Department of Rheumatology, The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Wuxi, 214023, Jiangsu, China.
Adv Rheumatol. 2023 Jul 13;63(1):31. doi: 10.1186/s42358-023-00313-3.
Fever is a common symptom of Idiopathic inflammatory myopathies (IIM). However, the exact correlation between fever and the prognosis of IIM is still unclear. This study aims to clarify if the IIM patients initiated with fever are associated with poorer outcomes.
This was a single-center retrospective cohort study. Data were collected from 79 newly diagnosed, treatment-naive IIM patients in the Affiliated Wuxi People's Hospital of Nanjing Medical University (Wuxi, Jiangsu, China) from November 2016 to June 2020. According to the presence or absence of fever at the onset, the IIM patients were divided into two groups(fever group n = 28, without fever group n = 51) Clinical characteristics, laboratory data, treatment, and outcomes were recorded. The Kaplan-Meier and log-rank tests were used to compare the all-cause mortality, relapse rate, and acute exacerbation of interstitial lung disease (AE-ILD) incidence. The association of fever with the outcomes was assessed in the unadjusted and adjusted forward logistic regression model.
Compared with the non-fever group, the age at onset of the fever group was higher, and mechanic's hands (MH) and interstitial lung disease (ILD) were more common. Systemic inflammation (CRP and ESR) was significantly higher in the fever group, while the level of albumin(ALB) and muscle enzymes were lower. The fever group seemed to be received more aggressive treatment, with higher dose glucocorticoids and higher rates of intravenous immunoglobulins(IVIG) use. The all-cause mortality rate and the incidence rate of AE-ILD were higher in the fever group. Even adjusted for the age at onset and treatments, fever was significantly associated with AE-ILD and all-cause mortality.
Our study has demonstrated that fever at initial diagnosis is associated with AE-ILD and mortality. Fever should serve as an early clinical warning sign for poor outcomes in IIM patients.
发热是特发性炎性肌病（IIM）的常见症状。然而，发热与 IIM 预后的确切相关性尚不清楚。本研究旨在阐明首发时发热的 IIM 患者是否与预后不良相关。
这是一项单中心回顾性队列研究。研究数据来自 2016 年 11 月至 2020 年 6 月期间在南京医科大学附属无锡人民医院（江苏无锡）新诊断、未经治疗的 79 例特发性炎性肌病患者。根据首发时是否发热，将 IIM 患者分为两组（发热组 n=28 例，无发热组 n=51 例）。记录临床特征、实验室数据、治疗和结局。采用 Kaplan-Meier 和 log-rank 检验比较全因死亡率、复发率和间质性肺病急性加重（AE-ILD）发生率。采用未经调整和向前逐步逻辑回归模型评估发热与结局的关系。
与无发热组相比，发热组的发病年龄更高，手呈畸形（MH）和间质性肺病（ILD）更常见。发热组的全身炎症（CRP 和 ESR）明显升高，而白蛋白（ALB）和肌肉酶水平较低。发热组似乎接受了更积极的治疗，糖皮质激素剂量更高，静脉注射免疫球蛋白（IVIG）使用率更高。发热组的全因死亡率和 AE-ILD 发生率更高。即使调整了发病年龄和治疗方法，发热与 AE-ILD 和全因死亡率显著相关。
本研究表明，初诊时发热与 AE-ILD 和死亡率相关。发热应作为 IIM 患者预后不良的早期临床预警信号。
