Low grade fever for four days. Low-Grade Fever in MS Patients: Uncovering the Link to Fatigue and Disease Progression

03.07.202311.06.2023 by alexxlab

How does a low-grade fever affect fatigue levels in multiple sclerosis patients. What is the connection between body temperature and MS disease progression. Why do relapsing-remitting MS patients experience elevated temperatures while secondary-progressive patients do not. How can MS patients manage fever-related fatigue symptoms.

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The Unique Nature of MS-Related Fatigue

Multiple sclerosis (MS) is a complex neurological condition that affects millions of people worldwide. One of the most debilitating symptoms experienced by MS patients is fatigue, which differs significantly from the tiredness felt by healthy individuals. According to the National Multiple Sclerosis Society, fatigue impacts approximately 80% of MS patients and can severely hinder their ability to function in daily life, often leading to early retirement.

Dr. Victoria M. Leavitt, a neuropsychologist and co-founder of the Manhattan Memory Center in New York City, emphasizes the unique nature of MS-related fatigue: “When I share my research on fatigue in MS with colleagues or friends, they say they know what it’s like, but the truth is they don’t.” This statement underscores the importance of understanding the specific characteristics of MS fatigue to develop effective treatment strategies.

Characteristics of MS Fatigue

Occurs daily
Energy levels typically reach their lowest point by mid-afternoon
Onset can be sudden
Exacerbated by heat

The Temperature-Fatigue Connection in MS

Recent research has uncovered a fascinating link between body temperature and fatigue levels in MS patients. Dr. Leavitt and her colleague, Dr. James F. Sumowski, a senior research scientist in neuropsychology and neuroscience at the Kessler Foundation, conducted a groundbreaking study that revealed a correlation between low-grade fever and fatigue in relapsing-remitting MS (RRMS) patients.

The study involved 50 RRMS patients, 40 healthy controls, and 22 secondary-progressive MS (SPMS) patients. The researchers discovered that RRMS patients who reported higher levels of fatigue also exhibited elevated body temperatures. Interestingly, this phenomenon was not observed in SPMS patients.

Key Findings of the Study

RRMS patients with fatigue often had a low-grade fever
Warmer body temperatures correlated with more severe fatigue in RRMS patients
SPMS patients did not exhibit elevated body temperatures
This is the first study to demonstrate a direct link between body temperature and fatigue levels in RRMS patients

Understanding the Causes of Low-Grade Fever in MS

The discovery of low-grade fever in RRMS patients raises questions about its underlying causes. Dr. Sumowski suggests that the elevated body temperature may be related to disease-specific inflammatory processes. He explains, “We know that elevated body temperature is linked to inflammation when otherwise healthy people experience a fever, as well as in other diseases (i.e., temperature of the joints in people with rheumatoid arthritis, temperature of the brain in acute stroke patients).”

However, the researchers believe that the inflammation in MS may not be chronic but rather fluctuate on a day-to-day basis. This theory aligns with the experience of many RRMS patients who report variations in their fatigue levels from one day to the next.

Inflammation and Body Temperature in MS

Elevated body temperature likely linked to inflammatory processes
Temperature fluctuations may correspond to daily changes in inflammation
Consistent with reported day-to-day variations in fatigue among RRMS patients

The Distinction Between RRMS and SPMS in Temperature Regulation

One intriguing aspect of the study was the absence of elevated body temperatures in SPMS patients. Dr. Leavitt explains that this difference may be related to the varying inflammatory processes in different types of MS. “We know that RRMS is associated with inflammatory processes, which can lead to [relapses]. In contrast, inflammatory processes are less pronounced in progressive forms of the disease.”

As patients transition from RRMS to SPMS, there is a shift away from inflammatory lesions and clinical exacerbations. This change in disease progression may explain why body temperature is higher in RRMS patients compared to those with SPMS.

Inflammatory Processes in RRMS vs. SPMS

RRMS characterized by more pronounced inflammatory processes
SPMS shows a decrease in inflammatory lesions and clinical exacerbations
Differences in inflammation may account for varying body temperature observations

The Impact of Heat on Neural Transmission in MS

The relationship between elevated body temperature and neural transmission in MS patients is an area that requires further investigation. Dr. Leavitt acknowledges that there is surprisingly little documentation on how heat directly affects brain signals in MS. She states, “For us, it is unclear whether body temperature has a direct relationship on neural transmission, or whether, alternatively, inflammation slows neural transmission and elevates body temperature.”

