Rheumatic disorders among patients with fever of unknown origin: A systematic review and meta-analysis

Betrains, Albrecht; Moreel, Lien; Langhe, E. De; Blockmans, Daniel Engelbert; Vanderschueren, Steven

doi:10.1016/j.semarthrit.2022.152066

Cited by 14 publications

(8 citation statements)

References 67 publications

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“…In approximately half of the cases an infectious cause is nally found; other causes are primarily in ammatory, malignant and nonin ammatory diseases. A systematic review and meta-analysis included 16884 patients with FUO, the research showed that rheumatic disease is a common cause of FUO, adultonset Still's disease(AOSD), giant cell arteritis(GCA), and systemic lupus erythematosus(SLE) were the most frequent disorders [4].In this study, AOSD, SLE, and undifferentiated connective tissue disease(UCTD) were the most frequent disorders in non-infectious in ammatory disease.…”

Section: Discussionmentioning

confidence: 76%

Analysis of Clinical Features of Non-infectious Inflammatory Fever

LI,

TIAN,

ZHOU

et al. 2023

Preprint

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Background Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. It is defined as temperature ≥ 37.8 ° C on several occasions, lasting ≥ three weeks, in the absence of diagnosis after three days of hospital investigation or 3 outpatient visits. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. At present, the clinical characteristics of non-infectious inflammatory diseases are less well described, the aim of this study is to analysis the features of non-infectious inflammatory diseases, more efficient differential diagnosis of FUO. Methods A total of 444 patients with non-infectious inflammatory fever were retrospectively studied, and another 133 patients with infectious fever act as control group, to analysis the clinical features of non-infectious inflammatory fever. Results The pathogenesis (212.47 ± 38.40 vs 105.52 ± 37.58) days of non-infectious inflammatory fever were longer than infectious fever(p < 0.05), and the levels of white blood cells (8.80 ± 0.27 vs 7.02 ± 0.32) x109/L, neutrophils (6.78 ± 0.25 vs 4.80 ± 0.24) x109/L, platelets (277.85 ± 6.23 vs 241.50 ± 8.47) x109/L, erythrocyte sedimentation rate (73.08 ± 1.65 vs 54.90 ± 3.23)mm/h, lactate dehydrogenase (311.29 ± 13.21 vs 248.21 ± 12.56)U/L, alpha-hydroxybutyrate dehydrogenase (233.94 ± 9.02 vs 188.35 ± 8.70)U/L, and ferritin (1008.37 ± 117.18 vs 509.38 ± 49.18) µg/L were increased obviously in non-infectious inflammatory fever group patients(p < 0.05), but the levels of red blood cells (3.63 ± 0.03 vs 6.28 ± 2.37) x1012/L, hemoglobin (101.98 ± 0.86 vs 113.90 ± 1.95) g/L, lymphocytes (1.35 ± 0.03 vs 1.55 ± 0.14) x109/L, and lymphocyte to C-reactive protein ratio (0.20 ± 0.04 vs 0.52 ± 0.17) were dropped (p < 0.05), and the positive rate of anti-nuclear antibodies(54.95% vs 30.08%), anti-RNP/Sm antibodies(14.19% vs 0.75%), anti-ds-DNA antibodies(8.33% vs 0%), anti-Sm antibodies(14.41% vs 0%), anti-nucleosome antibodies(8.56% vs 0%), anti-histone antibodies(4.73% vs 0%), anti-ribosomal P protein antibodies(6.98% vs 0%), anti-SSA antibodies(20.04% vs 5.26%), anti-SSB antibodies(6.76% vs 1.50%), and anti-Ro-52 antibodies(17.57% vs 3.76%) in non-infectious inflammatory fever patients were higher than infectious fever patients (p < 0.05), the concomitant symptoms of feeble(18.92% vs 11.28%), arthralgia(33.78% vs 21.05%), skin rash(11.71% vs 4.51%), and lower limb edema(4.73% vs 0%) were higher incidence in non-infectious inflammatory fever patients(p < 0.05), but the headache(4.28% vs 13.53%) was lower incidence in non-infectious inflammatory fever patients(p < 0.05), the incidence of pericardial effusion(15.54% vs 5.26%) was higher in non-infectious inflammatory fever patients(p < 0.05), but the incidence of pleural effusion(0.45% vs 8.27%) was lower in non-infectious inflammatory fever patients(p < 0.05). Conclusion The patients of non-infectious inflammatory fever have longer pathogenesis, and the levels of white blood cells, neutrophils, platelets, erythrocyte sedimentation rate, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, and ferritin were increased, the levels of red blood cells, hemoglobin, lymphocytes, and lymphocyte to C-reactive protein ratio were dropped, many autoantibodies were included, and the incidence of feeble, arthralgia, skin rash, lower limb edema, and pericardial effusion were higher, but the incidence of headache and pleural effusion were lower.

