Fever and rheumatoid arthritis. Rheumatoid Arthritis and Fever: Causes, Symptoms, and Treatment Options

28.06.202327.06.2023 by alexxlab

What are the causes of fever in rheumatoid arthritis patients. How does RA-related fever differ from other types of fever. What treatment options are available for managing fever in RA. When should a person with RA seek medical attention for fever.

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Understanding the Link Between Rheumatoid Arthritis and Fever

Rheumatoid arthritis (RA) is an autoimmune condition characterized by widespread inflammation, joint pain, and stiffness. While fever is not as common in RA as in other rheumatic diseases, some individuals with RA may experience low-grade fevers. These fevers can be attributed to various factors, including the inflammatory nature of the disease itself or as a side effect of RA medications.

It’s crucial to understand that fever in RA patients can be a complex issue, requiring careful evaluation to determine its underlying cause. In this comprehensive guide, we’ll explore the relationship between rheumatoid arthritis and fever, discussing causes, symptoms, and treatment options to help RA patients better manage their condition.

Causes of Fever in Rheumatoid Arthritis Patients

Fever in RA patients can stem from several sources:

Inflammation associated with RA
Side effects of RA medications
Infections due to a suppressed immune system
Complications of RA affecting other organs

Is inflammation the primary cause of fever in RA? While inflammation is a significant factor, it’s not the only cause. In the past, severe inflammation or RA affecting other organs was more likely to cause fever. However, with the advent of modern treatments like disease-modifying antirheumatic drugs (DMARDs) and biologics, such occurrences have become rare.

Medication-Induced Fever in RA

Can RA medications cause fever? Yes, in some cases, RA medications can lead to fever. Many RA treatments suppress the immune system to control inflammation. While effective in managing RA symptoms, this immunosuppression can increase susceptibility to viral or bacterial infections, which may manifest with fever as a symptom.

Recognizing Fever Symptoms in Rheumatoid Arthritis

Identifying fever in RA patients is crucial for proper management. The Centers for Disease Control and Prevention (CDC) defines fever as:

A temperature of 100.4°F (38°C) or higher
Feeling warm to the touch
Self-reported sensation of feeling feverish

In RA, fever tends to be low-grade and persistent. It often accompanies other symptoms such as aggressive disease progression, weight loss, and inflammation in multiple joint linings.

Differentiating RA Fever from Other Types of Fever

How does RA-related fever differ from other types of fever? RA fever is typically low-grade and chronic, whereas fevers caused by infections are often higher and more acute. However, it’s essential to rule out other potential causes before attributing a fever to RA.

RA Fever vs. Rheumatic Fever

Are RA fever and rheumatic fever the same? No, these are two distinct conditions. Rheumatic fever is an acute inflammatory disease that can occur after a streptococcal infection, primarily affecting children aged 5-15. While both conditions can cause joint pain and fever, rheumatic fever is temporary and unrelated to RA.

Treatment Options for Managing Fever in Rheumatoid Arthritis

Managing fever in RA patients involves addressing the underlying cause:

If the fever is due to RA inflammation, adjusting RA medications may help
For infection-related fevers, antibiotics or antiviral medications may be necessary
Over-the-counter fever reducers can provide symptomatic relief
Lifestyle modifications to support overall health and reduce inflammation

Medications for RA and Fever Management

Which medications are commonly used to treat RA and manage associated symptoms like fever? The primary medications for RA treatment include:

Disease-modifying antirheumatic drugs (DMARDs)
Biologics
Anti-tumor necrosis factor agents

These medications work by suppressing the immune system, reducing inflammation, and potentially decreasing the frequency and severity of RA flares, including fever.

Lifestyle Modifications to Prevent RA Flares and Associated Fever

Can lifestyle changes help prevent RA flares and associated fever? Yes, certain lifestyle modifications may help reduce the frequency and severity of RA flares:

Avoiding or quitting smoking
Limiting alcohol intake
Maintaining a healthy weight
Engaging in regular physical activity
Following an anti-inflammatory diet rich in plant-based foods

These lifestyle changes, combined with proper medication management, can contribute to better overall RA control and potentially reduce the occurrence of fever and other symptoms.

When to Seek Medical Attention for Fever in RA Patients

Knowing when to seek medical help for fever is crucial for RA patients. The CDC recommends seeking medical attention if:

Temperature is 100.4°F (38°C) or higher
Fever has lasted for more than 48 hours
Other symptoms indicative of an infection are present

Additionally, RA patients should contact their healthcare provider if they experience:

Pain in new areas
Worsening symptoms
Adverse reactions to medications
Joint symptoms lasting more than 1-2 days

How quickly should an RA patient seek medical attention for a persistent fever? It’s advisable to contact a healthcare provider within 24-48 hours of a persistent fever, especially if it’s accompanied by other concerning symptoms or doesn’t respond to over-the-counter fever reducers.

