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All of the information below is cited from the International Still's Disease Foundation.
Below the information is a link to take you to more detailed information. What is stills disease?Still’s disease is a form of arthritis that is characterized by high spiking fevers and evanescent (transient) salmon-colored rash (view pictures of the Still’s rash). Still’s disease was first described in children, but it is now known to occur, much less commonly, in adults (in whom it is referred to as Adult-onset Still’s disease, AOSD).
What causes still's disease?There have been a number of schools of thought. One is that Still’s disease is due to infection with a microbe. Another concept is that Still’s disease is a hypersensitive or autoimmune disorder. In truth, the cause of Still’s disease is still not known.
What are the symptoms of still's disease?Patients with Still’s disease usually present with systemic (body wide) symptoms. Extreme fatigue can accompany waves of high fevers that rise to 104 degrees F (41 degrees C) or even higher and rapidly return to normal levels or below. A faint salmon-colored skin rash characteristically comes and goes and usually does not itch (picture of the Still’s rash). There is commonly swelling of the lymph glands, enlargement of the spleen and liver, and sore throat. Some patients develop inflammation of the lungs (pleuritis) or around the heart (pericarditis) with occasional fluid accumulation around the lungs (pleural effusion) or heart (pericardial effusion). Although the arthritis may initially be overlooked because of the impressive nature of the systemic symptoms, everyone with Still’s disease eventually develops joint pain and swelling. This usually involves many joints (polyarticular arthritis). Any joint can be affected, although there are preferential patterns of joint involvement in Still’s disease.
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How is still's disease treated?
Still’s disease can cause serious damage to the joints, particularly the wrists knees and hips. It can also impair the function of the heart and lungs. Treatment of Still’s disease is directed toward the individual areas of inflammation. Many symptoms are often controlled with anti-inflammatory drugs, such as aspirin or other non-steroid drugs (NSAIDs). Cortisone medications (steroids), such as prednisone, are used to treat more severe features of the illness. For patients with persistent illness, medications that affect the inflammatory aspects of the immune system are used. Medications now being used are analogous to the classic “second-line” therapies used for patients with Rheumatoid Arthritis. These include Gold, Hydroxychloroquine (PLAQUENIL), Penicillamine, Azathioprine (IMURAN), Methotrexate(RHEUMATREX), and Cyclophosphamide. There is a new class of drugs called biologics that are very promising in treating Still’s. Enbrel, Remicade, Kineret and several others are available and are being used as a first line therapy in treating Still’s meaning you don’t have to take Methotrexate (MTX and fail before you can move on to one of the biologics. Most of the research however shows that when mtx is given along with enbrel or remicade that the outcome is much better than with either one alone.
You can find more info on these medications in our Treatments for Still’s meds section and the Still’s Research section.
You can find more info on these medications in our Treatments for Still’s meds section and the Still’s Research section.
Patient and Family Education
Patients and their families should understand that the disease is often cyclic in nature, and that they should expect “good” and “bad” days and even “good and “bad” hours of the day and the night. Further, they should understand that their actions on any given day can cause a “flare” or exacerbation of the disease (that is, a “bad” day). While a patient may never be able to completely stop a bad day, frequently a patient can manage her or his life to reduce the number of bad days.
