Adult Still's disease
Definition
Adult Still's disease is a rare illness marked by high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis.
It is more commonly called adult-onset Still's disease (AOSD).
Causes
Fewer than 1 out of 100,000 people develop adult Still's disease each year. It affects women more often than men.
Still's disease that occurs in children is called systemic juvenile idiopathic arthritis.
The cause of adult Still's disease is unknown. No risk factors for the disease have been identified.
Symptoms
Almost all patients will have fever, joint pain, sore throat, and a rash.
- Joint pain, warmth, and swelling are common. Usually, several joints are involved at the same time. Often, patients have morning stiffness of joints that lasts for several hours.
- The fever usually comes on quickly once per day, most commonly in the afternoon or evening.
- The skin rash is typically salmon pink colored and comes and goes with the fever.
Additional symptoms include:
- Abdominal pain and swelling
- Pain with a deep breath (pleurisy)
- Sore throat
- Swollen lymph nodes (glands)
- Weight loss
Occasionally, the spleen or liver may become swollen. Lung and heart inflammation may occur.
Treatment
The goal of treatment for adult Still's disease is to control the symptoms of arthritis. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are usually the first form of treatment.
Prednisone may be used for more severe cases.
If the disease persists for a long time (becomes chronic), medicines that suppress the immune system might be needed. Such medicines include:
- Methotrexate
- Tumor necrosis factor (TNF) antagonists such as Enbrel (etanercept)
Prognosis
Studies show that in about 20% of patients, all symptoms go away in a year and never come back. In about 30% of patients, all symptoms go away but then come back several times over the next years.
Symptoms continue for a long-time (chronic) in about half of patients with adult Still's disease.