The Impact of Fever on RA Disease Progression

Does fever affect the progression of rheumatoid arthritis? While fever itself may not directly impact RA progression, it can be an indicator of increased disease activity or complications. Persistent fever may suggest that current treatments are not adequately controlling inflammation, potentially leading to joint damage if left unaddressed.

Fever as a Marker of Disease Activity

Can fever be used as a marker for RA disease activity? While not as commonly used as other measures like joint counts or inflammatory markers, fever can be an additional indicator of disease activity in some RA patients. However, it’s important to consider fever in conjunction with other symptoms and clinical findings for a comprehensive assessment of RA activity.

Complications of Untreated Fever in Rheumatoid Arthritis

What are the potential complications of untreated fever in RA patients? Untreated fever in RA can lead to several complications:

Increased joint inflammation and damage
Fatigue and decreased quality of life
Potential organ involvement if fever is due to systemic inflammation
Increased risk of infection if fever is indicative of an underlying infection

How can these complications be prevented? Regular monitoring of symptoms, adherence to prescribed treatments, and prompt communication with healthcare providers about new or worsening symptoms, including fever, are key to preventing complications in RA.

Emerging Research on Fever in Rheumatoid Arthritis

What new developments are occurring in the field of RA and fever management? Recent research has focused on several areas:

Improved understanding of the inflammatory pathways involved in RA-related fever
Development of more targeted therapies to address specific inflammatory mediators
Investigation of biomarkers to better predict and monitor disease activity, including fever
Exploration of personalized medicine approaches to tailor treatments based on individual patient characteristics

These advancements hold promise for more effective management of RA symptoms, including fever, in the future.

The Role of Cytokines in RA-Related Fever

How do cytokines contribute to fever in RA patients? Cytokines, particularly interleukin-1 (IL-1) and tumor necrosis factor-alpha (TNF-α), play a crucial role in the inflammatory process of RA. These pro-inflammatory cytokines can act on the hypothalamus, the body’s thermoregulatory center, leading to an increase in body temperature. Understanding this mechanism has led to the development of targeted therapies that inhibit specific cytokines, potentially reducing both inflammation and associated fever in RA patients.

Differential Diagnosis: Distinguishing RA Fever from Other Conditions

How can healthcare providers distinguish RA-related fever from other conditions? Differentiating RA fever from other causes requires a comprehensive approach:

Detailed medical history, including RA disease duration and current treatments
Physical examination to assess joint involvement and other systemic symptoms
Laboratory tests, including complete blood count, inflammatory markers, and cultures if infection is suspected
Imaging studies to evaluate joint inflammation and potential complications

This thorough evaluation helps ensure accurate diagnosis and appropriate management of fever in RA patients.

Common Conditions Mimicking RA Fever

Which conditions might be mistaken for RA-related fever? Several conditions can present with symptoms similar to RA fever:

Infections (bacterial, viral, or fungal)
Other autoimmune diseases (e.g., systemic lupus erythematosus)
Malignancies
Drug-induced fever
Still’s disease (adult-onset)

Accurate diagnosis is crucial for appropriate treatment, highlighting the importance of comprehensive evaluation by healthcare professionals experienced in rheumatic diseases.

Patient Education: Managing Fever in Rheumatoid Arthritis

How can RA patients effectively manage fever at home? While it’s important to consult with healthcare providers for persistent or high fevers, there are several strategies patients can employ for managing low-grade fevers associated with RA:

Use over-the-counter fever reducers as directed by a healthcare provider
Stay well-hydrated to prevent dehydration
Rest and avoid overexertion during febrile episodes
Monitor temperature regularly and keep a log to share with healthcare providers
Practice good hygiene to prevent infections
Continue taking prescribed RA medications unless otherwise instructed by a healthcare provider

These self-management strategies, combined with regular medical care, can help RA patients effectively manage fever and maintain overall health.

The Importance of Medication Adherence in Fever Prevention

Why is medication adherence crucial in preventing RA-related fever? Consistent adherence to prescribed RA medications is essential for controlling inflammation, which is often the underlying cause of fever in RA. By maintaining proper disease control through medication adherence, patients can potentially reduce the frequency and severity of RA flares, including associated fevers. Additionally, some RA medications may help boost the immune system’s ability to fight off infections, further reducing the risk of fever from infectious causes.

