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Rheumatology & Autoimmune

Fever or Infection Signs During Rheumatoid Arthritis Treatment: Why to Call Early

24 min read
Fever or Infection Signs During Rheumatoid Arthritis Treatment: Why to Call Early

Key Takeaways

  • In untreated RA a low fever often reflects the disease itself, but during immune-suppressing treatment a fever should be assumed to signal infection until the care team says otherwise.
  • Corticosteroids, interleukin-6-blocking biologics and older age can each hold temperature and inflammatory markers down while an infection advances, so feeling unwell counts even when the thermometer reads normal.
  • RA usually affects joints in symmetrical pairs, so a single joint that is far hotter and more painful than its partner is a red flag for septic arthritis, a medical emergency.
  • MedlinePlus defines fever as 100.4°F (38°C) or higher and advises adults to seek care if it lasts beyond 48 to 72 hours or reaches 103°F, but rheumatology teams typically ask to hear about any fever the same day.
  • Many teams ask patients to hold a scheduled immune-suppressing dose during active infection, yet corticosteroids can be dangerous to stop abruptly, which is why pausing any medicine needs a clinician's instruction.
  • Inactivated vaccines, intact skin, prompt dental care, careful food handling and pre-treatment screening for latent tuberculosis and hepatitis B are the prevention measures most consistently recommended for people on RA treatment.
Quick Answer

A fever or any sign of infection during rheumatoid arthritis treatment deserves a same-day call to your rheumatology team, even when it feels minor. Many RA medicines dampen the immune system and can blunt the body's usual warning signs, so a temperature of 100.4°F (38°C) or higher, chills, a single hot joint, or suddenly feeling unwell may point to infection rather than a flare. Your team decides on tests and whether to pause medicine.

It is a little past two in the morning. The thermometer on the bathroom counter reads 100.6°F, the left knee has been aching since dinner, and tomorrow is injection day. Nothing about this feels dramatic. It feels like the start of an ordinary cold, or maybe a flare after a long week. The question that keeps a person awake is quieter than any of the symptoms: is this worth bothering anyone about?

For someone with rheumatoid arthritis, a fever or infection during treatment is not the same event it is for a neighbor without the disease. The medicines that keep joints from being destroyed also turn down the immune system’s volume. That trade is worth making. It just means the usual rules for waiting out a temperature no longer apply.

This explainer walks through what the evidence actually says about fevers in RA, how treatment changes the picture, and why the safest habit is to call early and let the treating team sort it out.

Is it normal to run a fever with rheumatoid arthritis?

Rheumatoid arthritis is an autoimmune disease, meaning the immune system mistakenly attacks the body’s own tissues, most visibly the lining of the joints. That misdirected attack releases the same chemical messengers the body uses to fight infection, and those messengers can nudge the body’s thermostat upward. Fever, fatigue and loss of appetite sit alongside joint pain on the symptom lists published by major medical centers, including the Mayo Clinic and the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

So yes, a modest rise in temperature can be part of RA itself, usually during periods when the disease is active. In practice it tends to be a low, grumbling warmth rather than a shaking chill, and it tends to travel with the joints: when several joints are stiff and swollen for hours in the morning, a slightly elevated reading fits the pattern.

The catch is the word “normal.” Fever is common enough in RA that many people learn to shrug it off, and that instinct is exactly what treatment changes. Once a person is taking a disease-modifying medicine, the immune system that used to run hot is being deliberately cooled. A fever in that setting carries a different weight, because the most likely alternative explanation, infection, is now both more probable and harder to see.

Clinicians often describe the tension this way: in untreated RA, fever mostly reflects the disease; in treated RA, fever has to be assumed to reflect something else until proven otherwise. That shift in the default assumption is the single most useful thing to carry away from this article.

Why fever and infection during rheumatoid arthritis treatment need a different rulebook

A healthy immune system responds to a bacterial invader with a well-rehearsed sequence. White blood cells rush to the site, chemical signals called cytokines flood the bloodstream, the brain raises body temperature, and the person feels wretched enough to lie down. Every one of those steps is also a signal to the outside world that something is wrong. Fever, redness, pus and pain are the body’s way of asking for help.

