Ra and fever: Rheumatoid arthritis fevers: Causes, symptoms, and treatment

22.06.202127.07.2023 by alexxlab

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.

People can treat a mild fever at home by:

staying hydrated
getting plenty of rest
keeping the room cool
taking over-the-counter medications, such as acetaminophen or ibuprofen, that reduce fever

Individuals should always check with a doctor before taking any medication.

Treatments options that can help manage RA symptoms during a flare include:

pain relief medication, such as acetaminophen
nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
corticosteroids

If a person has a high fever that persists, they should discuss it with a doctor or seek emergency medical help.

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

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

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 GABHS-pharyngitis) is an acute infectious disease affecting the lymphoid apparatus and the mucous membrane of the pharynx.

Of particular danger are the complications of BHSA-pharyngitis, 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.

The 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.

All patients with suspected ARF must undergo ECG and echocardiography (ultrasound of the heart) 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.

Author:

Chekaldina Elena Vladimirovna
otorhinolaryngologist, Ph.D.

Publication date: January 9, 2020

Update date: 9December 2022

Acute rheumatic fever (ARF) – causes, symptoms, diagnosis and treatment

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Acute rheumatic fever (ARF) or rheumatism is an infectious-allergic systemic inflammatory disease of the connective tissue with a primary lesion of the cardiovascular system, skin, and nervous system. Occurs in children under 15 years of age against the background of an excessive immune response after suffering infectious diseases.
Causes of rheumatism
The main cause of the disease is group A beta-hemolytic streptococcus. This bacterium has cross-reacting antigens that “knock down” the immune response and cause the body to attack heart and kidney cells. Streptococcus allocates pathogenicity factors:
– adhesive factors;
– superantigens;
– M-protein;
– streptolysin-S;
– streptolysin-O;
– hyaluronidase;
– streptokinase.
At risk are children with a burdened family history (hereditary predisposition to the development of ARF). The development of the disease also depends on the strain of streptococci (some of them are more pathogenic). Overcrowding, poor sanitation, frequent colds and infections can sensitize the body and lead to the development of ARF.
Clinic
Kisel-Jones ARF major and minor criteria:
1. Major criteria:
  1. Rheumocarditis (usually endomyocarditis).
  2. Polyarthritis (large joints, migratory inflammation, no deformities).
  3. Chorea minor (convulsions due to damage to subcortical structures).
  4. Rheumatic nodules (subcutaneous indurations).
  5. Anular erythema (redness on the skin of the trunk and extremities).
2. Minor Criteria:
  1. Fever
  2. Joint pain
Diagnosis
A pediatrician, internist, cardiologist or rheumatologist carefully studies the child’s developmental history, takes a family history and prescribes a laboratory th instrumental research.
- Streptococcus antibody test.
- Throat swab for bacteria or their fragments.
- Inflammatory blood markers (C-reactive protein, ESR rate).
- Electrocardiography (rhythm disturbances, changes in wave amplitude).
- Ultrasound of the heart (valvular changes, fluid in the heart chambers, assessment of heart function).
Treatment and complications
The main direction of therapy is to get rid of streptococcal infection in a timely manner. For this, antibiotics of the penicillin series are used. The course is from 10 to 14 days. After the main treatment, the patient is offered maintenance therapy to exclude recurrence of the disease. Prophylaxis continues until the patient reaches the age of 21 or at least 5 years in a row.
Non-steroidal anti-inflammatory drugs are used as symptomatic therapy. They reduce the temperature, remove articular manifestations and pain. If the desired effect does not occur, glucocorticosteroids are prescribed.
If minor chorea predominates in symptoms, then anticonvulsant therapy should be started. It is controlled by a neurologist or psychiatrist.
Prophylaxis
A distinction is made between primary, secondary and current prophylaxis of acute rheumatic fever.
1. Primary. Timely treatment of tonsillitis, caries, sinusitis, hardening of the child.
2. Secondary. Bicillin prophylaxis (Extencillin 2.4 million units every three weeks):
  1. At least 5 years.
  2. When the disease manifests itself in adolescence without the formation of heart disease – up to 18 years.
  3. Manifestation with heart disease – up to 25 years.
3. Current. Mandatory prescription of penicillins and NSAIDs in inflammatory diseases.
ARF is dangerous due to the formation of heart defects with late treatment.

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Ra and fever: Rheumatoid arthritis fevers: Causes, symptoms, and treatment

Rheumatoid arthritis fevers: Causes, symptoms, and treatment

Can RA medication cause fever?

Is RA fever the same as rheumatic fever?

Rheumatoid Arthritis Fevers: Why Do They Occur?

How we reviewed this article:

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Acute rheumatic fever: symptoms and treatment

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Diagnosis of ARF

Treatment of ARF

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Acute rheumatic fever (ARF) – causes, symptoms, diagnosis and treatment

Causes of rheumatism

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Diagnosis

Treatment and complications

Prophylaxis

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