Fever Management in Special RA Populations

How does fever management differ in special RA populations? Certain groups of RA patients may require special considerations when managing fever:

Elderly RA Patients

Older adults with RA may have a blunted fever response, meaning they might not develop a significant fever even in the presence of infection or increased disease activity. Healthcare providers must be vigilant in assessing other signs and symptoms of infection or RA flares in this population.

Pregnant RA Patients

Fever management in pregnant RA patients requires careful consideration of medication safety. Some common fever reducers and RA medications may not be suitable during pregnancy. Close coordination between rheumatologists and obstetricians is crucial for managing fever and RA symptoms in pregnant patients.

RA Patients with Comorbidities

Patients with RA and other chronic conditions, such as diabetes or heart disease, may require a tailored approach to fever management. These comorbidities can affect the choice of medications and the threshold for seeking medical attention for fever.

The Role of Telemedicine in Managing RA-Related Fever

How has telemedicine impacted the management of fever in RA patients? The rise of telemedicine has brought several benefits to RA fever management:

Improved access to healthcare providers for timely advice on fever management
Remote monitoring of symptoms, including fever, through patient-reported outcomes
Virtual consultations for medication adjustments or additional testing recommendations
Reduced risk of exposure to infections for immunocompromised RA patients

While telemedicine cannot completely replace in-person evaluations, it offers a valuable tool for ongoing management and monitoring of RA symptoms, including fever.

Limitations of Telemedicine in Fever Assessment

What are the challenges of assessing fever via telemedicine in RA patients? While telemedicine offers many advantages, it also has limitations in fever assessment:

Inability to perform physical examinations, which can be crucial in differentiating causes of fever
Potential for inaccurate temperature readings if patients lack proper equipment at home
Difficulty in assessing subtle clinical signs that may be apparent during in-person visits
Challenges in performing immediate diagnostic tests if needed

Healthcare providers must be aware of these limitations and use telemedicine judiciously, combining it with in-person evaluations when necessary for comprehensive care.

Future Directions in RA Fever Management

What future developments can we expect in the management of fever in RA patients? Several exciting areas of research and development hold promise for improved RA fever management:

Advanced wearable technologies for continuous temperature monitoring and early detection of fevers
Artificial intelligence algorithms to predict RA flares and associated fever based on patient-reported data and biomarkers
Development of more targeted immunomodulatory therapies with potentially fewer infectious complications
Improved understanding of the gut microbiome’s role in RA inflammation and fever, potentially leading to novel therapeutic approaches
Personalized medicine strategies to tailor fever management based on individual patient characteristics and genetic profiles

These advancements may lead to more precise, effective, and personalized approaches to managing fever and overall disease activity in RA patients.

The Potential of Precision Medicine in RA Fever Management

How might precision medicine impact fever management in RA? Precision medicine approaches hold significant potential for improving fever management in RA:

Genetic profiling to identify patients at higher risk of developing fever or infections
Pharmacogenomic testing to optimize medication selection and dosing for fever prevention and treatment
Biomarker-guided therapy adjustments to prevent fever-associated flares
Tailored lifestyle and environmental interventions based on individual patient characteristics

These personalized approaches could lead to more effective fever prevention and management strategies, ultimately improving outcomes for RA patients.

Rheumatoid arthritis fevers: Causes, symptoms, and treatment

People with rheumatoid arthritis sometimes experience a fever. It can occur due to inflammation that relates to the condition. Fevers can also develop due to rheumatoid arthritis drugs, which can make someone more susceptible to infections.

Common symptoms of rheumatoid arthritis (RA) include swelling, stiffness, and joint pain that is often worse in the morning. RA complications can include inflammation in various body organs.

Some people also experience a low grade fever. In the past, fever could occur if a person had severe inflammation or if RA affected other organs. However, treatment with DMARDs and biologic drugs means this is now rare.

Fever is a common symptom of other rheumatic diseases, such as gout and systemic lupus erythematosus, or lupus. It most likely results from inflammation.

In this article, we look at why a fever might occur with RA.

RA is an autoimmune condition, which means a person’s immune system mistakenly attacks its own cells. This causes widespread inflammation, stiffness, swelling, and joint pain.

A low grade fever may also appear and can indicate inflammation. It occurs when the immune system is reacting to a threat.

A long lasting, low grade fever is a common symptom of some inflammatory and autoimmune conditions, such as lupus.

However, a fever is less common with RA than with other rheumatic diseases. When it occurs, researchers say it tends to appear alongside aggressive disease, weight loss, and inflammation in the lining of several joints.

Can RA medication cause fever?

In some cases, using medications can lead to a fever in people with RA.

Doctors often prescribe medication that suppresses the immune system to treat RA. This can increase the risk of developing a viral or bacterial infection, which may involve a fever.