Doctor consulting with older female patient in clinic: Why fever and infection during rheumatoid arthritis treatment need a

RA treatment works by interrupting parts of that sequence. Conventional disease-modifying antirheumatic drugs, often shortened to DMARDs, slow the activity of immune cells broadly. Biologic medicines block specific cytokines or cell types. Targeted synthetic medicines such as JAK inhibitors interfere with the signaling pathways inside immune cells. Corticosteroids suppress inflammation across the board. The NHS notes that increased susceptibility to infection is a recognized side effect across these treatment classes.

Here is the consequence people rarely hear stated plainly. The same medicine that stops the immune system from inflaming a joint can also stop it from inflaming a chest infection loudly enough to notice. A person may have pneumonia with only mild breathlessness and a temperature that barely moves. A skin infection may spread with less redness than expected. The alarm is not broken, but the volume knob has been turned down.

That is why rheumatology teams typically ask patients on these medicines to report a fever or infection during rheumatoid arthritis treatment promptly rather than waiting to see how it develops. The waiting period that makes sense for a healthy adult is time an infection can use to gain ground in someone whose defenses are deliberately dampened. Calling early is not overcaution. It is the rulebook that matches the medicine.

RA flare vs infection: what are the symptoms of an RA flare?

A flare is a period when RA activity climbs after a stretch of relative calm. Most people who have lived with the disease for a while recognize their own version. The Mayo Clinic describes the core features: tender, warm, swollen joints, stiffness that is worse in the morning or after sitting still, fatigue, and sometimes low-grade fever or loss of appetite. Flares typically involve joints on both sides of the body, small joints of the hands and feet first, and they often build over a day or two rather than arriving in an hour.

Infection tends to break that pattern in ways that are worth noticing, though never worth diagnosing alone. A fever that climbs higher than a person’s usual flare temperature, shaking chills, sweats that soak the sheets, a cough producing colored sputum, pain or burning when passing urine, a wound that is spreading or oozing, or one joint that is far hotter and more painful than the rest all sit outside the usual flare script.

Symmetry is one of the more useful clues clinicians weigh. RA likes pairs: both wrists, both knees, matching knuckles. An infection inside a joint, by contrast, almost always picks one. A single joint that is dramatically worse than its partner should never be filed under “flare” without a clinician’s opinion.

The honest limitation is that these patterns overlap. Flares can feel feverish and infections can make every joint ache. People on immune-dampening medicines may have infections with softer versions of all these signs. The comparison is a starting point for a conversation with the care team, not a decision tree to run at the kitchen table. When the picture is unclear, the team would rather hear about a flare that turns out to be a flare than miss an infection that looked like one.

Can rheumatoid arthritis get infected? Septic arthritis explained

The joint itself can become infected, and this is the scenario rheumatologists worry about most when a patient describes a single hot joint. Septic arthritis means bacteria have entered the joint space, usually carried through the bloodstream from somewhere else, such as a skin break, a urinary infection or a dental abscess. A joint already damaged and inflamed by RA offers those bacteria an easier foothold than a healthy one, and immune-dampening treatment lowers the resistance further.

Healthcare provider consulting elderly patient about knee pain: Can rheumatoid arthritis get infected? Septic arthritis expl

What makes septic arthritis dangerous is speed. Bacteria multiplying inside a closed joint can begin damaging cartilage within days, and the infection can spill back into the bloodstream. Cleveland Clinic and other major centers treat it as a medical emergency requiring urgent assessment, which typically includes drawing fluid from the joint with a needle so it can be examined and cultured.

The classic presentation is one joint, most often a large one such as the knee, hip or shoulder, that becomes intensely painful, hot, swollen and nearly impossible to move or bear weight on, usually with fever. In a person with RA, though, the classic picture can be muted. The joint may already be swollen from disease, the fever may be suppressed by medicine, and the person may reasonably assume it is the worst flare they have had.