This uncertainty highlights the need for additional research to understand the complex interplay between body temperature, inflammation, and neural function in MS patients.

Potential Mechanisms of Heat-Related Neural Dysfunction

Direct impact of elevated temperature on neural transmission
Inflammation-induced slowing of neural signals and concurrent temperature increase
Possible combination of both factors

Advancements in Temperature Measurement Techniques

During their research, Leavitt and Sumowski made an unexpected discovery regarding temperature measurement accuracy. They found that hospital-grade oral thermometers were surprisingly inaccurate in detecting the low-grade fevers observed in RRMS patients. “Once we switched to in-ear thermometers,” said Leavitt, “we got much more accurate results.”

This finding led the researchers to theorize that measuring body temperature from within the ear may provide a more accurate representation of brain temperature. Given that the point of contact is closer to the brain itself, this method could potentially offer insights into the relationship between disease activity within the brain and elevated body temperature.

Implications of Improved Temperature Measurement

In-ear thermometers provide more accurate results for detecting low-grade fevers in MS patients
Proximity to the brain may offer better insights into disease activity
Potential for understanding the relationship between brain temperature and clinical symptoms

Future Directions in MS Temperature Research

The findings of this study open up new avenues for research in the field of MS. Dr. Leavitt expressed interest in extending their work to investigate brain temperature directly. She referenced a study published last year that found a correlation between elevated brain temperature and increased disability levels in RRMS patients.

“We are interested in extending this work,” said Leavitt, “as we think that brain temperature may bring us even closer to the source of elevated temperature and help us to understand whether it is related to inflammatory processes, fatigue, and other clinical symptoms.”

Potential Areas for Future Research

Direct measurement of brain temperature in MS patients
Correlation between brain temperature and disability levels
Investigation of the relationship between brain temperature and inflammatory processes
Exploration of brain temperature’s impact on fatigue and other MS symptoms

Managing Temperature-Related Fatigue in MS Patients

For RRMS patients who experience daily fatigue, managing body temperature may be crucial in alleviating symptoms. While the study does not provide specific recommendations, there are several strategies that MS patients can employ to help regulate their body temperature and potentially reduce fatigue:

Temperature Management Strategies for MS Patients

Stay hydrated to help regulate body temperature
Use cooling products such as neck wraps or vests
Avoid exposure to extreme heat, especially during peak hours
Plan activities during cooler parts of the day
Use air conditioning or fans to maintain a comfortable environment
Wear lightweight, breathable clothing
Take cool showers or baths to lower body temperature

It’s important for MS patients to work closely with their healthcare providers to develop personalized strategies for managing temperature-related fatigue. As research in this area continues to evolve, new treatments and interventions may become available to address this challenging aspect of MS.

The Role of Temperature Monitoring in MS Management

The findings of this study suggest that regular temperature monitoring could play a significant role in MS management, particularly for patients with RRMS. By tracking body temperature, patients and healthcare providers may be able to anticipate and prepare for periods of increased fatigue.

Benefits of Temperature Monitoring in MS

Early detection of low-grade fevers
Potential prediction of fatigue episodes
Improved understanding of individual temperature patterns
Enhanced ability to implement targeted interventions

Patients may consider keeping a temperature and fatigue diary to identify patterns and triggers. This information can be valuable for healthcare providers in developing tailored treatment plans and adjusting medications if necessary.

The Importance of Holistic MS Management

While the discovery of the link between low-grade fever and fatigue in RRMS patients is significant, it’s essential to remember that MS management requires a comprehensive approach. Temperature regulation is just one aspect of a complex condition that affects multiple systems in the body.

Components of Holistic MS Management

Disease-modifying therapies
Symptom management strategies
Lifestyle modifications (diet, exercise, stress reduction)
Cognitive rehabilitation
Emotional and psychological support
Regular monitoring and follow-up with healthcare providers

By addressing all aspects of MS, including temperature-related fatigue, patients can work towards improving their quality of life and maintaining optimal function.