In this case, a person may notice other symptoms, depending on the type of infection.

If someone with RA has a low grade fever that lasts a long time, it may be a symptom of RA.

However, before deciding that a fever relates to RA, a doctor will need to rule out other conditions that can cause it, including viral and bacterial infections.

The Centers for Disease Control and Prevention (CDC) consider a person to have a fever if any of the following are true:

the person’s temperature is 100.4°F (38°C) or over
they feel warm to the touch
they say they have felt feverish

A fever is a symptom of a disease. A doctor may offer treatment if they identify an underlying cause for the fever.

When should people seek help for a fever?

Is RA fever the same as rheumatic fever?

A separate disease from RA is rheumatic fever. This acute condition can occur after an infection with strep throat or scarlet fever. It involves a widespread inflammatory response, joint pain, and other symptoms.

The symptoms can be similar, but the two diseases are not related.

Rheumatic fever mostly affects children aged 5–15 years, but it is rare in adults and children aged under 3 years.

Like RA, rheumatic fever affects the joints. However, unlike RA, rheumatic fever is temporary, usually lasting only a few weeks. Severe cases of rheumatic fever can result in long-term heart damage, known as rheumatic heart disease.

Symptoms of RA may come and go. When symptoms are active, it is known as a flare. At other times, a person may have mild or no symptoms, which people call remission.

It is not always possible to prevent RA, but treatment aims to reduce the frequency and severity of flares. Drugs that help do this include:

disease-modifying antirheumatic drugs
biologics
anti-tumor necrosis factor agents

These drugs suppress the immune system, reducing the risk of RA symptoms. However, they can leave a person more prone to other infections.

Lifestyle habits that may help prevent flares include:

avoiding or quitting smoking, if applicable
limiting alcohol intake, if applicable
maintaining a moderate weight
being physically active
consuming an anti-inflammatory diet with plenty of plant-based foods

What are some natural remedies for RA?

According to recommendations from the CDC, people should consider seeking medical attention for a fever if:

their temperature is 100. 4°F (38°C) or higher
their fever has lasted for more than 48 hours
they have other symptoms that could indicate an infection

Additionally, individuals with RA should contact a doctor if they experience any of the following:

pain in new areas
worsening symptoms
adverse reactions to medication
joint symptoms that last more than 1–2 days

What happens during an RA flare?

Fever can be a symptom of RA. It can occur because of inflammation or because the drugs for treating the condition make people more susceptible to infections.

Anyone with a temperature higher than 100.4°F (38°C) should contact a doctor. They can investigate to see if the reason for the fever is RA or another cause.

Ways of managing a low grade fever at home include keeping cool, staying hydrated, and taking NSAIDs.

Rheumatoid Arthritis Fevers: Why Do They Occur?

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Medically reviewed by Elea Carey — By Elea Carey — Updated on July 7, 2020

Overview

Many people associate rheumatoid arthritis (RA) with joint pain, but low-grade fever is another common symptom. If you have RA and you’re experiencing a fever, it’s important to find out whether the fever indicates an underlying infection that could lead to complications.

A normally functioning immune system can tell the difference between “attackers,” such as germs or viruses, and healthy cells. When the body is attacked by illness, the immune system fights back. But when autoimmune dysfunction occurs, the immune system mistakes healthy cells for invaders, and attacks them instead. In someone with RA, this causes inflammation of the tissue around the joints. RA can also affect the eyes, lungs, skin, and heart.

Inflammation is a normal part of the immune response. However, inflammation from RA is part of the problem. It causes considerable pain, damage to joints, and reduced mobility. The same substances that cause inflammation of the joints can also cause a fever. While inflammation of the joints can be severe enough to cause a fever, it is important to remember that an infection is a real possibility. RA also causes an increase in metabolic rate, which can also result in a fever.

Normal body temperature ranges from 97°F to 99°F. Fevers under 101°F are not considered serious in adults and are also not uncommon in RA patients.

Medicines that suppress the immune system, also called immunosuppressants, are often used to treat RA. This means that the immune system in an RA patient might not respond effectively to a virus or bacterial infection. Additional illnesses can cause serious complications for RA patients.

Rheumatic fever is a serious illness that occurs mostly in children who have recently experienced strep throat. It has similarities to the early symptoms of RA, but is not related to RA.

Rheumatic fever affects joints. But unlike RA, rheumatic fever only lasts a few weeks. It can affect any single joint, and often the same joint on the other side of the body.

So how can you tell if your fever is caused by RA? The first step is to determine if you’ve been diagnosed with RA. If so, a fever under 101°F may indicate fever caused by RA. However, your doctor also needs to determine that you have:

no preceding virus, such as flu
no bacterial infection
no other diagnosis, such as cancer

Low-grade fever is an expected part of having RA. It’s usually caused by the inflammation of the joints, or by an improperly working immune system.