Two features should override that assumption. First, a joint that is wildly out of proportion to the others, when RA usually keeps things roughly symmetrical. Second, a joint that is getting rapidly worse over hours rather than settling as flares often do with rest. Either one, with or without a measurable temperature, is a reason to be seen the same day rather than to wait for the next scheduled appointment.

Prosthetic joints deserve a special mention. Many people with long-standing RA have had a hip or knee replaced, and an infection around an implant is both harder to clear and easier to miss. New pain, warmth or drainage near a replaced joint belongs on the urgent list.

How RA medicines quiet the body's alarm system, and sometimes silence it

Each treatment class alters the warning signs in its own way, and knowing the mechanism helps explain why teams ask specific questions on the phone.

Conventional DMARDs, the oldest group, act on rapidly dividing cells including white blood cells. The NHS explains they can take several weeks to a few months to show their benefit on joints. During that time and beyond, routine blood tests monitor the white cell count, because a shortage of neutrophils, the front-line bacterial fighters, is a known risk. Neutropenia, the medical term for that shortage, can mean an infection produces little pus and little redness because the cells that create those signs are simply not there in usual numbers.

Biologic medicines block particular signals. Several target tumor necrosis factor, or TNF, a cytokine that is central both to joint inflammation and to walling off certain infections such as tuberculosis. This is why teams commonly screen for latent tuberculosis before starting these medicines and why a persistent cough or night sweats on a biologic is taken seriously. Other biologics block interleukin-6, a cytokine that helps drive fever and raise inflammatory markers in the blood. A person on an interleukin-6 blocker can have a significant infection with a near-normal temperature and near-normal C-reactive protein, a blood marker of inflammation that clinicians normally lean on. Teams know this and interpret results accordingly, but only if they know what the patient is taking.

Corticosteroids, used short-term for flares according to NHS guidance, are the most powerful fever suppressors of all. They also cause a feeling of well-being that can mask how ill a person actually is. Older adults, in whom fever responses are naturally weaker, face a double effect.

None of this argues against the medicines. It argues for describing every symptom, including the ones that seem too small to mention, because the team is listening for a signal that treatment has partly muffled.

Which infections are more common during RA treatment?

The infections that trouble people on RA treatment are mostly the ordinary ones, arriving more often or hitting harder. Respiratory infections top the list: colds that turn into chest infections, bronchitis that lingers, pneumonia that would have been a bad week for someone else. Skin and soft tissue infections come next, often starting at a scratch, an insect bite, a cracked heel or an injection site. Urinary infections, particularly in women and in anyone with bladder problems, round out the common group. Cleveland Clinic and the NHS both flag heightened infection susceptibility as a recognized consequence of immune-suppressing RA treatment.

Beyond the everyday list sit infections that specifically exploit a dampened immune system. Shingles, the reactivation of the chickenpox virus that sleeps in nerve roots, appears more readily when cellular immunity is reduced, and some newer targeted medicine classes carry specific warnings about it. Tuberculosis can wake from a dormant state when TNF is blocked. Fungal infections that a healthy body ignores can take hold in the mouth, the lungs or the skin folds. Hepatitis B can reactivate in people who carried it silently.

Dental infections deserve their own paragraph because they are so often overlooked. Gum disease is more common in people with RA, and a smoldering tooth abscess is a classic hidden source of bacteria that later seed a joint. Persistent toothache, gum swelling or a bad taste in the mouth is medical information, not just a dental appointment to schedule eventually.

The pattern to hold onto is this: infections in treated RA are not exotic, but they are sneakier. A cold that is not clearing in the expected time, a bite that is still spreading on day three, a cough that keeps a person awake for a second week, each is a reasonable trigger for a call, and none needs a fever attached to justify it.

How long do RA fevers last?

