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학습 자료 둘러보기 →In a patient with an acute RA exacerbation, a fever >100.4°F (38°C) combined with a significantly elevated ESR (e.g., 85 mm/hr) is a critical red flag. This presentation must be treated as suspected systemic infection until proven otherwise, not simply a disease flare.
The primary concern is septic arthritis or another severe infection. Patients on DMARDs or biologics are immunocompromised and may not mount a typical immune response, making fever a paramount sign. Immediate interventions include obtaining blood cultures, a thorough infectious workup, and prompt notification of the provider.
Do not attribute a high fever solely to RA disease activity without ruling out infection. Delaying antimicrobial therapy in an immunocompromised patient can lead to rapid clinical deterioration and sepsis.
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