Contact a doctor in case of fever over 101°F. A fever could indicate an underlying viral or bacterial infection that the immune system has not responded to due to an immunosuppressant.

Last medically reviewed on November 17, 2016

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Autoimmune diseases fact sheet. (2012, July 16)
womenshealth.gov/publications/our-publications/fact-sheet/autoimmune-diseases.html
How the body regulates heat. (n.d.)
rush.edu/rumc/page-1298329859904.html
What is an inflammation? (2015, January 7)
ncbi.nlm.nih.gov/pubmedhealth/PMH0009852/

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available.

Current Version

Jul 7, 2020

Written By

Elea Carey

Edited By

Frank Crooks

Nov 17, 2016

Medically Reviewed By

Elea Carey

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Medically reviewed by Elea Carey — By Elea Carey — Updated on July 7, 2020

RHEUMATOID ARTHRITIS. CRIB FOR THE THERAPIST – “InfoMedPharmDialog”

RHEUMATOID ARTHRITIS. CRIB FOR THE THERAPIST

RHEUMATOID ARTHRITIS. THERAPIST’S CRIBE

The work of the rheumatology service is structured in such a way that the patient with joint pain comes first to the therapist. And it is this specialist who plays a decisive role in the differential diagnosis of rheumatic diseases. This requires the doctor to have a clearer understanding of the primary manifestations of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis.

Disease with high social significance

KANEVSKAYA Marina Zinovievna, Professor of the Department of Hospital Therapy No. THEM. Sechenov, d.m.s.

Rheumatoid arthritis is an autoimmune rheumatic disease accompanied by chronic erosive arthritis (synovitis) and systemic damage to internal organs. Therefore, it would be more correct to call this type of pathology rheumatoid disease, because joint damage is only one of the manifestations of the disease. It can occur at any age, even in children 1-2 years old, while there is no upper age limit at all. The peak incidence occurs in middle age. At the same time, women are ill 3 times more often than men.

The social significance of the disease is extremely high, since in the absence of timely diagnosis and adequate treatment, patients can become disabled in a few years. It is also known that the life expectancy of patients with rheumatoid arthritis is 5–7 years less than the average population.

Chronic inflammation in the synovial membrane with a predominance of exudative or proliferative processes leads to the growth and compaction of the connective tissue. The surface of the joints is covered with granulation tissue (pannus), which is involved in the destruction of the joints. A long-term inflammatory process eventually leads to the destruction of bone tissue and the formation of ankylosis.

“If a doctor detects a BMI and at least one associated disease, such as impaired fasting glucose or arterial hypertension, he is obliged to prescribe drug therapy to reduce body weight,” T.N. Markov.

Laboratory tests that can confirm abnormal carbohydrate metabolism include fasting glucose (FG) and oral glucose tolerance test – OGTT, and glycated hemoglobin. Ideally, a combination of these tests. As a rule, at least two measurements are needed when it comes to glucose levels. PTTG, according to T.N. Markova, can be considered the “gold standard” for screening patients at risk for type 2 diabetes. Impaired glucose tolerance will be indicated by indicators ranging from 7.8 to 11.1 mmol / l 2 hours after OGTT.

Onset of rheumatoid arthritis

As a rule, at the onset of the disease, small joints are primarily affected: the second-third metacarpophalangeal, proximal interphalangeal, and carpal joints (Fig. 1–3). A characteristic complaint of such patients is the inability to wring out a rag. For those who have affected wrist joints, this is the most painful movement.

Large and medium joints can also be involved in the pathological process. Of the large ones, these are the shoulder, elbow, hip, knee and ankle. The defeat of others (mandibular, clavicular-acromial, sternoclavicular) can be judged by the patient’s complaints. So, if the jaw joints are affected, the patient often says that it is difficult for him to chew and fully open his mouth.

It is very important to pay attention to the involvement or isolated lesion of the distal interphalangeal, first carpometacarpal joints of the hands, first metatarsophalangeal joints of the feet – these are the joints of exclusion. Their isolated lesion at the onset of the disease rules out rheumatoid arthritis.

X-ray changes are first detected in the metacarpophalangeal joints, carpal bones, styloid process of the ulna (Fig. 4). Sometimes, earlier than in the joints of the hands, destruction of the metatarsophalangeal joints develops – the fourth and fifth.

Typical variants of the debut of the articular syndrome

Rheumatoid arthritis is characterized by the symmetry of the lesion, meaning the affected area: for example, the wrist or metacarpophalangeal, but non-symmetrical joints of the hand on both sides can be affected. In these cases, in the presence of swelling, pain and stiffness, one can speak of an articular syndrome typical of rheumatoid arthritis.

