Fevers and Lupus

Fevers are a common symptom of lupus flares but can also be a symptom of infections.

Systemic lupus erythematosus (SLE) has many different symptoms. This is because Inflammation effects all of the parts of the body, from the joints, to the nervous system, to metabolism, leading to weight gain, pain, fatigue, and many other problems. One of the most common symptoms of SLE-related inflammation is fever, occurring in 35-86% of patients. In fact, lupus-related fevers are often one of the first symptoms of lupus. When it occurs alongside joint pain and malar rash, however, it forms the “classic triad” and may encourage further testing and diagnosis of SLE or other autoimmune diseases.

What is a Fever?

The body has many methods to fight off infection, and fevers are one of them. In response to inflammation, such as to a bacteria or virus, the body signals the hypothalamus, the organ that regulates many bodily functions, to heat up and try to ‘cook’ them out. This works because humans can survive heating up a range of temperatures above the normal 98.5 degrees for a short time with some discomfort. Many bacteria, viruses, and parasites cannot survive this overheating.

However, lupus is an autoimmune disease, and it can trigger inflammation responses, including recurring low-grade fevers, which are below 101 degrees. Flares can last from 2-6 days, can even linger for weeks, and this correlates to the fever symptom. They are not life threatening, but they are exhausting and, often, include headaches and can last for weeks at a time.

Other illnesses that are likely to occur alongside lupus, such as sarcoidosis, vasculitis, other autoinflammatory disorders, and rheumatism can trigger fevers. Some medications also might have low-grade fever as a potential side effect.

Low-grade fevers have the following symptoms:

• Warm, flushed skin
• Chills or shivering
• Sweating
• Muscle Aches
• Headaches
• Difficulty focusing

Sometimes, people with lupus have trouble regulating their body temperature in hot weather, experiencing symptoms like hot flashes, and sweats. In some cases, the thyroid, an important organ involved in metabolism regulation, can be effected by lupus and lead to overheating, as well as fatigue, muscle weakness, hair loss, or dryness of the eyes and mouth. The onset of menopause can also cause hot flashes, which is significant because many people with lupus are women. These are, however, different from lupus-related fevers.

There are also lupus headaches and migraines that are not related to fevers, and feel different from febrile (fever-related) headaches.

Diagnosing with Lupus Fevers

A “fever of unknown origin” is a catch-all term for low-grade fevers that do not have a known cause and last for a significant amount of time. Lupus fevers are often not diagnosed for a while because doctors try to rule out other causes first, even if the person is known to have lupus. This is because people with lupus are more vulnerable to infections that trigger fevers due to their lupus and immunosuppressive medications. and it is important to catch these as soon as possible, even though 60% of these fevers are likely to be lupus related. You can read more about infections and lupus, here.

The intensity of lupus-related fevers, and the flare triggers that cause them, can vary widely from person to person, which also make it difficult to diagnose fever symptoms quickly.

Treating Lupus Fevers

For the most part, lupus-related fevers should be treated like any other fever :

• Cold compresses or ice packs, to lower temperature
• Lots of water to avoid dehydration
• Rest, to overcome fatigue
• General self-care (eating right, sleeping right, and hygiene)

NSAIDs (naproxen, ibuprofen, acetaminorphin,) and steroid medications are very effective at controlling fevers and easing some of their uncomfortable symptoms. Antimalarial drugs , a common type of lupus medication, are also effective, as they reduce inflammation, which reduces fever. You can read more about lupus medications here.

In short, for the most part, fevers are unpleasant, but do not require too much special care and will go away on their own.

However, if the fever persists or gets into the higher temperature range (such as 101 degrees,) it is important to get a checkup to make sure it is not a potentially life-threatening infection. A doctor should be contacted at 104 degrees, if it is accompanied by a worsening cough, severe muscle pain, or feelings of disorientation.