From the Guidelines
Fever in Crohn's disease is primarily caused by active inflammation in the digestive tract, which can be exacerbated by immunomodulator therapy, increasing the risk of opportunistic infections 1. When Crohn's disease flares up, the body's immune system becomes overactive, attacking healthy tissues in the gastrointestinal tract and triggering an inflammatory response that can cause fever. This systemic inflammation releases cytokines (inflammatory proteins) that act on the hypothalamus in the brain, raising the body's temperature setpoint. Some key points to consider in the management of fever in Crohn's disease include:
- The use of immunomodulators such as corticosteroids, thiopurines, methotrexate, calcineurin inhibitors, anti-TNF agents, and other biologics, which can increase the risk of infections 1
- The importance of monitoring for opportunistic infections, particularly in patients treated with immunomodulators, especially in combination, and those with malnutrition, co-morbidities, and a history of serious infections 1
- The need for caution when treating elderly patients with immunosuppressive agents, including TNF inhibitors, due to the increased risk of infection-related hospitalizations and mortality 1
- The potential for fever to result from complications of Crohn's disease, such as intestinal abscesses, fistulas, or bacterial overgrowth, which can develop when the intestinal barrier is compromised, allowing bacteria to enter the bloodstream 1 Treatment of fever in Crohn's disease focuses on addressing the underlying inflammation with medications, and for fever specifically, acetaminophen can provide temporary relief. It is essential to note that persistent fever, especially when accompanied by severe abdominal pain, should prompt immediate medical attention as it may indicate a serious complication requiring antibiotics or surgical intervention.
From the Research
Causes of Fever in Crohn's Disease
- Fever in Crohn's disease can be caused by the underlying inflammation in the gastrointestinal tract 2
- Uncontrolled inflammation can lead to complications such as infections, abscesses, and fistulas, which can cause fever 2
- Certain medications used to treat Crohn's disease, such as corticosteroids and immunomodulators, can increase the risk of infections and fever 2, 3
Relationship Between Inflammation and Fever
- The inflammation in Crohn's disease can cause the release of pro-inflammatory cytokines, which can lead to fever 2
- The severity of the inflammation can correlate with the severity of the fever 2
- Effective control of inflammation is critical to reducing the risk of complications, including fever 2
Treatment Options for Fever in Crohn's Disease
- Treatment of fever in Crohn's disease typically involves addressing the underlying inflammation and infection 2, 3
- Medications such as aminosalicylates, corticosteroids, and biologics may be used to reduce inflammation and induce remission 4, 5, 6, 3
- Antibiotics may be used to treat infections that can cause fever in Crohn's disease 3