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ALL / Rheumatology
Still's disease in adults
Still's disease in adults
Epidemiology- has a bimodal age distribution - 15-25 yrs and 35-46 yrs
Features
- arthralgia
- elevated serum ferritin
- rash: salmon-pink, maculopapular
- pyrexia
- typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
- lymphadenopathy
- rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
The diagnosis of Still's disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%.
Management
- NSAIDs
- should be used first-line to manage fever, joint pain and serositis
- they should be trialled for at least a week before steroids are added.
- steroids
- may control symptoms but won't improve prognosis
- if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered
+PassMedicine Notes
Epidemiology
- has a bimodal age distribution - 15-25 yrs and 35-46 yrs
- arthralgia
- elevated serum ferritin
- rash: salmon-pink, maculopapular
- pyrexia
- typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
- lymphadenopathy
- rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative
The diagnosis of Still's disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%.
Management- NSAIDs
- should be used first-line to manage fever, joint pain and serositis
- they should be trialled for at least a week before steroids are added.
- steroids
- may control symptoms but won't improve prognosis
- if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered