Mediterranean fever (FMF); is an auto-inflammatory disease characterized by recurrent fever attacks. Inflammationcontinues even in the attack-free period. Monocyte to high-density lipoprotein cholesterol (HDL-C) ratio (MHR) is an inflammatorymarker that has recently begun to use. The aim of the study was to evaluate the relationship between MHR and FMF in children.Material and Methods: Sixty-two children with FMF in the attack-free period and 60-age and sex-matched- healthy controls includedin the study. Patients divided into subgroups according to their gene mutation type. Monocyte count and HDL-C levels retrieved frommedical records of patients and MHR were calculated from these data.Results: The MHR of individuals were close to each other and there was no statistically significant difference between them ( p>0.05).Twenty-four of the patients had heterozygous, 4 had homozygous, 11 had a compound and 21 had negative mutations. Two of thepatients had no mutation analysis. There was no significant difference between these four groups according to MHR (p=0.348).However, MHR revealed a positive correlation with fibrinogen (r=0.604, p<0.005, n=24), serum amyloid A (r=0.437, p=0.005, n=39),C-reactive protein (r=0.277, p=0.005, n=101), and erythrocyte sedimentation rate (r=0.404, p<0.001, n=104).Conclusion: As a result, we showed MHR was not different from healthy controls in FMF patients. Contrary to what is claimed, theuse of MHR as an inflammatory marker in FMF is doubtful.