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JAMA Clinical Challenge
January 6, 2020

Fever, Diarrhea, and Weight Loss in a Man With Inflammatory Polyarthritis

Author Affiliations
  • 1Division of Gastroenterology, University of Michigan, Ann Arbor
JAMA. 2020;323(4):369-370. doi:10.1001/jama.2019.18724

A 61-year-old white man with seronegative rheumatoid arthritis presented with hand and wrist pain. Over 2 years, he was prescribed various therapies including prednisone, methotrexate, tumor necrosis factor inhibitors, abatacept, and anakinra; he experienced intermittent improvement in his joint pain but had persistently elevated levels of inflammatory markers. He continued to experience asymmetric small- and large-joint polyarthralgias and later developed intermittent fevers (temperatures up to 38.3°C [101°F]) along with a 50-lb (22.7-kg) unintentional weight loss over the course of a few months.

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