Rheumatoid arthritis can also debut with damage to the wrist joints. Sometimes, at the onset of the disease, the elbow joint is involved in the pathological process, which is accompanied by a rapid limitation of its extension. The shoulder, knee, and ankle joints may be affected, but not in isolation, but in combination with the metacarpophalangeal and/or metatarsophalangeal joints.

If the shoulder joint is affected, the patient often complains of pain covering the arm with a belt. At the same time, one should not think that we are talking exclusively about muscle pain, it is associated specifically with arthritis of the shoulder joint.

Non-classical variants are also possible, for example, when two ankle joints, two knee joints are affected, and even more so one of them. In differential diagnosis, it is worth considering the possibilities of ultrasound examination. It helps to assess the thickness of the synovial membrane and the severity of synovitis in cases where there is no swelling in the joint area.

Diagnostic criteria

Differential diagnosis of rheumatoid arthritis is based on the 2010 classification criteria (table). To confirm the rheumatoid nature of the disease, the score should reach 6 out of 10. At the same time, not only edema or soreness, but also synovitis, detected by instrumental diagnostic methods, may indicate the involvement of the joints.

When evaluating laboratory parameters, they are considered negative if they are less than or equal to the upper limit of normal values. One of the questions that needs to be clarified concerns the patient’s seropositivity for rheumatoid factor and antibodies to cyclic citrullinated peptide.

How much higher than normal should the rheumatoid factor index be to speak of its positiveness? Of course, not by a few units, but by at least 50%. Patients are considered weakly positive if their rheumatoid factor exceeds the norm by less than 3 times, high positivity – an increase in the indicator by more than 3 times, but it is possible to exceed the norm by 50 times or more.

Acute phase parameters and duration of synovitis from 6 weeks and above give only 1 point. This means that after 1.5 months from the onset of the articular syndrome, with a score of 6 or more, we can talk about a high probability of rheumatoid arthritis in a patient and start therapy.

When a doctor formulates a diagnosis for the first time, it is advisable to test the patient’s blood for antibodies, which, with similar symptoms, can help in the differential diagnosis of diseases (systemic lupus erythematosus, systemic scleroderma).

Early diagnosis = effectiveness of therapy

Basic therapy should be started in the weeks following diagnosis. The best results of treatment are those patients who immediately after the onset of the disease were admitted to the clinic and within the first 6 months began to receive basic therapy. The prognosis for such patients will be significantly better than for those who started treatment from the 6th to the 12th month of the disease.

There may be several reasons for delaying treatment. Most often among them are called the lower activity of rheumatoid arthritis, a later visit to a rheumatologist, the appointment of inadequate treatment at the first stage – anti-inflammatory drugs or only plaquenil. In such patients, achieving remission takes much longer, and its periods are reduced. It is important not only to prescribe basic therapy to the patient, but to carefully monitor its effectiveness, achieving maximum suppression of the activity of the pathological process. The effectiveness and tolerability of therapy, especially in the first year of its use, should be assessed after 1-3 months.

I would like to note a very interesting fact. At a time when there were no biological genetically engineered drugs, and only synthetic basic anti-inflammatory drugs were used, with individually selected and tightly controlled therapy focused on suppressing disease activity, the remission rate in our patient population was above 30%. Such data are now noted only when using the most modern therapy.

Clinical signs of rheumatoid arthritis

Presence of prolonged morning stiffness. A very important question to ask the patient is when pain occurs. In the second half of the night, in the morning, or, on the contrary, in the evening, when the patient goes to bed? If the patient has night pain prevailing, and in the morning he does not feel it, then one should think about other diseases, because this is a sign of non-inflammatory pain. For rheumatoid arthritis, a typical and important symptom is a decrease in pain after movement. At night, the pain may recur, gradually increasing in the morning. In addition, rheumatoid arthritis is characterized by a correspondence between the severity of articular syndrome and the level of laboratory inflammatory activity.

Morning stiffness correlates with the severity of synovitis and disease activity. There are patients in whom the feeling of stiffness can remain until lunchtime, and only in the evening they get better.

Questions to ask the patient:

Do you feel stiff in the morning after waking up?

– Do you easily get out of bed at night and can you pull the covers over you at night?

– can you make a fist in the morning?

– how long does it take you to move freely and what can you do to reduce morning stiffness?

