The ying and yang of fever in rheumatic disease

Galloway, James; Cope, Andrew P.

doi:10.7861/clinmedicine.15-3-288

Cited by 10 publications

(4 citation statements)

References 39 publications

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“…Although inflammatory and immunologic issues inherent to myositis itself-a disease involving immune dysregulation-cannot be ruled out, this association likely depends on the use of aggressive immunosuppressive therapy linked with higher myositis activity. 38 A striking finding of this study is the comparable mortality rate in patients who experienced OI in comparison with the remainder of the cohort. The overall mortality in patients with OI in our cohort was 38.5%, higher than the range of 10.4% to 27.7% reported in other series.…”

Section: Viruses Of the Herpes Viridae Family (Vzv And Cmv)mentioning

confidence: 51%

“…Fevers at disease onset and myositis activity were factors associated with the development of OI. Although inflammatory and immunologic issues inherent to myositis itself—a disease involving immune dysregulation—cannot be ruled out, this association likely depends on the use of aggressive immunosuppressive therapy linked with higher myositis activity …”

Section: Discussionmentioning

confidence: 99%

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Opportunistic infections in patients with idiopathic inflammatory myopathies

et al. 2018

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Section: Viruses Of the Herpes Viridae Family (Vzv And Cmv)mentioning

confidence: 51%

Section: Discussionmentioning

confidence: 99%

Opportunistic infections in patients with idiopathic inflammatory myopathies

et al. 2018

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“…One of the contributing factors may be the unintended antipyretic effect of anti-inflammatory agents such as NSAIDs and glucocorticoids (GCs), which improve the symptoms of active RA. Furthermore, GC use not only increases the risk of developing TB but also masks constitutional symptoms suggestive of active infection [ 30 , 31 ]. Active TB infection should be considered as the cause of fever of unknown origin, but the fever can sometimes be low-grade or absent, particularly in the elderly [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Differential Diagnosis of Inflammatory Arthropathy Accompanying Active Tuberculosis Infection

Jung

Choi

2022

J Rheum Dis

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Objective The study aimed to ascertain the clinical manifestations of inflammatory arthritis accompanying tuberculosis (TB) for the differential diagnosis. Methods We retrospectively reviewed patients with active TB who presented with inflammatory arthropathy at Seoul Medical Center. Among 2,872 patients with active TB infection, 47 had inflammatory arthropathy 14 had crystal-induced arthropathy; 12, TB arthritis; 12, Poncet’s disease (PD); 8, Rheumatoid arthritis (RA); and 1, septic arthritis. The clinical characteristics and laboratory and radiographic findings of each group were analyzed. Results In TB arthritis, weight-bearing joints were more commonly affected than the elbow and wrist joints. When compared to TB arthritis, PD demonstrated a significantly higher proportion of polyarthritis and involved both large and small-to-medium-sized joints. The duration of arthritis symptoms after anti-TB treatment was significantly shorter in patients with PD (56 days vs. 90 days, p=0.028). When compared to PD, RA flares during active TB infection involved only small-to-medium-sized joints rather than a mixed distribution (62.5% vs. 16.7%, p=0.035). Patients with PD more commonly had fever at onset and showed a good response to nonsteroidal anti-inflammatory drugs alone or were in remission within 3 months after anti-TB treatment. The presence of rheumatoid factor or anti-cyclic citrullinated peptide and radiographic progression after 12 months was frequently observed in patients with RA flares. Conclusion The differential diagnosis of inflammatory arthritis accompanying active tuberculosis infection is challenging. Comprehensive history taking and physical examination, synovial fluid analysis, and a high level of clinical suspicion are essential to avoid delayed diagnosis and to reduce the significant morbidity involved.

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“…AOSD has been referred to as the archetypal febrile autoinflammatory illness [ 20 ]. It typically causes a diurnal fever, highest in the evening accompanied by a salmon pink rash and arthralgia.…”

Section: F-fdg Pet/ct Scanningmentioning

confidence: 99%

Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?

2018

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Purpose of reviewFever is common within rheumatology but it is often challenging to identify its source. To do so correctly is paramount in patients with an underlying inflammatory condition receiving immunosuppressive therapy. This review article looks at the available evidence and merits of both 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scans and new proposed biomarkers in determining the cause of fever within rheumatology.Recent findings18F-FDG PET/CT scans are already an established tool in the detection and diagnosis of malignancy and are emerging for use in fever of unknown origin. More recently, they have been used to identify rheumatological causes of fever such as large vessel vasculitis and adult-onset Still’s disease. Within these conditions, biomarkers such as procalcitonin and presepsin may help to differentiate endogenous from exogenous pyrogens.Summary18F-FDG PET/CT scanning shows promise in locating the source of pyrogens and may be superior to other conventional forms of imaging. As evidence and test availability increases, its use is likely to become commonplace in the diagnostic work-up of fever. Once a source is located, selected biomarkers may be used to confirm a cause.

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The ying and yang of fever in rheumatic disease

Cited by 10 publications

References 39 publications

Opportunistic infections in patients with idiopathic inflammatory myopathies

Opportunistic infections in patients with idiopathic inflammatory myopathies

Differential Diagnosis of Inflammatory Arthropathy Accompanying Active Tuberculosis Infection

Differentiating Disease Flare From Infection: A Common Problem in Rheumatology. Do 18F-FDG PET/CT Scans and Novel Biomarkers Hold The Answer?

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