Clinical significance of fever in the systemic lupus erythematosus patient receiving steroid therapy.
BACKGROUND
Active systemic lupus erythematosus (SLE) can cause fever. Steroids (glucocorticoids) suppress SLE fever; however, the extent to which steroid therapy affects SLE fever not previously been rigorously studied.


METHODS
Study A is a prospective study of recurrently active SLE patients (N= 92, 60 renal SLE and 32 nonrenal SLE) who recorded daily oral evening temperatures while participating in a longitudinal study of risk factors for SLE flare. Study B is a retrospective study of consecutive febrile SLE patients (N= 22) who received steroids initially because SLE was suspected. At final analysis 11 had SLE fever and 11 had infection fever.


RESULTS
In study A during a mean follow-up of 13.2 +/- 8.1 months, 51 of the 92 patients experienced 73 SLE flares. In only one patient was SLE fever associated with SLE flare. In the other 50 patients who flared, there was no significant trend to develop fever prior to or at the onset of SLE flare. Prednisone, median dose 10 mg, was being received at 82% of the study visits at which an SLE flare was declared. In study B, prednisone 28 mg (range 20 to 40 mg) completely suppressed SLE fever, usually within 24 hours. In contrast, infection fever persisted despite prednisone 35 to 300 mg/day. Of those with infection fever, three developed fatal sepsis when high-dose steroid therapy was continued.


CONCLUSIONS
In SLE patients receiving prednisone at maintenance doses or greater, SLE fever is rare. When fever does develop, it is usually due to infection. Continuing high steroid dose steroid therapy in those with infection fever may increase the risk of severe sepsis.
Rovin
Brad H
BH
Department of Internal Medicine, The Ohio State University, Columbus, Ohio 43210, USA.
Tang
Yuxiao
Y
Sun
Junfeng
J
Nagaraja
Haikady N
HN
Hackshaw
Kevin V
KV
Gray
Linda
L
Rice
Robert
R
Birmingham
Daniel J
DJ
Yu
Chack-Yung
CY
Spetie
Dan N
DN
Aziz
Amy
A
Hebert
Lee A
LA
D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000188:drug therapy* / Q000453:epidemiology*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors
D005938:Glucocorticoids; D011239:Prednisolone