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Section: Discussionmentioning

confidence: 76%

Analysis of Clinical Features of Non-infectious Inflammatory Fever

LI,

TIAN,

ZHOU

et al. 2023

Preprint

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show abstract

“…In approximately half of the cases an infectious cause is finally found; other causes are primarily inflammatory, malignant and noninflammatory diseases. A systematic review and meta-analysis included 16884 patients with FUO, the research showed that rheumatic disease is a common cause of FUO, adultonset Still's disease(AOSD), giant cell arteritis(GCA), and systemic lupus erythematosus(SLE) were the most frequent disorders [4].In this study, AOSD, SLE, and undifferentiated connective tissue disease(UCTD) were the most frequent disorders in non-infectious inflammatory disease.…”

Section: Discussionmentioning

confidence: 77%

“…Autoantibodies have been identified as a symbol of autoimmune disorders and are frequently considered a clinical marker of these disorders [21]. Study showed that AOSD, GCA, and SLE are a common cause of FUO [4], SLE is an autoimmune disease characterized by multiple organ inflammatory damage and wide spectrum of autoantibodies. The autoantibodies, especially anti-dsDNA and anti-Sm autoantibodies are highly specific to SLE, and participate in the immune complex formation and inflammatory damage on multiple end-organs such as kidney, skin, and central nervous system (CNS) [22].…”

Section: Financial Support and Sponsorshipmentioning

confidence: 99%

Analysis of Clinical Features of Non-infectious Inflammatory Fever

LI,

LIAN,

ZHANG

et al. 2024

Preprint

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Background: Fever of undetermined origin (FUO) is a challenging entity with a striking presence in hospitals around the world. The main etiologies are infectious, neoplastic, and non-infectious inflammatory diseases. At present, the clinical characteristics of non-infectious inflammatory diseases are less well described, the aim of this study is to analysis the features of non-infectious inflammatory diseases, more efficient differential diagnosis of FUO. Methods: A total of 444 patients with non-infectious inflammatory fever were retrospectively studied, and another 133 patients with infectious fever act as control group, to analysis the clinical features of non-infectious inflammatory fever. Results: The pathogenesis of non-infectious inflammatory fever were longer than infectious fever, and the levels of WBC, NEU, PLT, ESR, LDH, α-HBDH, and FRT were increased obviously in non-infectious inflammatory fever group, but the levels of RBC, HGB, LMY, and LCR were dropped, and the positive rate of anti-nuclear antibodies, anti-RNP/Sm, anti-ds-DNA, anti-Sm, anti-nucleosome, anti-histone, anti-ribosomal P protein, anti-SSA, anti-SSB, and anti-Ro-52 antibodies in non-infectious inflammatory fever patients were higher than infectious fever, the concomitant symptoms of feeble, arthralgia, skin rash, and lower limb edema were higher incidence in non-infectious inflammatory fever, but the headache was lower incidence in non-infectious inflammatory fever, the incidence of pericardial effusion was higher in non-infectious inflammatory fever, but the incidence of pleural effusion was lower in non-infectious inflammatory fever. Conclusion: The patients of non-infectious inflammatory fever have longer pathogenesis, and the levels of white blood cells, neutrophils, platelets, erythrocyte sedimentation rate, lactate dehydrogenase, alpha-hydroxybutyrate dehydrogenase, and ferritin were increased, the levels of red blood cells, hemoglobin, lymphocytes, and lymphocyte to C-reactive protein ratio were dropped, many autoantibodies were included, and the incidence of feeble, arthralgia, skin rash, lower limb edema, and pericardial effusion were higher, but the incidence of headache and pleural effusion were lower.