People search this question hoping for a number, and honesty requires saying that no guideline sets a standard duration for fever in rheumatoid arthritis. What the evidence supports is a pattern. A temperature that rises and falls with joint activity, staying in the low range and settling as a flare settles, is the kind clinicians associate with the disease itself. A temperature that keeps climbing, spikes and drops sharply, or persists after the joints have quieted does not follow that pattern and needs another explanation.

MedlinePlus offers the general benchmarks that apply to any adult. Fever is defined as a temperature of 100.4°F (38°C) or higher. Adults are advised to contact a clinician if a fever lasts longer than 48 to 72 hours, if it stays at or keeps rising above 103°F (39.4°C), or if it comes with confusion, stiff neck, severe headache, difficulty breathing or a new rash.

Those benchmarks are the floor, not the ceiling, for someone on immune-dampening treatment. Rheumatology teams commonly ask to be told about any temperature at or above the fever threshold on the day it happens, rather than at the 48-hour mark, because the window in which an infection is easy to treat is shorter when the immune system is not helping. Many also ask patients to call about feeling feverish even when the thermometer stays below 100.4°F, since medicines can hold the reading down while the infection proceeds.

The practical answer to “how long do RA fevers last” is therefore less about hours and more about direction. A low temperature that is easing along with the joints can usually be discussed at the next appointment. Anything rising, persisting, recurring or arriving with new symptoms should be reported now, and the treating team decides what comes next.

Flare, infection or medicine reaction: a side-by-side table

Three explanations compete whenever someone on RA treatment feels feverish: the disease is active, an infection has taken hold, or the medicine itself is causing a reaction. The table below lays out the patterns clinicians weigh. It is meant to make the conversation with the care team sharper, not to replace it, because the overlap between columns is exactly where mistakes happen.

Feature RA flare Infection Medicine reaction
Temperature Low, tracks joint activity Often higher, may spike, may be blunted by treatment Variable; some reactions cause fever hours after a dose
Joints Several, usually symmetrical One joint far worse than others if the joint is infected; otherwise joints may simply ache Usually not the main feature
Other clues Morning stiffness, fatigue, familiar pattern Cough, urinary symptoms, wound changes, chills, sweats, sore throat, rash Injection-site redness, hives, mouth ulcers, unusual bruising
Onset Builds over a day or two Can be gradual or abrupt; abrupt worsening is concerning Often linked in time to a dose or a new medicine
What the team may check Joint count, inflammatory markers Blood counts, cultures, urine, chest imaging, joint fluid Blood counts, liver tests, timing review

Two cautions belong beneath the table. Inflammatory markers such as C-reactive protein rise in both flares and infections, so a high reading does not settle the question on its own, and certain biologics can keep the marker low even during infection. Blood counts matter for a different reason: a falling white cell count can be both a medicine effect and the reason an infection is not producing the usual signs.

The columns also blur in a way no table can capture. Infection frequently triggers a flare, so a person can have both at once. A team that hears “this feels like a flare, but there is also this cough” has far more to work with than one that hears only the familiar part.

Should you stop your RA medicine when you have a fever?

This is the question behind almost every late-night search, and the only responsible answer is that the decision belongs to the prescribing clinician, made with the specific medicine, the specific infection and the specific person in view. What can be explained is how teams usually think about it, so that the phone call makes sense.

Many rheumatology teams ask patients to hold a scheduled dose of an immune-suppressing medicine while an active infection is being assessed or treated, and to restart once the infection has cleared and the clinician says so. The logic is straightforward: a temporary pause gives the immune system a freer hand against the invader, and a short gap in most long-acting treatments rarely undoes months of joint control. This is a common approach, not a universal rule, and it is not something to do without instruction.

Corticosteroids are the important exception in the other direction. A person who has taken steroids for a while may have adrenal glands that have stopped producing their own cortisol, the hormone the body needs to cope with stress such as infection. Stopping steroids suddenly in that setting can cause a dangerous drop in blood pressure and blood sugar. Teams may actually adjust steroids differently during illness, which is one more reason the decision cannot be made alone.

