What is Still’s Disease?

Still’s disease, also known as Adult-onset Still’s disease (AOSD), is a rare inflammatory arthritis that may cause joint inflammation, high fever and a salmon-colored rash on the skin.

Credit: Paisit Teeraphatsakoo/Shutterstock.com

Still’s disease is an auto-inflammatory illness, which means that the inflammation is triggered by an alteration in immune function. Normally, inflammation is the result of certain a stimulus such as injury or infection. However, in Still’s disease, the inflammation occurs spontaneously without a clear cause.

Still’s disease affects women slightly more than men. It can occur in adults of all ages but it tends to affect two age groups most commonly – people between the ages of 36 and 46 and those between the ages of 15 and 25.

Symptoms

The symptoms usually start with a high fever that spikes once or twice a day. However, the progression and severity of the disease’s symptoms vary from one person to another.

Most individuals with Still’s disease may develop a combination of the symptoms, which are similar to a systemic inflammatory disease. These symptoms include joint pain and inflammation, a salmon-pink skin rash, and muscle pain. The other symptoms associated with Still’s disease include swollen lymph nodes or a sore throat.

Causes

The exact cause of Still’s disease is still unknown, although many researchers think that it may be the result of an environmental trigger like a previous viral or bacterial infection, stress, exposure to ultraviolet light and certain toxins.

Some scientists believe that the condition is an auto-inflammatory syndrome, which is a group of disorders that features recurrent episodes of inflammation due to a problem in the immune system. As a result, the immune system mistakenly attacks healthy tissue.

Still’s disease rarely affects members of the same family, hence many scientists speculate that it’s not a hereditary illness. Moreover, some researchers think that specialized proteins from immune system cells called cytokines may also play a role in the development and progression of Still’s disease. Particularly, Interleukin-1 (IL-1) cytokines, which are major mediators of innate immune reactions, are thought to contribute to the development of Still’s disease.

Diagnosis

The initial step in diagnosing Still’s disease is to take a comprehensive medical history of the patient. The doctor will also perform a complete physical examination. Since the initial symptoms of the condition are similar to other inflammatory diseases, eliminating other diseases will help trim down the possible conditions.

Certain blood tests can help the doctor diagnose adult Still’s disease or Still’s disease:

  • Complete blood count (CBC)
  • Erythrocyte Sedimentation Rate (ESR)
  • C-reactive protein (CRP)
  • Fibrinogen level
  • Ferritin level
  • Liver function tests

There is no single test that can diagnose the condition. Some blood tests can be used to rule out the presence of other diseases with similar symptoms. Other tests, like a CT-scan, magnetic resonance imaging (MRI) scan and an X-ray, can help determine the extent of damage caused by the inflammation.

Treatment

Still’s disease may lead to serious damage to the joints, specifically the knees, hips, and wrists. It can also impair lung and heart function. The goal of treatment for Still’s disease or AOSD is to control the symptoms of arthritis and to reduce inflammation.

The initial treatment is aimed at controlling the symptoms of joint inflammation and fever through anti-inflammatory drugs. The doctor may also prescribe corticosteroids to effectively control inflammation.

The condition may take a toll on the joints. In severe cases of Still’s disease, the patient may undergo joint replacement surgery. Patients with the condition should adhere to their medication regime to minimize inflammation and to prevent joint destruction.

Further Reading

Last Updated: Jun 18, 2019

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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