Adult Still's disease with myocarditis and peritonitis

A 26-year-old woman had myocarditis and peritonitis during an acute multisystem attack of Still's disease. To our knowledge, these complications are rare manifestations of adult Still's disease. Treatment with high-dose adrenocorticosteroids was rapidly successful in controlling these manifestations.

Adult-onset Still's disease in India

Adult onset Still's disease was provisionally diagnosed in 31 patients from northern India over a period of five years, in 27 of whom the diagnosis was subsequently felt to have been confirmed. This report describes the clinical characteristics of these patients along with the different therapeutic measures used and their response. Adult onset Still's disease should be considered in the differential diagnosis of 'pyrexia of unknown origin'.

Adult onset Still's disease: clinical experience with 18 patients over 15 years in northern India

Over a 15 year period 18 patients (eight men, 10 women), 16-50 years old, were diagnosed as having adult onset Still's disease. Fever and arthralgia were always present but prominent lymphadenopathy was uncommon and the serosa were rarely affected. The typical rash of this disease was observed in nine patients. Several complications, including deforming arthritis, amyloidosis, granulomatous hepatitis, uveitis, scleritis, cutaneous vasculitis, and cardiomyopathy, were observed during follow up. Two patients were affected by a nosocomial infection during immunosuppressive treatment for uncontrolled disease. There were no characteristic features at necropsy. Ten patients had a monocyclic course that responded well to aspirin and indomethacin, whereas eight had a polycyclic pattern which invariably required treatment with corticosteroids. Serious complications developed exclusively in the latter group. This group of patients requires early, intensive disease modifying treatment.

[Efficiency of cyclophosphamide bolus in Still's disease in adults. A case]

The value of monthly intravenous injections of cyclophosphamide in adults with steroid-dependent Still's disease is documented by the report of a case. In the short term and perhaps also in the long term, this regimen reduces the amount of prednisone needed.

[Adult-onset Still's disease. Diagnosis, differential diagnosis and treatment]

The article describes two cases of adult Still's disease and reviews the relevant literature. Adult onset Still's disease is characterized by high peaks of fever, arthritis, arthralgia, rash, increased erythrocyte sedimentation rate, leucocytosis, liver dysfunction and negative tests for antinuclear antibodies and rheumatoid factors. Still's disease should be regarded as a possible differential diagnosis in adult patients who present such features.

[Treatment of Still's disease with bolus methylprednisolone. Retrospective study of 7 patients]

The problems raised by the treatment of Still's disease in the child or adult led the authors to evaluate the short term clinical efficacy of bolus doses of methylprednisolone. Seven patients were given 12 boluses, followed by oral corticosteroids at 5 to 10 mg in 9 cases out of 12. Still's disease was active in all cases. A frank clinical improvement was seen on the fourth day. The response duration was 3 weeks to 20 months, with a mean follow-up period of 7 months. There were 3 early relapses, 5 late relapses between 2 and 20 months and 4 patients are still in remission at 5, 6, 15 and 19 months. There were no immediate adverse reactions. These results suggest the usefulness of boluses of methylprednisolone in exacerbations of Still's disease, avoiding the disadvantages of high dosage daily corticosteroids.

Low dose methotrexate treatment in adult Still's disease

Six patients with adult Still's disease who had either failed to respond to or had adverse effects from previous therapy were given weekly low dose methotrexate (MTX) therapy. They were followed for 4-28 months (mean 14 +/- 9 months). At 12 months of therapy 3 patients were evaluated as having a complete response. One patient had a partial response to MTX after 7 months. Therapy was discontinued in 1 patient at 4 months due to flares of rash and arthralgias after each MTX administration. One patient failed to respond to therapy despite maximum dosage, but was able to reduce his corticosteroid dose. MTX may be a useful therapy to consider in patients with adult Still's disease who are resistant to conventional therapy and may allow a reduction in the concomitant dose of corticosteroids.

[Still's disease in adults]

Retrospective case series for the last five years have focussed the attention of the authors on some clinical and biological patterns of adult onset Still's disease. Its diagnosis is made difficult because of the great diversity of clinical and biological signs. Organ failures complicate sometimes the disease, and may be fatal. Major high levels of plasma ferritin associated with an haemophagocytic syndrome occur in 20 percent of the acute cases: this association could eventually respond well to an immunodepressive therapy.

Takayasu's arteritis associated with Still's disease in an adult

We report a new case of association between adult Still's disease and Takayasu's arteritis (TA). This association is infrequent and raises again the controversy of the origin of Takayasu's arteritis.

Treatment of fulminant adult Still's disease with intravenous pulse methylprednisolone therapy

We describe a patient with fulminant adult onset Still's disease and multiple organ involvement. The acute flare persisted despite high doses of prednisone but responded to megadose intravenous pulse methylprednisolone therapy. This treatment modality may be useful in temporizing severe multisystem exacerbations of adult Still's disease.

[Therapy strategies for Still's syndrome of adults (AOSD)]

The differential diagnosis of seronegative polyarthritides are manyfold and can cause problems even for the routine rheumatologist. Together with the symptom "fever of unknown origin" an intensive diagnostic workup is often unavoidable. Five patients with this symptom combination are discussed who also had different typical manifestations of the adult onset Still's disease (AOSD).

Adult-onset Still's disease: hepatic involvement and various serum markers relating to the disease activity

A 53-year-old woman was admitted to our hospital due to high fever, arthralgia and skin rash. Main laboratory data included the following: WBC 17,100/mm, GOT 58 U, GPT 47 U, LDH 1,510 U, ferritin 19,000 ng/ml, adenosine deaminase 79.1 U/l. She was diagnosed as having adult-onset Still's disease. Aspirin (3.0 g/day) and prednisolone (40 mg/day) were administered. All the symptoms and laboratory data improved rapidly. Adenosine deaminase, ferritin, and LDH are considered to originate mainly from the liver. Liver injury in this disease may be a primary lesion, and various serum markers may be associated with the liver abnormalities.