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<link rel="alternative" hreflang="en" href="https://medlineplus.gov/ency/article/000450.htm"/><meta property="og:title" content="Adult Still disease: MedlinePlus Medical Encyclopedia"/><meta property="og:url" content="https://medlineplus.gov/ency/article/000450.htm"/><meta property="twitter:title" content="Adult Still disease: MedlinePlus Medical Encyclopedia"/><meta name="twitter:card" content="summary_large_image"/><meta name="description" content="Adult Still disease (ASD) is a rare illness that causes high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis."/><meta itemprop="description" name="description" content="Adult Still disease (ASD) is a rare illness that causes high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis."/><meta property="og:description" content="Adult Still disease (ASD) is a rare illness that causes high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis."/><meta property="twitter:description" content="Adult Still disease (ASD) is a rare illness that causes high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis."/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_1.jpg"/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_2.jpg"/><meta property="og:image" content="https://medlineplus.gov/images/share_ency_3.jpg"/><meta property="twitter:image" content="https://medlineplus.gov/images/share_ency_1.jpg"/>
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</div><div><span>Adult Still disease</span></div></div>
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</a><h1 class="with-also" itemprop="name">Adult Still disease</h1>
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</noscript></div><div class="main"><div id="ency_summary"><p>Adult Still disease (ASD) is a rare illness that causes high fevers, rash, and joint pain. It may lead to long-term (chronic) arthritis.</p><p>Adult Still disease is a severe version of juvenile idiopathic arthritis (JIA), which occurs in children. Adults can have the same condition, although it is much less common. It is also called adult-onset Still disease (AOSD).</p></div><section><div class="section"><div class="section-header"><div class="section-title"><h2>Causes</h2></div><div class="section-button"><button type="submit" aria-controls="section-1" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-1"><p>Fewer than 1 out of 100,000 people develop ASD each year. It affects women more often than men.</p><p>The cause of adult Still disease is unknown. No risk factors for the disease have been identified.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Symptoms</h2></div><div class="section-button"><button type="submit" aria-controls="section-2" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-2"><p>Almost all people with the disease will have fever, joint pain, sore throat, and a rash.</p><ul><li>Joint pain, warmth, and swelling are common. Most often, several joints are involved at the same time. Often, people with the condition have morning stiffness of joints that lasts for at least one hour.</li><li>The fever comes on quickly once per day, most commonly in the afternoon or evening.</li><li>The skin rash is often salmon-pink colored and comes and goes with the fever. </li></ul><p>Additional symptoms include:</p><ul><li>Abdominal pain and swelling</li><li>Pain when taking a deep breath (pleurisy)</li><li>Sore throat</li><li>Swollen lymph nodes (glands)</li><li>Weight loss </li></ul><p>The spleen or liver may become swollen. Lung and heart inflammation may also occur.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Exams and Tests</h2></div><div class="section-button"><button type="submit" aria-controls="section-3" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-3"><p>AOSD can only be diagnosed after many other diseases (such as infections and cancer) are ruled out. You may need many medical tests before a final diagnosis is made.</p><p>A physical exam may show a fever, rash, and arthritis. The health care provider will use a stethoscope to listen for changes in the sound of your heart or lungs.</p><p>The following blood tests can be helpful in diagnosing adult Still disease:</p><ul><li><a test="test" href="./003642.htm">Complete blood count</a> (CBC), may show a high number of white blood cells (granulocytes) and reduced number of red blood cells.</li><li><a test="test" href="./003356.htm">C-reactive protein</a> (CRP), a measure of inflammation, will be higher than normal.</li><li><a test="test" href="./003638.htm">ESR</a> (sedimentation rate), a measure of inflammation, will be higher than normal.</li><li><a test="test" href="./003490.htm">Ferritin</a> level will be very high.</li><li>Fibrinogen level will be high.</li><li><a test="test" href="./003436.htm">Liver function tests</a> will show high levels of <a test="test" href="./003472.htm">AST</a> and <a test="test" href="./003473.htm">ALT</a>.</li><li><a test="test" href="./003548.htm">Rheumatoid factor</a> and <a test="test" href="./003535.htm">ANA</a> test will be negative.</li><li>Blood cultures and viral studies will be negative.