Still’s disease

Disease database

Still’s disease, also known as systemic-onset juvenile idiopathic arthritis (SJIA), is a rare inflammatory disorder that primarily affects children. It is characterized by persistent high fever, rash, joint pain, sore throat, lymphadenopathy, hepatosplenomegaly, pleuritis, pericarditis, myocarditis, and renal disease. This article aims to provide valuable insights into Still’s disease, its symptoms, diagnosis, treatment options, and tips for managing the condition.

Fever: The Persistent Companion

The hallmark symptom of Still’s disease is a persistent high fever that typically spikes in the evening and subsides in the morning. The fever can reach as high as 104°F (40°C) and may last for weeks or even months. It is important to monitor and manage the fever to prevent complications and discomfort.

Rash: Unveiling the Skin Manifestations

A characteristic rash often accompanies Still’s disease. It presents as a salmon-pink or pale red maculopapular eruption, primarily affecting the trunk and extremities. The rash may come and go, and its appearance is often associated with fever spikes. Although the rash itself is not harmful, it serves as a visual indicator of the underlying inflammatory process.

Joint Pain: The Unwelcome Guest

Joint pain is a common symptom of Still’s disease and can be debilitating for affected individuals. The pain is typically worse in the morning and improves throughout the day. It primarily affects large joints such as the knees, wrists, and ankles. The inflammation in the joints can lead to stiffness, swelling, and limited range of motion.

Sore Throat: A Common Complaint

Many individuals with Still’s disease experience a sore throat, which can be accompanied by swollen tonsils and difficulty swallowing. The sore throat is often a result of the underlying systemic inflammation and can be managed with over-the-counter pain relievers and throat lozenges.

Lymphadenopathy: Enlarged Lymph Nodes

Lymphadenopathy, or enlarged lymph nodes, is a common finding in Still’s disease. The lymph nodes may be tender to touch and can be felt in areas such as the neck, armpits, and groin. While lymphadenopathy is not typically painful, it serves as an important clinical clue in diagnosing the condition.

Hepatosplenomegaly: The Enlarged Organs

In some cases of Still’s disease, the liver (hepatomegaly) and spleen (splenomegaly) may become enlarged. This enlargement is a result of the systemic inflammation and can be detected through physical examination or imaging tests. Monitoring liver and spleen size is crucial to assess disease progression and response to treatment.

Pleuritis: Inflammation of the Lungs

Pleuritis, or inflammation of the lining surrounding the lungs, can occur in individuals with Still’s disease. This can lead to chest pain, especially during deep breathing or coughing. Pleuritis may require specific treatment approaches to alleviate symptoms and prevent complications.

Pericarditis: Inflammation of the Heart

Pericarditis, inflammation of the sac surrounding the heart, is another potential complication of Still’s disease. It can cause chest pain, shortness of breath, and a rapid heartbeat. Prompt medical attention is necessary to manage pericarditis and prevent further cardiac complications.

Myocarditis: Inflammation of the Heart Muscle

Myocarditis, inflammation of the heart muscle itself, can occur in severe cases of Still’s disease. This can lead to heart failure and other cardiac complications. Close monitoring of cardiac function and early intervention are crucial in managing myocarditis.

Renal Disease: The Impact on Kidneys

Still’s disease can also affect the kidneys, leading to renal disease. This can manifest as proteinuria (presence of excess protein in the urine), hematuria (blood in the urine), or impaired kidney function. Regular monitoring of kidney function and appropriate management strategies are essential to preserve renal health.

Diagnosis and Treatment

Diagnosing Still’s disease can be challenging due to its overlapping symptoms with other conditions. A thorough medical history, physical examination, and laboratory tests are essential for an accurate diagnosis. Blood tests may reveal elevated inflammatory markers, such as C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR).

Treatment for Still’s disease aims to control symptoms, reduce inflammation, and prevent complications. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often prescribed to manage fever, joint pain, and inflammation. In more severe cases, corticosteroids may be used to suppress the immune system and reduce inflammation.

For individuals with persistent or severe symptoms, disease-modifying antirheumatic drugs (DMARDs) such as methotrexate or biologic agents may be prescribed. These medications help to regulate the immune system and reduce inflammation. Regular follow-up appointments and monitoring are necessary to assess treatment response and adjust medications as needed.

Managing Still’s Disease: Tips and Lifestyle Changes

While there is no known cure for Still’s disease, there are several strategies individuals can adopt to manage their symptoms and improve their quality of life:

  • Follow the prescribed treatment plan and take medications as directed.
  • Engage in regular physical activity to maintain joint mobility and overall fitness.
  • Apply heat or cold packs to affected joints for pain relief.
  • Practice relaxation techniques, such as deep breathing or meditation, to manage stress and reduce inflammation.
  • Ensure a balanced diet rich in fruits, vegetables, and omega-3 fatty acids to support overall health and reduce inflammation.
  • Stay hydrated and avoid excessive alcohol consumption.
  • Seek emotional support from friends, family, or support groups to cope with the challenges of living with a chronic condition.

It is important for individuals with Still’s disease to work closely with their healthcare team to develop a personalized management plan that addresses their specific needs and goals.

In conclusion, Still’s disease is a complex inflammatory disorder that primarily affects children. It presents with a range of symptoms, including fever, rash, joint pain, sore throat, lymphadenopathy, hepatosplenomegaly, pleuritis, pericarditis, myocarditis, and renal disease. While there is no cure for Still’s disease, early diagnosis and appropriate treatment can help manage symptoms, reduce inflammation, and prevent complications. By following a comprehensive management plan and making lifestyle changes, individuals with Still’s disease can lead fulfilling lives despite the challenges posed by the condition.

Haroon Rashid, MD
Rate author
Urgent Care Center of Arlington, VA
Add a comment