I am a warm-weather girl. I was born and raised at the beach, and in the sun is where I prefer to be (wearing sunscreen and a hat, of course). I was also raised in the South where the inevitable humid days can be sweltering and even a little miserable. Nonetheless, I much prefer the misery of being hot to the misery of being cold and will take a hot, humid day over a cold, bone-chilling one any day of the week. There is only circumstance where my love of all things hot stops short: fevers.
When rheumatoid arthritis first began its assault on me a couple of years ago, one of my most persistent symptoms was feeling flushed and feverish. I remember reading about this after my diagnosis, and the fatigue and fevers were often described as 'feelings of malaise.' This fancy description always evoked romantic images of old movies where the ingÃ©nue lays on her chaise lounge, suffering valiantly from some vague but pitiful disease as her lover declares his undying devotion to her. In reality, my 'feelings of malaise' were unfortunately not as glamorous: they usually struck while I was bent over my computer at work and resulted with me dragging my poor self home in a cab and curling up in old pajamas on the couch by myself. In other words, you can dress up the symptoms of RA with pretty, French words all you want, but underneath, feeling crappy is just that.
Often, these fevers behaved like phantoms. They would come and go at their own whim and were impossible to pin down with a thermometer, yet they seemed to be always there, hanging around ready to swoop in at any moment and make me feel even worse than I already did. Now, that my RA is mostly under control, they are typically an arbiter of an approaching flare, so as soon as I feel the telltale hot rush in my cheeks and forehead, I know that the fatigue and pain are likely not far behind.
That is, unless it's not a flare coming on, but a cold or infection. Since the medications I take work by suppressing my immune system, these fevers are one of the most confusing symptoms to deal with. Is my RA acting up, or am I starting to get sick? Or is it both? It's nearly impossible to know.
A few months ago, I was feeling really rundown and tired and not altogether great. I started feeling feverish off and on, and figured my RA was letting me know who was boss. But then my glands became a little swollen, so I worried I was getting sick instead with a cold. I emailed my medical super squad to see what I should do and was told to come in that afternoon.
I felt feverish all morning long, despite the NSAID's I had taken. But as soon as I got to my rheumatologists office, the fever suddenly vanished. When the nurse took my vitals, my temperature was only about 98 degrees. I went back to see my rheumatologist, and when he came in, we went over all my symptoms. I described how I'd been feeling feverish off and on for a few days, and now all these other symptoms had begun. As we were talking, I suddenly felt my cheeks feeling flush again. It was almost as if someone was turning my internal thermostat up on high as we spoke. The nurse came and took my temperature again, and sure enough, it registered a small fever.
I asked my rheumatologist what he thought was causing the fevers- my RA, or the probable infection. Unfortunately, there really wasn't a way to know for sure, which always feels frustrating. I left the doctor's office with a prescription for some antibiotics, and instructions for lots of liquids and rest. I also had orders to skip my shots for the next week to make sure the infection cleared up as quickly as possible. Unfortunately, the downside of skipping my shots meant that my RA would not be held at bay as effectively, and since it was possible the fevers were the product of my faulty immune system rather than the cold, they might very well continue.
Saying you feel feverish, or are experiencing 'feelings of malaise' doesn't sound so bad, but the truth is that trying to get through the day when your head feels like it is on fire every ten minutes is pretty miserable.
I'm happy to report that once I got back on my shots, the fevers subsided and haven't swooped down again since (knock on wood). I'm hoping that as the weather heats up, the only fever I'll experience will be one in anticipation of longer days and sunshine.
Sara is the author of the blog The Single Gal's Guide to Rheumatoid Arthritis.