Who is usually asked to keep going? People with a mild cold and no fever are often told to continue, particularly on conventional DMARDs, though practices vary. Who is usually asked to wait? Anyone with a confirmed bacterial infection needing antibiotics, anyone with fever of uncertain cause, anyone about to have surgery or a procedure, and anyone whose blood counts have dropped. The lists are typical, not binding.

The safest sentence to say on the phone is simply: “I have a fever and my next dose is due. What would you like me to do?”

What happens in the days after you call

Knowing the likely sequence takes some of the dread out of picking up the phone. The first conversation is usually with a nurse or the on-call clinician, who will ask about the temperature, the timeline, which joints are involved, any cough, urinary or skin symptoms, recent travel, recent dental work, and exactly which medicines were taken when. Having the medicine list and a written record of temperatures within reach makes this quicker.

Based on that call, three paths are common. A mild picture with no red flags may lead to advice to hold the next dose, rest, drink fluids and call back if anything changes, with a follow-up planned within a day or two. A moderate picture typically leads to a same-day or next-day appointment where blood is drawn for a full blood count and inflammatory markers, urine is tested, and a chest examination or X-ray is arranged if breathing symptoms are present. A concerning picture, particularly a single hot joint, breathlessness, confusion or a very high temperature, leads to urgent in-person assessment, which may include drawing fluid from the joint or admission for intravenous antibiotics.

Results from blood counts and urine tests often return within hours; cultures, which grow bacteria to identify them, usually take a couple of days. Teams frequently begin treatment before cultures are back if infection looks likely, then adjust once the organism is known.

Over the following week, the pattern most people experience is that the infection is treated, the paused RA medicine stays on hold until the clinician confirms recovery, and a flare may surface because both the infection and the pause have stirred the disease. That flare is expected and managed; it is not a sign that anything went wrong. Restarting treatment, and whether anything about the regimen should change afterward, is discussed at follow-up. Each of these steps is a typical shape, not a guarantee, and the treating team adapts it to the person in front of them.

What people often get wrong about rheumatoid arthritis fever and infection during treatment

“If I don’t have a fever, I don’t have an infection.” This is the most consequential myth. Corticosteroids, interleukin-6 blockers and older age can each hold temperature down while infection advances. Feeling unusually unwell, breathless, confused or shivery counts even when the thermometer disagrees.

“My biologic gives me a fever, so this is probably just that.” Some medicines do cause short-lived reactions after a dose, and teams recognize those patterns. Attributing every fever to the medicine, though, is how a real infection gets a head start. A fever that does not fit the person’s established post-dose pattern, or that arrives with new symptoms, needs a fresh look.

“Stopping my medicine for a few days will wreck my joints.” Flares can follow a pause, and they are unpleasant, but a short, clinician-directed hold is a routine part of managing infection in RA. Permanent damage comes from months of uncontrolled disease, not a week of caution. Equally wrong is the reverse assumption that stopping is always safe; steroids in particular can be dangerous to stop abruptly.

“Infections come from being weak or doing something wrong.” Increased infection risk is a predictable pharmacological effect of treatments that work by dampening immunity. It reflects the medicine doing its job, not a failure of hygiene or character.

“A fever with joint pain is always a flare.” Infection commonly triggers flares, so both can be present. The joint pain does not rule out the infection.

“Calling about something small wastes the team’s time.” Rheumatology teams build their systems around exactly these calls. A reassuring conversation costs a few minutes. A missed infection can cost a hospital stay. Among everything in this article, that asymmetry is the point most worth remembering.

How to lower infection risk during RA treatment

Prevention will not make treated RA risk-free, and no honest source claims it does, but several habits shift the odds in the right direction and are recommended across mainstream guidance.

Vaccination is the highest-yield step. Inactivated vaccines, the kind that contain no living virus, are generally recommended for people on immune-suppressing treatment, and national schedules typically include seasonal influenza, pneumococcal and COVID-19 vaccines for this group. Live vaccines, which contain weakened but living organisms, are generally avoided while immunity is suppressed and are usually given, if needed, before treatment starts. Which vaccines, and their timing around doses, is a conversation for the prescribing team, since some medicines reduce vaccine response and the schedule may be adjusted accordingly.

