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Systemic autoinflammatory diseases (SAIDs) are a growing group of rare disorders caused by dysregulation of the innate immune system leading to episodes of organ-specific and systemic inflammation. Autoinflammation as a distinct disease category was first reported in 1999 as a group of monogenic disorders with resultant activation of the inflammasome and cytokine excess, presenting as periodic fever and inflammation in serous membranes. Since this original description, the focus has shifted considerably to the inclusion of complex multifactorial conditions, and more than 30 associated genes have been identified. Disease severity varies from mild to life threatening. Advances in the understanding of the pathogenetic role of interleukin-1, have opened new promising horizons in the treatment of these patients, and significantly altered disease outcome.