Interosseous muscle atrophy. This is an informative diagnostic sign, which is expressed in a decrease in muscle volume, up to hypotrophy, primarily on the back of the hand. In the late period, atrophy is accompanied by ulnar deviation of the hand with deviation of the fingers to the side, subluxation of the metacarpophalangeal joints, combined with muscle weakness. This is the so-called walrus fin – a symptom that clearly indicates the diagnosis of late rheumatoid arthritis.

Another late sign is a deformed position of the finger, called the “swan neck”. In this case, the joint closest to the fingertip is bent towards the palm, and the joint closest to the palm, on the contrary, is bent in the opposite direction from the palm. “Button loop” is also a symptom of a long-term illness. It is expressed in flexion of the proximal interphalangeal joints with simultaneous hyperextension of the distal ones. The classic variant of early rheumatoid arthritis is also manifested by defiguration of the joints of the hands – swelling of the proximal interphalangeal joints, so that the fingers become spindle-shaped. It is important for the doctor to identify signs of early disease in order to refer the patient to a consultation with a rheumatologist in time for the purpose of timely prescribing therapy.

Extra-articular manifestations of rheumatoid arthritis

First of all, we should focus on general symptoms – weakness, fatigue, weight loss of 4 kg or more. Patients sometimes complain of fever, but high fever is rare.

Ophthalmopathy (most commonly uveitis), splenomegaly, lymphadenopathy, myalgia and myositis may occur (uncommon). Extra-articular signs are rheumatoid nodules, vasculitis (up to severe necrosis), digital arteritis with vascular intimal proliferation and thrombus formation, palmar erythema, peri- and endomyocarditis, granulomatous aortitis. Coronaritis is rare, and infarction in patients with rheumatoid arthritis is often associated not with inflammation of the arteries of the heart, but with the development of coronary disease.

Diseases of the cardiovascular system are often asymptomatic, sometimes there are rhythm disturbances (more often tachycardia). An increase in blood pressure indicates an increase in vascular stiffness. Therefore, patients should always be advised to monitor blood pressure.

Glomerulonephritis in a patient with rheumatoid arthritis is fundamentally different from the same disease in systemic lupus erythematosus. The patient may sometimes appear red blood cells in the urine, but proteinuria will be at a minimum level. Morphologically, various variants of glomerulonephritis are determined, up to mesangiocapillary. Whereas with a kidney biopsy with a long course of a poorly controlled disease, signs of amyloidosis are also detected.

Patients with rheumatoid arthritis may experience pleurisy (usually dry), shortness of breath, cough. Interstitial lung disease may be accompanied by fever. But pulmonary hypertension in patients is rarely detected. Peripheral neuropathy is often manifested by paresthesia, sensory disturbances such as “sock” (short or long), “gloves” (high or cut off). A fairly common occurrence is the “carpal tunnel” syndrome associated with compression of the median nerve.

Myalgias are common, in these cases, patients will complain of a deterioration in exercise tolerance. This will also be indicated by a decrease in range of motion due to inflammation.

Nataliya2021-09-29T16:16:21+03:00

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Acute rheumatic fever: symptoms and treatment

Acute rheumatic fever is treated by an otorhinolaryngologist

In some cases, consultation with a cardiologist or neurologist is required.

Acute rheumatic fever (ARF) is a non-purulent complication that occurs 2-4 weeks after streptococcal tonsillopharyngitis.

Streptococcal tonsillopharyngitis (hereinafter referred to as GABHS-pharyngitis) is an acute infectious disease affecting the lymphoid apparatus and pharyngeal mucosa.

Complications of GABHS-pharyngitis are of particular danger, which are divided into:

early (purulent), developing on the 4-6th day from the onset of the disease – otitis media, sinusitis, paratonsillar abscess, cervical lymphadenitis, pneumonia, etc.;
late (non-purulent) – acute rheumatic fever, post-streptococcal glomerulonephritis, toxic shock.

ARF epidemiology

Acute rheumatic fever and rheumatic heart disease are called diseases of poverty and economic disadvantage. Complications caused by GABHS are the leading cause of death from cardiovascular diseases in people under the age of 50 living in developing countries. ARF can occur at any age.

Around 470,000 new cases of ARF and 275,000 deaths associated with rheumatic heart disease are reported annually worldwide.

ARF is most common in children aged 5 to 15 years. ARF develops in 0.5-3% of cases if GABHS-pharyngitis is not treated.

Causes of ARF development

The causes of ARF development are not fully defined, but the role of GABHS in this process is obvious: ARF occurs only after GABHS-pharyngitis or scarlet fever with concomitant pharyngitis and does not occur after infections of the skin and soft tissues. This is thought to be due to different immune responses to skin and pharyngeal infections, as well as a lack of rheumatogenic potential in strains that cause skin infections.