Implications for MS Research and Treatment

The discovery of the relationship between low-grade fever and fatigue in RRMS patients opens up new possibilities for research and treatment development. This finding may lead to novel approaches in managing MS-related fatigue and potentially other symptoms of the disease.

Potential Areas of Impact

Development of targeted temperature regulation therapies
Improved understanding of the role of inflammation in MS progression
Enhanced diagnostic tools based on temperature monitoring
New avenues for investigating the underlying mechanisms of MS
Potential for personalized treatment plans based on individual temperature patterns

As research in this area progresses, it may lead to more effective treatments and management strategies for MS patients, ultimately improving their quality of life and potentially slowing disease progression.

The Role of Patient Education and Self-Advocacy

With the emergence of new findings like the link between low-grade fever and fatigue in MS, patient education becomes increasingly important. MS patients should be encouraged to stay informed about the latest research and to discuss new developments with their healthcare providers.

Key Aspects of Patient Education and Self-Advocacy

Understanding the various symptoms and manifestations of MS
Learning about the latest research and treatment options
Developing skills for effective communication with healthcare providers
Participating actively in treatment decisions
Joining support groups or patient advocacy organizations
Sharing experiences and insights with other MS patients

By becoming well-informed and actively engaged in their care, MS patients can play a crucial role in advancing research and improving treatment outcomes for themselves and others living with the condition.

The Future of MS Research and Treatment

The discovery of the relationship between low-grade fever and fatigue in RRMS patients is just one example of the ongoing advancements in MS research. As our understanding of the disease continues to grow, it paves the way for more targeted and effective treatments.

Promising Areas of MS Research

Gene therapy and stem cell treatments
Advanced imaging techniques for early detection and monitoring
Personalized medicine approaches based on genetic and environmental factors
Novel drug delivery systems for more effective treatments
Rehabilitation techniques incorporating virtual reality and artificial intelligence

While there is still much to learn about MS, ongoing research efforts provide hope for improved management strategies and potentially curative treatments in the future. The findings on temperature regulation and fatigue represent just one piece of the complex puzzle that is multiple sclerosis, but they underscore the importance of continued scientific inquiry and innovation in the field.

Could a Low-Grade Fever Be Making Your MS Fatigue Worse?

A new study shows that relapsing-remitting MS patients who suffer from fatigue may also be running a fever.

The fatigue multiple sclerosis (MS) patients experience is very different from the type experienced by healthy people. According to the National Multiple Sclerosis Society, fatigue occurs in about 80 percent of MS patients and “can significantly interfere with a person’s ability to function at home and work.” Fatigue is often cause for early retirement.

“When I share my research on fatigue in MS with colleagues or friends,” Victoria M. Leavitt, Ph.D., a neuropsychologist and co-founder of the Manhattan Memory Center in New York City told Healthline, “they say they know what it’s like, but the truth is they don’t.”

MS fatigue usually occurs every day, with lack of energy peaking by mid-afternoon. Onset can be sudden and is aggravated by heat.

In her earlier work, Leavitt found that outdoor temperature has an impact on cognition in MS patients. The results of that study made the team question whether internal temperature might also play a role in the disease process.

In their new study, Leavitt along with James F. Sumowski, Ph.D., a senior research scientist in neuropsychology and neuroscience at the Kessler Foundation, found that patients with relapsing MS who complained of fatigue also had a low-grade fever.

They studied 50 patients with relapsing-remitting MS (RRMS), 40 healthy controls, and 22 patients with secondary-progressive MS (SPMS). They discovered that warmer body temperatures in patients with RRMS were linked to more extreme fatigue. The volunteers with SPMS did not have a fever. This is the first-ever demonstration that body temperature is elevated in those with RRMS, and that it directly impacts their level of fatigue.

Learn How Warm Weather Affects Cognition in MS »

Healthline asked Leavitt and Sumowski for more details about their findings.

What’s Causing the Low-Grade Fever?

“We think it is a disease-related inflammatory processes,” explained Sumowski, “We know that elevated body temperature is linked to inflammation when otherwise healthy people experience a fever, as well as in other diseases (i. e., temperature of the joints in people with rheumatoid arthritis, temperature of the brain in acute stroke patients).”

“Rather than chronic inflammation, however, we think that body temperature may fluctuate with day-to-day fluctuations in inflammation among RRMS patients, although this still needs to be investigated directly,” he added. “Indeed, many RRMS patients report day-to-day fluctuations in fatigue.”

