Standardised work-up programme for fever of unknown origin and contribution of magnetic resonance imaging for the diagnosis of hidden systemic vasculitis

• Published in: Annals of the rheumatic diseases Vol. 64; no. 1; pp. 105 - 110
• Main Authors: Wagner, A D, Andresen, J, Raum, E, Lotz, J, Zeidler, H, Kuipers, J G, Jendro, M C
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.01.2005; BMJ; BMJ Publishing Group LTD
• Subjects: [18F]FDG-PET; [18F]fluorodeoxyglucose positron emission tomography; ACR; Adult; American College of Rheumatology; Aorta, Thoracic - pathology; Arteritis - complications; Arteritis - diagnosis; Biological and medical sciences; C reactive protein; Clinical Protocols; CRP; Diagnostic tests; echo delay time; erythrocyte sedimentation rate; ESR; Extended Report; Female; fever of unknown origin; Fever of Unknown Origin - etiology; FUO; GCA; giant cell arteritis; HIV; Human immunodeficiency virus; Humans; magnetic resonance imaging; Magnetic Resonance Imaging - methods; Male; Medical imaging; Medical sciences; Middle Aged; MRI; NMR; Nuclear magnetic resonance; Patients; PDCs; Physicians; potentially diagnostic clues; Questionnaires; Retrospective Studies; Rheumatology; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; spin echo; Studies; systemic vasculitis; Takayasu Arteritis - complications; Takayasu Arteritis - diagnosis; Takayasu’s arteritis; Ultrasonic imaging; Veins & arteries; Vascular disease; Undetermined primary site; Vasculitis; Cardiovascular disease; Medical imagery; Diagnosis; Disseminated; Nuclear magnetic resonance imaging; Fever
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/ard.2003.018259

Background: Fever of unknown origin (FUO) is a diagnostic challenge. Rheumatologists are often in charge of patients with FUO because the vasculitides, especially, are potential and common causes of FUO. Objective: To evaluate the value of a standardised investigation to identify the cause of FUO. Methods: A standardised work-up programme for patients with FUO was started at the beginning of September 1999. The rate of identified causes of FUO was compared between all patients with FUO admitted to a tertiary care centre of rheumatology between January 1996 and August 1999 (control group) and September 1999 and January 2003 (work-up group). In January 2002 magnetic resonance imaging (MRI) was added to the investigation. Results: 67 patients with FUO were identified—32 before and 35 after institution of the work-up programme. Before implementation 25% of all patients with FUO remained undiagnosed, after implementation 37%. After institution of the investigation the percentage of patients with vasculitides increased significantly from 6% (n = 2) to 26% (n = 9, p = 0.047, Fisher’s exact test). This increase could be attributed to the addition of MRI in 2002. When all patients with FUO before 2002 (n = 55) and thereafter (n = 12) were compared the prevalence of systemic vasculitis increased from 11% (n = 6) to 42% (n = 5, p = 0.021). Conclusion: Implementation of a standardised work-up programme for FUO did not improve the overall rate of diagnosis. Addition of MRI significantly increased the diagnosis of systemic vasculitis as the underlying cause of FUO. MRI should be included in the investigation of patients with FUO when vasculitis is suspected.