Adult-Onset Still’s Disease
Adult Still’s disease is a rare type of inflammatory arthritis that is similar to rheumatoid arthritis. It shares characteristics of systemic-onset juvenile idiopathic arthritis, but it begins in adulthood. Inflammation may affect a few joints at first, but may advance to include more joints over time. Some people may have only one bout of the illness followed by lasting remission, while others may develop chronic arthritis.
The cause of adult Still’s disease is unknown. Some research suggests that it may be triggered by an infection.
Symptoms usually begin with a high fever that spikes once or twice a day and a salmon-pink rash on the trunk, arms or legs. Other symptoms include sore throat and swollen lymph nodes in the neck. A few weeks after these initial symptoms, joints and muscles begin aching. These aches last at least two weeks. The most commonly affected joints are the knee and wrist. The ankles, shoulders, elbows and finger joints may also be involved.
Diagnosis is based on review of symptoms and medical history, such as the appearance of the rash and recent fevers of unexplained origin. There is no single test that can diagnose adult Still’s disease. Instead, blood tests are performed to rule out other conditions with similar symptoms. Other tests, such as X-rays, may be done to check for damage caused by inflammation.
Patients in the early acute stage of adult Still’s disease are given nonsteroidal anti-inflammatory drugs (NSAIDs), such as naproxen or ibuprofen, and corticosteroids to reduce pain and inflammation. Immunosuppressive drugs, such as methotrexate and biologic response modifiers, may be needed in more severe cases or if the arthritis becomes chronic.
With adult Still’s disease, the medications may need to be taken even after symptoms go away. This is called maintenance therapy. It is important to keep the inflammation under control to prevent more damage to the body. If prednisone is taken for a long time, a doctor may recommend taking calcium and vitamin D to prevent thinning of the bones.