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“…3,4 Diagnosis of an NIID is more likely with longer duration of fever/inflammation and the presence of IUO. 5 The clinical significance of patients presenting with recurrent low-grade temperatures (≤38.2°C) without evidence of inflammation is unclear and how they should be approached is an issue for clinicians. One suggestion is to avoid extensive investigation in this group -in the absence of any potential diagnostic clues, symptoms or signs suggestive of significant systemic illness, only a complete blood count, inflammatory markers, and urinalysis are suggested, although our practice is to exclude connective tissue disease too.…”

Section: Periodic Inflammationmentioning

confidence: 99%

“…19 The most common NIID diagnoses for IUO are: adult-onset Still' disease (AOSD) (20%), large vessel vasculitis (10%), systemic lupus erythematosus (10%), anti-neutrophil cytoplasm antibody (ANCA)-associated vasculitis (7%), and polymyalgia rheumatica (7%). 5 An index of suspicion must be maintained for atypical infections and for uncommon presentations of the more common NIIDs, such as occult inflammatory bowel diseases and sacroiliitis.…”

Section: High-value Non-said Diagnosesmentioning

confidence: 99%

Clinical Approach to Periodic Inflammation of Unknown Origin in Adults, with a Focus on the Diagnosis of Systemic Autoinflammatory Diseases

Caterson,

Lachmann

2024

touchREVIEWS in RMD

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In most of these unknown cases, it's not that I'm completely lost. I know in a general sense that there is an inflammatory disease present. I know that there doesn't appear to be cancer in the background, or infection. I have a lengthy list of conditions that the patient does not have. But one of my most difficult tasks when I sit down with a patient at a follow-visit is to take a deep breath, adjust my glasses and admit that I don't know what's wrong." Charles Radis. The rheumatologist as detective. The Rheumatologist, 1 Feb 2015. Patients with periodic inflammation who remain undiagnosed after initial rational and targeted investigation pose a clinical conundrum. This editorial presents an approach to these cases and focuses on the recognition and diagnosis of systemic autoinflammatory diseases (SAIDs). This approach utilises genetic testing for SAIDs, recognising the presentations of non-genetic SAIDs, and empiric trials of therapy in suspected inflammatory disease. Ultimately, not achieving a final diagnosis is very common and the clinician's role is to help manage the uncertainty around this through support, follow-up and reassurance. This editorial outlines a clinical approach to patients with periodic inflammation of unknown origin despite initial rational and targeted investigation. The focus of the editorial is on the recognition and diagnosis of systemic autoinflammatory diseases (SAIDs). Although rare, SAIDs are valuable diagnoses given they carry a risk of disease-associated damage and are often treatable. The authors are from a subspecialty clinic in London, UK, which is the national referral centre for adult SAIDs. The basis of this approach is both a review of the literature and our experience from our fever clinic to which patients are referred for the consideration of a SAID diagnosis in the setting of periodic fever and inflammation.

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Rheumatic disorders among patients with fever of unknown origin: A systematic review and meta-analysis

Cited by 14 publications

References 67 publications

Analysis of Clinical Features of Non-infectious Inflammatory Fever

Analysis of Clinical Features of Non-infectious Inflammatory Fever

Analysis of Clinical Features of Non-infectious Inflammatory Fever

Clinical Approach to Periodic Inflammation of Unknown Origin in Adults, with a Focus on the Diagnosis of Systemic Autoinflammatory Diseases

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