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Medical Editor:

William C. Shiel Jr., MD, FACP, FACR

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

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Medical Editor:

Catherine Burt Driver, MD

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

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In this Article

• Still's disease facts
• What is Still's disease?
• What causes Still's disease?
• How does Still's disease relate to juvenile idiopathic arthritis?
• What are symptoms and signs of Still's disease?
• How is Still's disease diagnosed?
• What is the frequency of Still's disease and its features?
• How is Still's disease treated?
• What research is being done on Still's disease?
• What is the outlook (prognosis) with Still's disease?
• Patient Comments: Still's Disease - Treatment
• Patient Comments: Still's Disease - Symptoms
• Still's Disease Index

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 nonsteroidal 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).

A wide variety of research is ongoing related to Still's disease. While intravenous immunoglobulin therapy has been used 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 the injectable biologic medication, anakinra (Kineret), can be a beneficial treatment for Still's disease.

For more information about Still's disease, please visit the following sites:

• Pediatric Rheumatology home page (http://www.goldscout.com)



• Arthritis Foundation (http://www.arthritis.org)