Fevers are a common symptom of lupus.  At times it can be your body telling you what you already know … you have inflammation, but sometimes it’s your body telling you that you have a dangerous complication, like an infection.  So, it is important to take fevers seriously!   Read more to discover the causes of fevers and the precautions you can take to stop them from getting worse.

 

• Introduction: The Basics in 20 Seconds
• The Science of Fevers
• Lupus and Fevers
• Diagnosis and Treatment of Fevers with Lupus
• In Conclusion

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Introduction: The Basics in 20 Seconds!

Low-grade, recurring fevers are common for those living with lupus.  Normally, they are managed by the same immunosuppressive and anti-inflammatory medications that are taken for other symptoms of SLE.  Yet, they can also indicate other conditions and should be monitored carefully.

 Here are some quick facts about lupus and fever:

• Fevers occur in from 36% to 86% of those living with lupus.
• Fevers are often one of the first symptoms of lupus and are often used to measure the severity of the lupus in clinical trials.
• Fevers are statistically more common in White lupus patients than in other groups.
• Recently, the reports of fevers have declined.  This is probably due to the more common use of NSAIDs (nonsteroidal anti-inflammatory drugs) by patients and the general public.
• It is tricky to diagnose the cause of fever in patients with lupus because there are many reasons for a person to experience elevated body temperature.
• If a fever is higher than 102° F, or lasts longer than a couple of days, consult a healthcare provider! This fever may be caused by an infection.
• Infections are serious for those living with lupus – because immunosuppressive medications can increase the risk for getting infections as well as increase their severity.

Whether a fever is cause by lupus or not, it is important to take them seriously.  Read on to find out more!

The Science of Fevers

Why do we get fevers?

Fevers play a critical role in the body’s immune response to infections.  A fever increases the temperature of the entire body and fights infections at the “systemic” level.  Why?  The bacteria, viruses and even some parasites that cause disease often have a very narrow range of temperature in which they can survive.  They tend to favor 98.6° Fahrenheit (37° C.), the average temperature of a healthy human.  Anything significantly higher or lower can keep them from thriving or spreading throughout the body.

Of course, this can be a very uncomfortable strategy.  However, the body also has ways of cooling itself (such as sweating) that microbes do not, and anyway … a fever is meant to be a very short-term solution.

While any temperature above the normal temperature range is considered a fever, according to the Harvard School of Medicine, there are different levels of fever severity.  For adults, these are:

• Low-grade: 99.1° to 100.4° F (37.3° to 38.0° C);
• Moderate-grade: 100.6° to 102.2° F (38.1° to 39.0° C);
• High-grade: 102.4° to 105.8° F (39.1° to 4°1 C);
• Hyperthermia: Greater than 105.8° (41° C).

Anything above moderate-grade in adults should be considered serious and needs medical attention – especially for those with lupus.

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So, how does the body actually create the fever? 

 Well, as it turns out, it’s almost “all in your head.”  The hypothalamus, a very small organ that sits at the bottom of the brain, is the “body’s thermostat.” It monitors the blood for chemicals called pyrogens (“fever creators”) that are produced by some microbes as well as the body’s tissues when damaged by pathogens.  The most important of these chemicals are ones you may have heard about – prostaglandins, interferons and some interleukins.

Through the very complex interactions of these chemicals, the hypothalamus raises the body’s temperature “set point.”  This in turn causes the body to generate more heat by burning fat, shivering muscles and constricting blood vessels in the skin until this higher set point is reached.

Anything that triggers the immune system to produce systemic inflammation, like lupus, can also cause fevers.

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Lupus and Fevers

Of course, those living with lupus already know what it is like to deal with an immune system that does harm.  Fevers are just another example of this.

 It is estimated that, for lupus patients:

• 60% of fevers are directly caused by SLE.
• 23% are caused by infections, mostly from bacteria.
• 17% are from overlapping conditions or miscellaneous causes.

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Fevers Caused by Lupus

With lupus, the body mistakenly attacks itself by producing antibodies and and inflammatory chemicals like the cytokines, interferons and to fight an infection that does not exist.  The result can trigger a fever.

Fevers are frequently one of the earliest symptoms in a lupus diagnosis.

Fever is often used in measure the severity of lupus in patients.  One example is the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scoring method, which is often used in clinical trials as a way of measuring the effectiveness of medications or other therapies.

As with lupus flares, lupus fevers can be very irregular in how often they occur.  They are unpredictable, but it is also possible to notice how they are triggered.

Fevers seem to be less associated with lupus in older patients. So, after the age of 50, SLE patients should take fevers seriously because they may indicate a more serious underlying condition and organ damage.

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Fevers Associated with Lupus, But Not Caused by Lupus.

