Epidemiology

• has a bimodal age distribution - 15-25 yrs and 35-46 yrs

PC

• arthralgia
• rash: salmon-pink, maculopapular
• pyrexia
  • typically rises in the late afternoon/early evening in a daily pattern and accompanies a worsening of joint symptoms and rash
• lymphadenopathy

Investigations

• elevated serum ferritin
• rheumatoid factor (RF) and anti-nuclear antibody (ANA) negative (need to be excluded before diagnosing still’s disease

The diagnosis of Still's disease in adults can be challenging. The Yamaguchi criteria is the most widely used criteria and has a sensitivity of 93.5%.

Management

• NSAIDs
  • should be used first-line to manage fever, joint pain and serositis
  • they should be trialled for at least a week before steroids are added.
• steroids
  • may control symptoms but won't improve prognosis
• if symptoms persist, the use of methotrexate, IL-1 or anti-TNF therapy can be considered