Still's
disease
Still's disease is a disorder
featuring inflammation that is characterized by high spiking fevers, evanescent
(transient) salmon-colored rash and/or arthritis.
Still's disease was first described in children, but it is now known to occur, much less
commonly, in adults (in whom it is referred to as adult-onset Still's disease).
Causes of Still's disease
The cause of Adult Still's disease is unknown. The condition
rarely occurs in adults. It is more common in children, where it is called Systemic
Juvenile Rheumatoid Arthritis. No risk factors for the disease have been identified.
Symptoms of Still's disease
Almost all patients will have fever, joint pain, sore throat,
and a rash. The fever usually comes on quickly once per day, most commonly in the
afternoon or evening. The rash is typically salmon pink colored and comes and goes with
the fever.
Another common symptom is joint pain and inflammation (warmth and swelling of the
joint). Usually, several joints are involved at the same time.
Additional symptoms include swollen lymph nodes (glands), pain with a deep breath
(pleurisy), abdominal pain and swelling, and weight loss.
Diagnosis of Still's disease
The physical exam may show the fever, rash, and arthritis. Other
signs include enlargement of the lymph nodes, liver, or spleen. Also, the presence of
changes in the sound of the heart or lungs may indicate pericarditis or pleurisy.
Blood tests that can be helpful in diagnosing Adult Still's Disease include:
- Elevation in the ESR (sedimentation rate)
- Elevation in the White Blood Cell count
- Elevation in liver function tests
- Decrease in the Red Blood Cell count
- Very high elevation in the Ferritin level
- Negative rheumatoid factor and ANA test
Other tests may include:
- joint X-rays
- chest X-ray that may show pericarditis or pleural effusion
- abdominal X-ray, CT scan or ultrasound for liver and spleen enlargement
Adult Still's Disease can only be diagnosed after other diseases are excluded. It may
require many medical tests before a final diagnosis is made.
Treatment of Still's disease
The symptoms of arthritis are generally controlled with adequate
doses of salicylates (aspirin) or nonsteroidal anti-inflammatory medications (NSAIDs) such
as ibuprofen. Prednisone may be used for more severe cases. In the disease becomes chronic
immunosuppressive medications might be needed. These may include methotrexate or new
biologic therapies.
Expectations (prognosis)
Studies show that about 20% of patients have all of the symptoms
go away in a year and never come back. About 30% of patients have all of the symptoms go
away, but they come back several times over the next years. The rest of the patients
(about 50%) will develop a chronic arthritis.
Complications
- arthritis
- liver disease
- spleen enlargement
- pericarditis
- pleural effusion
Calling your health care provider
Call for an appointment with your health care provider if
symptoms are present that are suggestive of Adult Still's disease.
Call your health care provider if cough, difficulty breathing, or other symptoms develop
in a person with Adult Still's. |