Skin is the body’s first wall. Keeping it intact matters more on these medicines: moisturizing cracked heels and knuckles, treating athlete’s foot, cleaning and covering cuts promptly, rotating injection sites and watching them for spreading redness. Hand washing before eating and after public spaces remains the most evidence-supported everyday measure against respiratory and gut infections.

Dental care is prevention in disguise. Regular dental checks and prompt treatment of gum disease remove a common hidden source of bloodstream bacteria. Telling the dentist about RA medicines helps them plan around procedures.

Food safety takes on extra weight because some foodborne organisms that cause a day of misery in healthy adults can cause serious illness when immunity is dampened. Standard advice about thorough cooking, avoiding unpasteurized products and careful handling of raw meat applies with more force.

Screening before treatment, including tests for latent tuberculosis and hepatitis B, is a routine safeguard that many teams carry out, and it is worth confirming it has been done. Knowing your own blood count trends, and asking when results come back, closes the loop between prevention and early detection.

Questions to ask your care team

The most useful time to ask about fever and infection is before either happens, ideally at the visit where a new medicine is started or a dose schedule is set. A few well-aimed questions turn a vague worry into a plan.

  • What temperature, or what symptoms, should prompt me to call you the same day, and what number do I use out of hours?
  • If I develop a fever or an infection, should I hold my next dose while I wait to hear from you, or take it? Does the answer differ for each of my medicines?
  • Am I taking anything that could mask a fever or keep my inflammatory markers low, and how does that change what you want me to report?
  • Have I been screened for latent tuberculosis and hepatitis B, and are there other tests you recommend before or during treatment?
  • Which vaccines do you recommend for me, and how should they be timed around my doses?
  • How often will my blood counts be checked, and how will I learn the results?
  • If one joint becomes much more painful than the others, where should I go and how quickly?
  • Should I tell my dentist, surgeon or other doctors anything specific about my medicines before procedures?
  • After an infection clears, how will we decide when to restart treatment, and who makes that call?

Write the answers down. Many people keep a single card or phone note with their medicine names, the fever threshold their team uses, the out-of-hours number and the standing instruction about pausing doses. When two in the morning arrives, that note is worth more than any amount of searching, and it turns a frightening moment into a call that both sides know how to handle.

When to call your doctor

The threshold for calling is lower during RA treatment than for most adults, and the treating team expects that. Contact the rheumatology team the same day for a temperature of 100.4°F (38°C) or higher, for chills or sweats even without a measured fever, for a cough, sore throat or urinary symptoms that are worsening or not improving, for any wound, bite or injection site that is spreading, hot or leaking, for a new painful rash especially on one side of the body, and for feeling generally unwell in a way that does not match a usual flare. MedlinePlus also advises adults to seek care for any fever lasting beyond 48 to 72 hours or reaching 103°F (39.4°C).

Seek emergency care, or call emergency services, rather than waiting for a callback if any of the following occur:

  • One joint that is severely painful, hot and swollen, far worse than the others, or impossible to move or bear weight on.
  • Difficulty breathing, chest pain, or lips or fingertips turning blue or gray.
  • Confusion, unusual drowsiness, or difficulty staying awake.
  • A stiff neck with headache, or a rash that does not fade when pressed with a glass.
  • Very fast heartbeat, dizziness on standing, or passing little or no urine, which can signal sepsis, the body’s life-threatening response to infection.
  • Fever of 103°F or higher that will not settle, or any fever with shaking that cannot be controlled.
  • New pain, warmth or drainage around a replaced joint.

When in doubt, err toward the call. Every decision about tests, pausing or restarting medicines, and antibiotics rests with the treating team, and they are far better placed to say “this is fine” than anyone is to say it alone at home.

