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Fever and rheumatic disease

Descriptions of fever in the context of rheumatic diseases date back to Hippocrates, with early descriptions of rheumatic fever.

The prevalence of fever in different inflammatory diseases (e.g. Adult-onset Still’s disease, systemic lupus erythematosus, Systemic vasculitis) is likely to be dictated by the production of specific pyrogens (e.g. IL-1, IL-6 and immune complexes).

  • Low grade fever is common in chronic inflammatory diseases
  • Inflammatory process is driven by inflammatory mediators that also serve to function as pyrogens.
  • Drugs commonly used to treat immune-mediated inflammatory disease, such as NSAIDs and Glucocorticoids may mask the febrile component of rheumatic disease.
  • Anti-rheumatic drugs may also cause fever.
  • An acute polyarthritis presenting with fever may well be associated with an acute viral infection (e.g. parvovirus).
  • A rule of thumb remains that fever must prompt systematic and robust investigation to exclude infection




FUO and rheumatic disease