Still’s Disease — Adult

Very Rare:  Incidence 2 / million
  • Onset usually 40 – 60 y.o.
Joint Involvement  (from most to less common)
·         Knees, wrists, ankles, elbows, hand PIPs, shoulders
·         Either arthralgias or frank arthritis
·         May become destructive
 
Other Signs / Symptoms
  • Fever (dramatic) for ≥1 week
  • Rash, especially during fever  [see pix below]
  • Pharyngitis
  • Cervical adenopathy (? slightly tender)
  • Hepatosplenomegaly
Lab Tests (in order of frequency)
  • ESR elevated (100% sensitive)
  • Negative ANA & RF (very sensitive)
  • Leukocytosis
  • Elevated LFTs, LDH
  • Normocytic Anemia

Diagnosis:  Clinical.  No specific test

Still’s Rash
  • Transient, salmon-colored, maculopapular
  • Trunk & extremities, esp. areas of pressure (under breasts, beltline)

                 

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