Definition: Adult Still's disease is a rare illness which causes high fevers, rash, and joint pain. This may also lead to long-term (chronic)arthritis. Still's disease is a severe version of juvenile idiopathic arthritis (JIA), which occurs in children. Adults can have the same condition although it is much less common. It is also called adult-onset Still's disease (AOSD). Cause: The cause of adult Still's disease is unknown, but researchers are investigating the possibility that it might be triggered by some type of infection. Some people experience just one episode of adult Still's disease. In other people, the condition persists or recurs. It affects women more often than men. Pathophysiology: The cause of adult-onset Still's disease is not known, but it presumably involves interleukin-1 (IL-1), since drugs that block the action of IL-1ß are effective in treatment. Interleukin-18 is expressed at high levels.
Symptoms: Joint pain, warmth, and swelling are common. Most often, several joints are involved at the same time. Often, people with the condition have morning stiffness of joints that lasts for several hours. The fever comes on quickly once per day, most commonly in the afternoon or evening. The skin rash is often salmon-pink colored and comes and goes with the fever. Symptoms also include Abdominal pain and swelling, Pain when taking a deep breath (pleurisy) and Sore throat and its diagonosis can be done by Complete blood count (CBC), may show a high number of white blood cells and reduced number of red blood cells. C-reactive protein (CRP), a measure of inflammation, will be higher than normal. ESR (sedimentation rate), a measure of inflammation, will be higher than normal. Ferritin level will be very high. Fibrinogen level will be high. Liver function tests will show high levels of AST and ALT. Rheumatoid factor and ANA test will be negative.
Treatment: Prednisone may be used for more severe cases. Medicines that suppress the immune system can also be used. Such medicines include: Methotrexate, Anakinra (interleukin-1 receptor agonist), Tocilizumab (interleukin 6 inhibitor), Tumor necrosis factor (TNF) antagonists such as Enbrel (etanercept) Drugs also Include Nonsteroidal anti-inflammatory drugs (NSAIDs), Steroids, Methotrexate, Biologic response modifiers.