Frequently asked questions

Is it normal to run a fever with rheumatoid arthritis?

A low-grade fever can be part of active rheumatoid arthritis, because the same immune chemicals that inflame joints also nudge body temperature upward; the Mayo Clinic and NIAMS list fever among RA symptoms. Once a person is on immune-suppressing treatment, however, fever is more likely to mean infection and is harder to read, so it should be reported to the care team rather than assumed to be the disease.

Is a low grade fever from rheumatoid arthritis worth reporting?

Yes, during treatment it is. A slightly raised temperature that tracks a flare and settles with it may turn out to be nothing, but medicines such as corticosteroids and certain biologics can keep an infection’s fever artificially low, so a modest reading may be the only visible sign. Most rheumatology teams prefer a quick call about a low fever to a delayed call about a serious infection.

What are the symptoms of an RA flare?

A flare typically brings tender, warm, swollen joints on both sides of the body, morning stiffness lasting an hour or more, deep fatigue, and sometimes a low fever or loss of appetite, building over a day or two. Symptoms outside that familiar pattern, such as high or spiking fever, chills, cough, urinary burning, a spreading wound or one joint far worse than the rest, point away from a simple flare and need clinical assessment.

Can rheumatoid arthritis get infected?

The joint itself can become infected, a condition called septic arthritis, and RA-damaged joints on immune-suppressing treatment are more vulnerable. It usually affects one joint, which becomes intensely hot, swollen and painful to move, often with fever, although treatment can mute these signs. Septic arthritis is an emergency because bacteria can damage cartilage within days, so a single dramatically worse joint needs same-day assessment.

How long do RA fevers last?

No guideline sets a standard duration, but a fever tied to RA itself tends to stay low and rise and fall with joint activity, easing as the flare eases. MedlinePlus advises any adult to seek care for a fever lasting more than 48 to 72 hours or reaching 103°F (39.4°C). People on immune-suppressing treatment are usually asked to call about any fever the same day, without waiting for those thresholds.

Do biologics hide a fever?

Some can. Biologics that block interleukin-6 interfere directly with the signaling that raises body temperature and C-reactive protein, so a person on them may have a significant infection with a near-normal temperature and near-normal blood markers. Other biologics do not suppress fever as strongly but still raise infection risk. Because of this, teams ask patients on biologics to report feeling unwell even when the thermometer is unremarkable.

Should I take my scheduled injection if I have a cold?

Call the team before deciding. Many rheumatology teams advise holding an immune-suppressing dose during an active infection and restarting once it has cleared, but practice varies with the medicine, the severity of the illness and whether a fever is present. A mild cold without fever is sometimes managed by continuing. The prescribing clinician makes that call, and asking takes only a few minutes.

Can I take an over-the-counter fever reducer while on RA treatment?

Check with the care team or pharmacist first. Some over-the-counter pain and fever medicines interact with common RA treatments or add to their effects on the liver, kidneys or stomach, and lowering a fever can also hide the pattern the team uses to judge how an infection is behaving. Once the team knows about the fever, they can advise on what is safe to take alongside your specific medicines.

Will a fever or infection mean stopping my RA treatment for good?

Usually not. A clinician-directed pause during an infection is a routine, temporary step, and treatment is commonly restarted once the infection has cleared. A flare may surface during the gap and is managed as expected. Only repeated or severe infections lead teams to reconsider the regimen, and even then the discussion is about adjusting the approach with the patient, not abandoning treatment altogether.

What tests are done when someone on RA treatment has a fever?

Teams typically start with a full blood count to check white cells, inflammatory markers such as C-reactive protein, and a urine test, adding a chest examination or X-ray if there are breathing symptoms. Blood or urine cultures, which take a couple of days to grow bacteria, may be sent. If one joint is hot and swollen, fluid is often drawn from it with a needle and examined for infection.

References

This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor about your individual situation.

Dr. Şule Eren
Dr. Şule Eren, MD
Author
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Published November 6, 2026 Last updated September 21, 2026
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