Fevers in SLE patients can also be caused by other conditions, such as:

• Vasculitis, the inflammation of blood vessels that can affect between 11% and 36% of lupus patients.
• Sarcoidosis, an inflammatory disease that results in the growth of tiny granulomas in different parts of the body, including the lungs, eyes, skin and heart.
• Rheumatic fever.
• Malignancies, particularly hematological malignancies such as non-Hodgkin’s lymphoma.
• Hormone changes, like hyperthyroidism, when the thyroid produces too much thyroid hormone.
• Drug reactions. For example, corticosteroids, like prednisone, can cause fevers, hot flashes, sweating and other fever-like side effects.
• Infections. Lupus significantly increases a person’s risk for infections – due to both the disease itself as well as the use of immunosuppressant drugs.

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Diagnosis and Treatment of Fevers with Lupus

Diagnosis

As mentioned earlier, recurring fever in lupus patients is common.  However, lupus fever can be tricky to diagnose because there are many other reasons for a person to have an elevated body temperature. The primary diagnostic plan is to rule out every other cause.

Once that is done, lupus fever diagnoses are often confirmed when they are associated with:

• Other lupus symptoms, like rashes, pain, or other signs of flares;
• Lower complement C3 levels, and
• Low white blood cell (WBC) counts. That is because a fever with a high WBC count is often caused by an infection.

Treatments

Lupus fevers are generally treated like most other acute lupus symptoms:

• Nonsteroidal anti-inflammatory drugs (NSAIDs), like aspirin are the most common and easily taken medications for lupus fevers. Please note that the chronic use NSAIDs can increase the risk of kidney damage, so those with lupus nephritis should take great care or avoid their use.  Always ask a healthcare provider before taking NSAIDs!
• Antipyretics (fever reducers), like acetaminophen (Tylenol) are also very common for low- to moderate-level fevers.
• Steroids: Moderate to high doses of steroids, like prednisone are used for fevers.  Of course, they are commonly used to reduce many symptoms of lupus and so can indirectly reduce fevers too.  However, it has been found that heavy doses of steroids may also increase the risk of severe sepsis – ta situation when the body goes into an extreme, life-threatening reaction due to an infection.
• Cooling the head, neck or body with cool towels can also be helpful for short-term, quick relief.

Again, everyone’s lupus and lupus symptoms are unique.  Check with a healthcare provider if you have any questions about a fever or possible treatment options.

 

In Conclusion:

Low-grade, recurring fevers are common for those living with lupus.  Normally, they are easily managed by the same immunosuppressive and anti-inflammatory medications that are taken for other symptoms of SLE.

So, what are the big take-aways?

• Stay on your treatment plan – take your meds!
• Maintain a healthy lifestyle of a good diet and regular exercise.
• Avoid things that may trigger lupus flares in general.
• In particular, avoid injuries and infections!
• Stay up-to-date on any vaccinations that your healthcare provider suggests.
• Let your healthcare provider know if your fever is higher than 102°

Taking these precautions will go a long way in helping you manage both lupus and any fevers that come your way

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References

Balli, S., Shumway, K.R., & Sharan, S. Physiology, (2023, September 4). Physiology, fever. StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK562334/

Rovin, B.H., Tang, Y., Sun, J., Nagaraja, H.N., Hackshaw, K.V., Gray, L., Rice, R., Birmingham, D.J., Yu, C.-Y., Spetie, D.N., Aziz, A., Hebert, L.A. (2005). Clinical significance of fever in the systemic lupus erythematosus patient receiving steroid therapy. Kidney international, 68(2), 747-759. https://doi.org/10.1016/S0085-2538(15)50895-8.

Centers for Disease Control and Prevention (2023, August 24). What is sepsis?  Sepsis. https://www.sciencedirect.com/science/article/pii/S0085253815508958

LeWine, H.E., (2023, May 22). Fever in adults: When to worry. Harvard Health Publishing. https://www.health.harvard.edu/diseases-and-conditions/treating-fever-in-adults#:~:text=While%20any%20temperature%20above%20your,(39.1%20to%2041%20C).

Shoar, N., Shoar, S., Hoseini, S.S., & Layaei, Z.A. (2014). Fever of unknown origin as an onset for late-onset systemic erythematosus. Thrita, 3(1), e7864. https://doi.org/10.5812/thrita.7864

Timlin, H., Syed, A., Haque, U., Adler, B., Law, G., Machireddy, K., & Manno, R. (2018). Fevers in adult lupus patients. Cureus, 10(5), e2098. doi:10.7759/cureus.c12

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Author: Greg Dardis, MS      

Professor Dardis was formerly the Chair of the Science Department at Marylhurst University and is currently an Assistant Professor at Portland State University and the American College of Healthcare Sciences.  His focus has been human biology and physiology with an interest in  autoimmunity.  Professor Dardis is also a former President of the Board of Directors of Kaleidoscope Fighting Lupus.

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