Why Not Secondary-Progressive MS?

“This is a great question,” said Leavitt, “and it relates to our hypothesis that body temperature is related to inflammation. We know that RRMS is associated with inflammatory processes, which can lead to [relapses]. In contrast, inflammatory processes are less pronounced in progressive forms of the disease.”

“Indeed, there is a shift away from inflammatory lesions and clinical exacerbations after persons convert from RRMS to secondary-progressive MS (SPMS),” she added. “It makes sense, therefore, that (if body temperature is related to inflammation) body temperature would be higher in RRMS relative to SPMS. ”

Learn How MS Patients Are Especially Sensitive to Heat »

Is Heat Slowing Down Brain Signals?

Just as electronic devices malfunction when they become overheated, a fever might interfere with signals from the brain to the rest of the body. But according to Leavitt, there is surprisingly little to document this.

“For us, it is unclear whether body temperature has a direct relationship on neural transmission, or whether, alternatively, inflammation slows neural transmission and elevates body temperature,” she said. “This is an important question for future research.”

During their study, Leavitt and Sumowski made an unexpected observation: hospital grade oral thermometers were surprisingly inaccurate. “Once we switched to in-ear thermometers,” said Leavitt, “we got much more accurate results.”

They theorized that if measuring body temperature from within the ear is more accurate, and the point of contact is closer to the brain itself, perhaps the fever is emanating from the disease activity within the brain. Leavitt referred to a study published last year that found that people with RRMS who had an elevated brain temperature experienced a greater level of disability.

If you have RRMS and suffer from daily fatigue, what can you do? Besides the obvious goal of keeping your body cool, Sumowski said people with MS might want to, “avoid situations that may cause additional inflammation, including smoking, obesity, and exposure to allergens.”

Learn How Smoking Could Speed Up MS Progression »

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

In case of RA fever, you should:

Drink plenty of fluids.
Keep warm if you’re experiencing chills.
Remove extra layers of clothing and try to keep cool if you’re hot and sweating.

Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or pain relievers containing acetaminophen, may reduce fever. Be sure to ask your doctor about safe dosage.

If your fever rises above 101°F, contact a doctor so that the underlying cause can be determined. If you have RA, make sure to tell your doctor. Be prepared to tell them what medicines you’re using for RA treatment.

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

What is subfebrile temperature? | Psychotherapist Donskoy Dmitry Ivanovich (Minsk)

Body temperature is one of the physical parameters of the human body and, contrary to popular belief, it should not be unchanged and always be at the level of 36. 6 degrees C. Insignificant by physical standards a deviation (0.4-1.0 degrees C) from the magic number “36.6” is regarded by many people as an elevated temperature, which is completely wrong.

According to numerous studies, the average normal body temperature of most adults is not 36.6, but 37 degrees Celsius. Moreover, normal temperature varies significantly (from 35.5 to 37.5 degrees C) in different people depending on the physiological state of their body, time of day, place of measurement, physical activity, hormonal status, as well as environmental factors (humidity , room temperature).

In healthy people, body temperature changes during the day by 0.5 degrees C. As a rule, the lowest body temperature is observed between 4 and 6 o’clock in the morning, and the highest between 16 and 20 o’clock. Thus, the vast majority of complaints about temperature fluctuations up to 37-37.5 degrees C in the evening are explained by the usual physiological increase in temperature. Each person has their own daily rhythm of body temperature changes, which varies depending on the time zone, work and leisure schedule.

In women, in addition to daily variations, body temperature also changes by 0.3-0.5 degrees during the menstrual cycle. The highest numbers up to 38 degrees C are observed between 15 and 25 days of the menstrual cycle of 28 days.

Body temperature may rise after eating, after smoking, in case of mental agitation (after stress). A true fever ( hyperthermia ) is considered to be a temperature measured in the oral cavity, rectum, in the ear canal, above 38.3 degrees C.

Subfebrile body temperature is a state of the body characterized by a constant or periodic increase in temperature from 37.2 to 38.3 degrees C (when measured in the mouth, rectum or ear canal). A similar condition is typical for young asthenic women who are prone to the appearance of headaches, vegetative dystonia. Often the so-called. habitual hyperthermia is accompanied by weakness, insomnia, shortness of breath, pain in the chest, abdomen. Often the cause of prolonged subfebrile temperature can be stress and mental stress (psychogenic temperature).

