Still’s Disease

Still’s Disease – General Information

Still’s Disease is an inflammatory disease characterized by the presence of a daily spiking fever or an achy and swollen joint. There are also cases in which the patient can experience a salmon pink rash that can appear all over the body. It is a rare medical condition which, if progresses, it can cause chronic arthritis and other life threatening complications. The disease (Still’s Disease) was named after the first doctor who described it in children, George Still. The condition is known as a systemic onset juvenile rheumatoid arthritis. There is no available treatment for this kind of medical condition, but there are medications that can bring symptom relief and can prevent any further more severe complications.

There is no certain cause for this kind of disease, but most researchers think that it is provoked by a viral or bacterial infection. Usually, age is the main risk factor in developing Still’s Disease. Patients have an increased risk of developing the disease in two stages of life: once from 15 to 20 years old and from 36 to 46 years old. In most cases, male patients are more affected than the female patients are. If the disease is not treated properly in time or not treated at all, it can progress to a more severe stage causing life threatening complications such as joint destruction, inflammation of the patient’s heart, and excess fluid around the patient’s lungs. If these complications are not treated early they can lead to the death of the patient. 

Still’s Disease – Symptoms

In the first stages of development the Still’s Disease usually causes no signs and symptoms appear at all, which makes it very challenging to diagnose and treat. It is a kind of disease that if it is discovered early it can be cured, but if it advances to a more severe stage, the treatment is applied only to relieve the present symptoms. Once Still’s Disease reaches this stage the patient can experience a combination of several signs and symptoms that can include fever, of at least 102 F for more than a week, rash, which can appear as a pink bumpy or flat rash in addition to fever, achy and swollen joints, and muscle pain. The fever usually reaches its high limit in the late afternoon or early evening, and between these episodes the patient’s body temperature can reach normal levels.

The rash usually appears on the patient’s trunk, arms and legs. Any physical contact such as rubbing the skin or exposing it to hot or cold water can make the rash to recur. The achy sensation in the joints can appear especially on the patient’s knees, wrists, ankles and elbows. In most cases, the pain lasts for at least two weeks. The muscle pain usually appears and disappears with fever and it can interfere in the patient’s daily activities. Other signs and symptoms that the Still’s Disease can be caused in advance stages of evolution and include sore throat, swollen lymph nodes in the patient’s neck, and enlarged liver or spleen.

Still’s Disease – Treatment

Usually, most of the doctors apply a large variety of drugs depending on the severity of the patient’s signs and symptoms or if the patient also experiences other side effects. The most common medicines used to treat Still’s Disease can include non steroidal anti inflammatory drugs, glucocorticoids, and Methotrexate. The non steroidal anti inflammatory drugs (NSAIDs), such as Aspirin, Ibuprofen or Naproxen act by reducing the patient’s inflammation. These medicines are also helpful in controlling the patient’s mild signs and symptoms, and if they are applied on a prolonged period of time, doctors have to make regular blood tests to monitor the patient’s liver function, because high doses of these medicines can cause damage to the liver. Glucocorticoids are usually administered in patient’s who present episodes of high fever, severe joint pain or certain complications that affected the patient’s internal organs. The most common glucocorticoid medicine used to treat Still’s Disease is Prednisone. These medicines act by subduing the body’s immune response and can lower the patient’s resistance to certain infections, increasing also the risk of developing a bone disorder also known as osteoporosis.

Another medicine used to treat Still’s Disease is Methotrexate, prescribed as Rheumatrex, and that can have significant effects if it is administered in small series, in combination with other medicines. It is very important to know that if the patient is taking this kind of medicine, smaller doses of corticosteroids have to be also taken to control the disease’s manifestation and healing process. In treating Still’s Disease, there are also other medicines that are not basic for this disease, but some patients reported that they can bring little to significant improvement. The most common medicine of this type is called tumor necrosis factor blocker or TNF. The medicine can be prescribed as Remicade or Etanercept, and acts by reducing joint swellings. Other experimental drugs that can bring improvement include Cyclosporine or Sandimmune, immunoglobulin administered intravenously, Anakinra or Kineret and Thalidomide or Thalomid.

Even if the treatment is applied properly, it is very challenging to predict the disease’s evolution, and if it is not monitored and maintained closely it can progress to more severe conditions. The most common severe complication that can be triggered by the Still’s Disease is called chronic arthritis. This is a disease that can last for many years and can lead to debilitating arthritis, but most patients respond well to this type of treatment. There are cases in which the patient can experience occasional flare-ups, and in these cases it is very important to control the symptoms, because they can cause other complications that can threaten the patient’s life. It is very important that the patient keeps taking the prescribed treatment even if the present signs and symptoms improved or disappeared because this kind of medical condition can recur easily. If the patient is taking glucocorticoids for more than three weeks, he must also take a combination of calcium and vitamin D supplements to prevent osteoporosis and other more severe conditions to develop.