Still's Disease (cont.)
What is the outlook with Still's disease?
The fever and other systemic features tend to run their course within
several months. The arthritis can be a long-term problem. It usually stays
on after the systemic features have gone. The arthritis can then become
chronic and persist into adulthood. Persisting arthritis of the wrists, with eventual fusion, is common.
How is Still's disease treated?
Still's disease can cause serious
damage to the joints, particularly the wrists. 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 nonsteroid drugs (NSAIDs). Cortisone
medications (steroids) such as prednisone are used to treat
more severe
features of 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 (Cuprimine, Depen), azathioprine
(Imuran), methotrexate (Rheumatrex, Trexall), and cyclophosphamide (Cytoxan).
What research is being done on Still's disease?
A wide variety of research is ongoing related to Still's disease. At one of the recent meetings of the American College of Rheumatology,
for example, a paper was presented which demonstrated the effectiveness of intravenous immunoglobulin therapy in adult-onset Still's disease. More studies are needed to confirm these results.
Also, TNF-inhibitors (etanercept [Enbrel] and infliximab [Remicade]) have been used successfully in people who have failed other treatments (much as they are now used in rheumatoid arthritis). The intravenous infusions of infliximab helped decrease the Still's
disease signs and symptoms, including fever, arthritis, muscle pains, enlarged
spleen, and rash, in virtually all patients in some studies.
Recent research suggests that anakinra (Kineret) may be a beneficial treatment for Still's disease.
For more information about Still's disease, please visit the following sites:
- Still's disease presents with a high spiking fever.
- Still's disease is commonly associated with a rash without itching.
- Still's disease always causes joint inflammation (arthritis).
- The cause of Still's disease is not known.
- Still's disease can be associated with inflammation of internal organs.
- Still's disease is diagnosed by the characteristic clinical features. These features include high intermittent fever; joint inflammation and pain, muscle pain, faint salmon-colored skin rash, swelling of the lymph glands or enlargement of the spleen and liver, and inflammation of the lungs (pleuritis) or around the heart (pericarditis).
- Classic blood tests for rheumatic diseases are negative.
- Treatment is directed toward the individual areas of inflammation.
References:
Clinical Primer of Rheumatology, Lippincott Williams & Wilkens, edited by William Koopman, et al., 2003.
Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy,
et al., 2000.
Last Editorial Review: 9/11/2007
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