Rheumatoid Arthritis Fevers

Last week, I mentioned my Rheumatoid Arthritis fevers in another post. What a surprising variety of reactions. Some said, “Me too.” Others said, “Ohmygosh I had no idea the fever was from RA!” And others said, “What on earth do you mean by RA fever?”

What do you mean by Rheumatoid Arthritis fevers?

When the Mayo Clinic defines Rheumatoid Arthritis, they mention fever. You also will see “fever” included if you read Mayo Clinic’s list of Rheumatoid Arthritis symptoms. Fever is listed by John’s Hopkins as a symptom which precludes “clinical remission” in their “Diagnostic Guidelines.” The American College of Rheumatology mentions fever on page two of their explanation of RA. If you read historical descriptions of RA, you will notice that fever is mentioned along with redness or rashes and crippling pain.

Typically, a rheumatoid fever is a low grade fever. A low grade fever is usually considered to be less than 100.4 degrees Fahrenheit. A normal body temperature for most people is 98.6, so a low grade fever could be a temperature between 98.7 and 100.4.

What causes Rheumatoid Arthritis fevers?

• According to MedicineNet, “Fever: A mildly elevated temperature is not unusual in a person with active inflammation from rheumatoid arthritis.”
• RA inflammation is related to cytokine activity. Fevers are related to cytokines, too.
• Researchers believe that the typical fevers of systemic onset Juvenile RA are related to serum levels of “the proinflammatory cytokine” IL-6, according to the Journal of Rheumatology.
• According to this exciting article from the University of Colorado Denver, it’s IL-1. They diluted a form of IL-1 a million times and it still triggered lymphocytes that cause fever. In 2009, as a result of his work on this project, Dr. Dinarello won the largest award in medicine or science in the United States.

Why doesn’t everyone know about Rheumatoid Arthritis fevers?

This puzzles me. Frankly, RA is a puzzle in many ways. There is much misinformation and misleading information. It seems like patients know exactly what RA is, but sometimes it seems like they are the only ones. And they don’t always speak freely about what daily RA is like, even to doctors, because so often they struggle to resist the mantle of hypochondriac. (Please read that link if you are not familiar with that post. It is doctors and the Arthritis Foundation who have used that word, not me.)

It is typical for people with Rheumatoid Arthritis to have a fever. If the RA is not “controlled” or the patient has flares, there will likely be a fever as one indicator of that. So, why is this “textbook” “typical” symptom of RA discussed so little today?

Why is it that fever, the one known typical RA symptom that is easily objectively measurable, is hardly measured?

Whenever I take my child to the pediatrician, the nurse takes his temperature. However, I have never had my temperature taken at a rheumatology appointment. Once, I requested it, and the MA became very frustrated because she did not know why. She said, “We don’t do that here.” Why not?

Isn’t a fever a sign of inflammation in the body? Wouldn’t it be important to use body temperature patterns as a measure of RA activity? It seems to associate more with disease activity than blood tests do.

How often does your rheumatologist take your temperature? How often do you have a low-grade fever? Do you own a good digital thermometer?

Recommended reading:

• Rheumatoid Factor Test: Should We Rely on Rheumatoid Factor Levels?
• Rheumatoid Arthritis Pain in the Twilight Zone
• My Basic Class in Rheumatoid Arthritis: RA 101