Diagnosis of ARF

The major and minor Jones Criteria, developed by the American Heart Association, are used to diagnose ARF.

Five major criteria:

1. Carditis and valvulitis – develops in 50-70% of cases.

Damage to the layers and valves of the heart. Occurs within 3 weeks after GABHS-pharyngitis. It usually begins with endocarditis, followed by the development of pancarditis, of the heart valves, the mitral and aortic valves are more often affected. Disease progression can last for years after ARF and lead to heart failure.

2. Arthritis (migratory polyarthritis) – develops in 35-66% of cases.

inflammation of the joint – the earliest manifestation of ARF, occurs within 21 days after GABHS-pharyngitis, lasts 4 weeks and disappears without a trace. The knee, ankle, elbow, and wrist joints are most commonly affected. Arthritis is migratory in nature – several joints are successively affected.

3. Damage to the central nervous system (rheumatic chorea, Sydenham’s chorea, “St. Vitt’s dance”) – develops in 10-30% of cases.

Sharp, irregular, involuntary movements of the limbs, muscle weakness, emotional disorders. Occurs 1-8 months after acute GABHS-pharyngitis. Mimic muscles are more often affected, speech disorders can be observed. Emotional changes are manifested by outbursts of inappropriate behavior, including crying and restlessness. In 17-35% of patients, it can develop into an obsessive-compulsive disorder.

4. Erythema rheumatica – develops in less than 6% of cases.

Pink or pale red, non-pruritic ring-shaped rash. Localized on the body or limbs, but not on the face. The rash may appear, disappear, reappear.

5. Subcutaneous nodules – develop in less than 10% of cases.

Dense painless formations from a few millimeters to 2 cm. They persist for no more than a month. The localization of the nodules is more often over the bone, on the extensor surfaces, symmetrically. The skin over the nodule is not inflamed, mobile.

Minor criteria:

Arthralgia – joint pain.
Fever (above 38.5°C).
Increased erythrocyte sedimentation rate (ESR) – above 60 mm / h, C-reactive protein (CRP) – above 30 mg / l.
Prolongation of the PR interval on the ECG.

Diagnosis of ARF is established on the basis of:

the fact of GABHS pharyngitis — confirmed by a positive rapid test, bacteriological examination at the time of acute infection or an increase in the titer of antistreptolysin-O (ASLO) already at the time of complications;
Jones criteria: 2 major criteria, 1 major and 2 minor criteria, or 3 minor criteria if the patient has previously had ARF.

ECG and echocardiography (ultrasound of the heart) are mandatory for all patients with suspected ARF to detect morphological changes in the heart valves and signs of pathological regurgitation (blood reflux). Laboratory studies according to indications (since they are non-specific) – ESR and CRP. With signs of chorea, a neurological examination is necessary.

Treatment of ARF

GABHS eradication is necessary regardless of whether there are signs of pharyngitis. Antibacterial therapy is carried out similarly to therapy for acute tonsillopharyngitis.

Symptomatic therapy:

arthritis – non-steroidal anti-inflammatory drugs to relieve pain and prevent involvement of new joints;
carditis – treatment is carried out only with the development of heart failure;
chorea – usually does not require treatment, but sometimes it may be necessary to prescribe antipsychotics, anticonvulsants;
erythema and subcutaneous nodules – not treated.

ARF prevention

Primary — timely diagnosis and treatment of GABHS-pharyngitis.

Secondary – prevention of new episodes of GABHS infection, including eradication of GABHS even in asymptomatic carriage.

The duration of antibiotic prophylaxis is determined on the basis of the characteristics of the existing pathological process. If we are talking about post-streptococcal arthritis, it can be limited to 1-2 years. In ARF without carditis, the duration of antibiotics is 5 years or up to 21 years of the patient (which is longer), ARF with carditis without consequences – 10 years or up to 21 years (which is longer), ARF with heart valve disease – 10 years or up to 40 years ( longer), and sometimes for life.

How is ARF treated at Rassvet Clinic?

We carry out timely diagnosis and adequate treatment of GABHS-pharyngitis, which reduces the incidence of ARF by almost 70%. When choosing antibiotic therapy, we always give preference to penicillin antibiotics, as the most effective drugs that have been proven to reduce the incidence of ARF. We never reduce antibiotic therapy when there is clinical improvement. If GABHS-pharyngitis is detected, we do not prescribe local treatment (rinses, sprays) to the detriment of systemic antibiotic therapy.

We provide adequate eradication therapy for GABHS in ARF in order to prevent relapses and progression of rheumatic heart disease. We offer a complete examination for diagnosed ARF – ECG, ECHO-KG, consultation with a cardiologist and neurologist with the selection of the necessary therapy.