Summary
Adult onset Still's disease is a rare rheumatic condition. Prevalence is 1/80 000. Its main feature is the combination of symptoms, such as fever higher than 39°C, cutaneous rash during fever peaks, joint or muscle pain, lymph node hypertrophy, increase of white blood cells (especially polymorphonuclear neutrophils) and abnormalities of liver metabolism. Other symptoms may also be present. None of these signs is sufficient to establish the diagnosis, and several other diseases (notably infectious or neoplastic diseases) may produce similar symptoms. Thus, adult onset Still's disease often corresponds to a « diagnosis of exclusion », meaning that the diagnosis is retained when the other possible diagnoses have been completely ruled out. The evolution of the disease is difficult to predict; it may be limited to only one flare or may recur over a period of several months or years. Sometimes, joint erosions may happen (roughly 1 patient out of 3). Treatments have 2 objectives :
- To limit the intensity of the symptoms of the disease. Aspirin and NSAIDs are the most common drugs for that purpose, and are usable at the beginning of the disease, even if the diagnosis is not completely ascertained.
- To control the disease evolution, through the use of corticosteroids, methotrexate, ciclosporine A, sometimes intravenous immunoglobulins or TNF alpha inhibitor as Etanercept or Infliximab.
Expert reviewer(s)
Last update: January 2004
