Fever as an initial manifestation of spondyloarthritis: A retrospective study.
<h4>Objectives</h4>We aimed to evaluate a wide spectrum of clinical features of adult patients with spondyloarthritis (SpA) whose initial manifestation was fever, using the Assessment of SpondyloArthritis international Society (ASAS) classification criteria.<h4>Methods</h4>We...
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Public Library of Science (PLoS)
2017-01-01
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| author | Se Jin Byun William Han Bae Seung Min Jung Sang-Won Lee Yong-Beom Park Jason Jungsik Song |
| author_facet | Se Jin Byun William Han Bae Seung Min Jung Sang-Won Lee Yong-Beom Park Jason Jungsik Song |
| author_sort | Se Jin Byun |
| collection | DOAJ |
| description | <h4>Objectives</h4>We aimed to evaluate a wide spectrum of clinical features of adult patients with spondyloarthritis (SpA) whose initial manifestation was fever, using the Assessment of SpondyloArthritis international Society (ASAS) classification criteria.<h4>Methods</h4>We retrospectively collected the electronic medical records of hospitalized SpA patients who initially presented to the Severance Hospital (Seoul, Korea) with fever from January 2010 to May 2016. As a control group, we also recruited one-hundred consecutive patients who were diagnosed with SpA in our outpatient clinic. Clinical features and laboratory findings were compared in two patient groups.<h4>Results</h4>There were 26 patients who had fever as initial presentation of SpA (reactive arthritis 50%, undifferentiated SpA 26.9%, ankylosing spondylitis 15.4%, enteropathic arthritis 3.8%, psoriatic arthritis 3.8%). Peripheral SpA was more common in febrile SpA patients than in control SpA patients (65.4% vs 24.0%, p<0.001). Febrile SpA patients were less frequently HLA-B27 positive than control SpA patients (52.2% vs 77.0%, p<0.05). At baseline, systemic inflammatory markers were significantly higher in the febrile SpA patients (white blood cell count, 11.57 vs 7.81 cells/μL, p<0.001; erythrocyte sedimentation rate, 69.2 vs 41.0 mm/h, p<0.001; C-reactive protein, 109.6 vs 15.3 mg/L, p<0.001). The proportion of patients treated with systemic steroids was significantly higher in febrile SpA patients (57.7% vs. 11.0%, p<0.001). The proportion of patients who visited rheumatology specialty was significantly lower in febrile SpA patients than in control SpA patients (7.7% vs 59.0%, p<0.001).<h4>Conclusion</h4>Various subgroups of SpA can be presented with fever as an initial manifestation. Febrile SpA patients demonstrated higher systemic inflammation and a lower chance to visit rheumatology in early stage. When evaluating febrile patients with any clinical features of SpA, clinicians are advised to consider performing SpA-focused evaluation including HLA-B27 or a simple sacroiliac joint radiograph. |
| format | Article |
| id | doaj-art-3ecc3547cb9c43fea1bbeb42ae7c3a8a |
| institution | DOAJ |
| issn | 1932-6203 |
| language | English |
| publishDate | 2017-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-3ecc3547cb9c43fea1bbeb42ae7c3a8a2025-08-20T02:46:01ZengPublic Library of Science (PLoS)PLoS ONE1932-62032017-01-01129e018432310.1371/journal.pone.0184323Fever as an initial manifestation of spondyloarthritis: A retrospective study.Se Jin ByunWilliam Han BaeSeung Min JungSang-Won LeeYong-Beom ParkJason Jungsik Song<h4>Objectives</h4>We aimed to evaluate a wide spectrum of clinical features of adult patients with spondyloarthritis (SpA) whose initial manifestation was fever, using the Assessment of SpondyloArthritis international Society (ASAS) classification criteria.<h4>Methods</h4>We retrospectively collected the electronic medical records of hospitalized SpA patients who initially presented to the Severance Hospital (Seoul, Korea) with fever from January 2010 to May 2016. As a control group, we also recruited one-hundred consecutive patients who were diagnosed with SpA in our outpatient clinic. Clinical features and laboratory findings were compared in two patient groups.<h4>Results</h4>There were 26 patients who had fever as initial presentation of SpA (reactive arthritis 50%, undifferentiated SpA 26.9%, ankylosing spondylitis 15.4%, enteropathic arthritis 3.8%, psoriatic arthritis 3.8%). Peripheral SpA was more common in febrile SpA patients than in control SpA patients (65.4% vs 24.0%, p<0.001). Febrile SpA patients were less frequently HLA-B27 positive than control SpA patients (52.2% vs 77.0%, p<0.05). At baseline, systemic inflammatory markers were significantly higher in the febrile SpA patients (white blood cell count, 11.57 vs 7.81 cells/μL, p<0.001; erythrocyte sedimentation rate, 69.2 vs 41.0 mm/h, p<0.001; C-reactive protein, 109.6 vs 15.3 mg/L, p<0.001). The proportion of patients treated with systemic steroids was significantly higher in febrile SpA patients (57.7% vs. 11.0%, p<0.001). The proportion of patients who visited rheumatology specialty was significantly lower in febrile SpA patients than in control SpA patients (7.7% vs 59.0%, p<0.001).<h4>Conclusion</h4>Various subgroups of SpA can be presented with fever as an initial manifestation. Febrile SpA patients demonstrated higher systemic inflammation and a lower chance to visit rheumatology in early stage. When evaluating febrile patients with any clinical features of SpA, clinicians are advised to consider performing SpA-focused evaluation including HLA-B27 or a simple sacroiliac joint radiograph.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184323&type=printable |
| spellingShingle | Se Jin Byun William Han Bae Seung Min Jung Sang-Won Lee Yong-Beom Park Jason Jungsik Song Fever as an initial manifestation of spondyloarthritis: A retrospective study. PLoS ONE |
| title | Fever as an initial manifestation of spondyloarthritis: A retrospective study. |
| title_full | Fever as an initial manifestation of spondyloarthritis: A retrospective study. |
| title_fullStr | Fever as an initial manifestation of spondyloarthritis: A retrospective study. |
| title_full_unstemmed | Fever as an initial manifestation of spondyloarthritis: A retrospective study. |
| title_short | Fever as an initial manifestation of spondyloarthritis: A retrospective study. |
| title_sort | fever as an initial manifestation of spondyloarthritis a retrospective study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0184323&type=printable |
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