</li></ul><p>Other tests may be needed to check for inflammation of the joints, chest, liver, and spleen:</p><ul><li><a test="test" href="./003777.htm">Abdominal ultrasound</a></li><li><a test="test" href="./003789.htm">CT scan of the abdomen</a></li><li>X-rays of the joints, chest, or stomach area (abdomen)</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Treatment</h2></div><div class="section-button"><button type="submit" aria-controls="section-4" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-4"><p>The goal of treatment for adult Still disease is to control the symptoms of <a test="test" href="./001243.htm">arthritis</a>. Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are most often used first.</p><p>Prednisone may be used for more severe cases.</p><p>If the disease is severe or persists for a long time (becomes chronic), medicines that suppress the immune system might be needed. Such medicines include:</p><ul><li>Methotrexate</li><li>Anakinra (interleukin-1 receptor agonist)</li><li>Tocilizumab (interleukin 6 inhibitor)</li><li>Tumor necrosis factor (TNF) antagonists such as etanercept (Enbrel)</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Outlook (Prognosis)</h2></div><div class="section-button"><button type="submit" aria-controls="section-5" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-5"><p>In many people, symptoms may come back several times over the next few years.</p><p>Symptoms continue for a long time (chronic) in about one third of people with adult Still disease.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Possible Complications</h2></div><div class="section-button"><button type="submit" aria-controls="section-6" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-6"><p>A potentially life threatening complication of the disease, called macrophage activation syndrome, can be very severe with high fevers, severe illness and low blood cell counts. The bone marrow is involved and bone marrow biopsy is needed to make the diagnosis.</p><p>Other complications may include:</p><ul><li>Arthritis in several joints</li><li>Liver disease</li><li><a test="test" href="./000182.htm">Pericarditis</a></li><li><a test="test" href="./000086.htm">Pleural effusion</a></li><li>Spleen enlargement</li></ul></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>When to Contact a Medical Professional</h2></div><div class="section-button"><button type="submit" aria-controls="section-7" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-7"><p>Contact your provider if you have symptoms of adult Still disease.</p><p>If you have already been diagnosed with the condition, you should call your provider if you have a <a test="test" href="./003072.htm">cough</a> or <a test="test" href="./003075.htm">difficulty breathing</a>.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Prevention</h2></div><div class="section-button"><button type="submit" aria-controls="section-8" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-8"><p>There is no known prevention.</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>Alternative Names</h2></div><div class="section-button"><button type="submit" aria-controls="section-Alt" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Alt"><p>Still's disease - adult; Adult-onset Still's disease; AOSD; Wissler-Fanconi syndrome</p></div></div></section><section><div class="section"><div class="section-header"><div class="section-title"><h2>References</h2></div><div class="section-button"><button type="submit" aria-controls="section-Ref" role="button" title="Expand/Collapse section"><span class="icon icon-section-action">
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</div></div><div class="section-body" id="section-Ref"><p>Alonso ER, Marques AO. Adult-onset still disease. In: Hochberg MC, Gravallese EM, Smolen JS, van der Heijde D, Weinblatt ME, Weisman MH, eds. <em>Rheumatology</em>. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 173.</p><p>Gerfaud-Valentin M, Maucort-Boulch D, Hot A, et al. Adult-onset still disease: manifestations, treatment, outcome, and prognostic factors in 57 patients. <em>Medicine (Baltimore)</em>. 2014;93(2):91-99. PMID: 24646465 <a href="https://pubmed.ncbi.nlm.nih.gov/24646465/" target="_blank">pubmed.ncbi.nlm.nih.gov/24646465/</a>.</p><p>Kaneko Y, Kameda H, Ikeda K, et al. Tocilizumab in patients with adult-onset still's disease refractory to glucocorticoid treatment: a randomised, double-blind, placebo-controlled phase III trial. <em>Ann Rheum Dis</em>. 2018;77(12):1720-1729. PMID: 30279267 <a href="https://pubmed.ncbi.nlm.nih.gov/30279267/" target="_blank">pubmed.ncbi.nlm.nih.gov/30279267/</a>.</p><p>National Organization for Rare Disorders website. Rare diseases.org. Adult onset Still's disease. <a href="https://rarediseases.org/rare-diseases/adult-onset-stills-disease/" target="_blank">rarediseases.org/rare-diseases/adult-onset-stills-disease/</a>. Updated 2021. Accessed March 3, 2023.</p><p>Ortiz-Sanjuán F, Blanco R, Riancho-Zarrabeitia L, et al. Efficacy of anakinra in refractory adult-onset Still's disease: multicenter study of 41 patients and literature review. <em>Medicine (Baltimore)</em>. 2015;94(39):e1554. PMID: 26426623 <a href="https://pubmed.ncbi.nlm.nih.gov/26426623/" target="_blank">pubmed.ncbi.nlm.nih.gov/26426623/</a>.</p></div></div></section>
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