Prolonged fever above 37.5 degrees C but less than 38.5 degrees C may also be a sign of illness. However, very rarely prolonged subfebrile temperature is the only manifestation of the disease. There are other signs of diseases of internal organs or infections, changes in the composition of blood, urine.

How to treat subfebrile temperature?

Until the cause of subfebrile temperature remains unknown, there can be no talk of any etiological treatment. The use of antipyretics is not recommended, as this can make the diagnosis difficult.

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Publication date: 2020-04-02

What is subfebrile temperature: causes, diagnosis

Subfebrile condition is a condition in which body temperature rises to 38 °C for a long period. Chronic subfebrile temperature is called an unreasonable increase in body temperature for more than two weeks. In this state, a person can either feel unchanged or feel unwell. Often subfebrile condition is the only complaint of the patient. Prolonged subfebrile temperature and weakness may be the first symptoms of a serious illness.

Possible causes of subfebrile temperature

In humans, normal body temperature (BT) is maintained by special mechanisms of thermoregulation. Known physiological fluctuations of TT during the day, called circadian rhythms. The difference between morning and evening body temperature reaches 0.5-1.0 °C. What is subfebrile temperature? This is an increase in temperature that persists for a long period. Isolated cases of TT rise above 37.1 ° C are not considered subfebrile. There are low subfebrile condition (up to 37.1 °C) and high subfebrile condition (up to 38.0 °C).

Possible causes of subfebrile temperature in adults:

bacterial infections that cause diseases of the upper respiratory tract, pneumonia, typhoid fever and others;
viral infections: influenza, SARS, hepatitis, HIV/AIDS;
urinary tract infections: cystitis, urethritis;
allergies – eg hay fever;
response to drug therapy. Some drugs can cause a fever, known as drug fever. When you stop taking the drug, hyperthermia disappears;
inflammatory diseases of the pelvic organs;
hyperthyroidism;
appendicitis;
tuberculosis. Permanent subfebrile condition is observed with a hard-to-detect form of tuberculosis;
hormonal changes. Subfebrile temperature in women can be observed in the second half of the menstrual cycle, during PMS, pregnancy and menopause;
inflammatory diseases of the gastrointestinal tract;
lymphoma and other types of malignant neoplasms;
intense physical activity;
eating;
emotional tension and stress;
exposure to external heat (eg sauna, hot shop).

Chronic subfebrile condition should be taken seriously and a doctor should be consulted.

Subfebrile temperature in a child has been holding for a week: possible causes

Subfebrile condition is a frequently diagnosed condition in babies, as well as the first symptom of many diseases.

Main causes of subfebrile temperature in children:

acute respiratory infections;
infectious lesions of the gastrointestinal tract. In this case, fever is often accompanied by vomiting and diarrhea;
teething;
childhood infectious diseases: chicken pox, measles, mumps (mumps), rubella and others;
some vaccinations. Usually the temperature reaction to the vaccine lasts 1-3 days;
otitis;
cystitis;
active games;
prolonged crying.

If the child has had a subfebrile temperature for more than a week, you should consult a doctor. Differential diagnosis of febrile conditions is considered quite difficult even for experienced professionals. Subfebrile fever may be accompanied by other symptoms, this will make it easier for the doctor to make a diagnosis. The spectrum of diseases that occur with low-grade fever includes pathologies related to the competence of a pediatrician, otolaryngologist, infectious disease specialist, surgeon, phthisiatrician, cardiologist, oncologist and other specialists. Sometimes a full examination may be required to identify the cause of a prolonged fever. Read more about the examination program on our website https://www.dobrobut.com.

What tests will help determine the cause of chronic subfebrile condition

To find out the causes of prolonged fever, you may need:

urinalysis;
clinical and biochemical blood tests;
analysis of feces for worm eggs;
video laryngoscopy;
otoscopy;
tuberculin tests;
hormone test;
ECG;
ultrasound.

If there is a regular increase in body temperature in the evening, the doctor will refer you to a fluorography or x-ray of the lungs.

Related services:

Pediatrician’s consultation

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