Adult-Onset Still's Disease

Adult-onset Still’s disease (often called AOSD) is a relatively rare condition. It begins with fever and may lead to arthritis. Classified as an inflammatory illness, the disease often causes fatigue and swelling in joints, tissues, organs, and lymph nodes. Adult Still’s disease affects only about one in every 100,000 people, but it has been observed throughout the world. In children, a similar condition exists called juvenile idiopathic arthritis.

The causes of adult Still’s disease are still unknown. Doctors suspect that the condition may be related to certain antigens (substances that cause your body to produce antibodies to fight infection). Some people may just be genetically predisposed to the condition.

People between the ages of 16 and 46 are at a higher risk for AOSD. The condition affects women at a slightly higher rate than men. Recent research suggests that adult Still’s disease is probably not hereditary.

Adult Still’s disease typically begins with a fever that lasts for several days and is much higher during the night. Along with this fever, you might experience a quick-changing rash on your skin, similar to hives.

Other symptoms of AOSD include:

• sore throat
• swollen and tender joints
• inflamed or swollen lymph nodes
• muscle pain
• abdominal pain
• pain associated with deep breathing
• weight loss

In some extreme cases, individuals develop an enlarged liver or spleen. Inflammation of the tissues around major organs like the heart and lungs is another rare complication.

It may take multiple tests for your doctor to find the correct diagnosis. He or she will need to rule out certain types of cancer, mononucleosis, and other conditions (such as Lyme disease) that share many of the initial symptoms of Still’s disease.

At first, your doctor will notice your fever and rash. Along with joint pain, these are the three symptoms that indicate the possibility of AOSD. Your doctor will use blood tests to learn more about the inflammation in your joints and to help develop a treatment plan. In addition, your doctor may listen to your heart and lungs, or use radiology tests to examine your chest, liver, and spleen.

Because the initial symptoms of AOSD are often followed by the onset of arthritis, doctors will usually focus their treatment on addressing the arthritis. One of the most common treatments involves taking non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil) and naproxen (Aleve). Prescription drugs such as prednisone may also be used.

More powerful drugs used to treat extreme cases of Still’s disease are called glucocorticoids, which are a category of corticosteroid drugs. Your doctor might try to limit the use of these drugs, however, because of their side effects, which can include high blood pressure and fluid retention. If your AOSD becomes chronic, medicines that suppress your immune system might be necessary. Such medicines include anakinra (Kineret), methotrexate (Rheumatrex), and etanercept (Enbrel).

Home care for adults with Still’s disease includes consistent administration of prescribed medications. In some cases, exercise will be helpful because it can build muscle and strengthen joints. Your doctor will probably suggest a particular exercise plan for you. You may also be advised to take vitamins, such as calcium and vitamin E supplements, to help prevent osteoporosis.

AOSD is treatable, but symptoms may recur. Scientific studies suggest that about half of all patients with AOSD will ultimately develop chronic arthritis. This means that joint symptoms may persist for many years.