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Misdiagnosis of Still's Disease

Jack Cush, MD

High fever, strange rashes, scary labs often lead to a consideration of Still's disease (AOSD or systemic JIA). Yet the dramatic onset of a systemic disorder may overlap with another, and possibly as rare, systemic disorder that should not be misdiagnosed or mistreated. A current case review by Zhu et al. presents six cases initially diagnosed as systemic JIA, teaching several important lessons.

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Doubting RS3PE (8.14.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and journal articles this week where RheumNow featured info on cancer, deadly viruses, AI rules, poetry and good moons rising.

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ZEUS Trial: IL-6 Inhibition Fails to Cut Cardiovascular Events

Jack Cush, MD

The phase 3 ZEUS trial (published in JAMA Dec. 2025)  tested the IL-6 ligand inhibitor ziltivekimab in over 6,000 patients with atherosclerotic cardiovascular disease, chronic kidney disease, and elevated hsCRP—a population enriched for an inflammatory driver of risk.

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Mentshlichkeit* (8.7.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news and recent journal reports on RheumNow.com.

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A Tribute to Daniel L. Kastner, MD, PhD (1951–2026)

Jack Cush, MD

The rheumatology, genetics and NIH communities mourn for Dr. Daniel L. Kastner, who died on July 28, 2026, in Bethesda, Maryland, at age 74. The following are declarations, tributes, and memories dedicated to this mensch of a man, titan of science, memorable mentor and humble physician.

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$2 Million in Research Grants for Juvenile Arthritis

Jack Cush, MD

July is Juvenile Arthritis Awareness Month, and while many people think of arthritis as a disease of aging, nearly 300,000 children in the U.S. are living with a rheumatic disease.

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Chikungunya Club Meeting (7.24.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal reports from the past week on RheumNow.com.

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Gout Cavalcade (7.10.2026)

Jack Cush, MD

Dr. Jack Cush reviews the news, journal articles and regulatory decisions from the past week. July is Gout: More than Flares month.

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🔥 Still’s Disease Awareness Day 2026 🐉 I Won’t Be Still: Making Still’s Disease Visible Show us a moment from your life with Still’s Disease. 📸 Share a photo/video + what “I Won’t Be Still” means to you. For 47 hours, let’s make Still’s visible. #MyStills #StillsDay https://t.co/B7VNmlIOQj

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AiArthritis IFAiArthritis ( View Tweet)
🆕 #AutoInflammatory / Periodic Fever Syndromes In Memory of Dr. Dan Kastner🕊️ So grateful Dr. Kastner agreed to review this graphic >1 year ago, providing thoughtful input and suggestions to improve the final version 🙏 New Board Review Series for Rheum OnePagers 📟 #RheumX https://t.co/zx8dX2yHkA

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Mithu Maheswaranathan, MD MithuRheum ( View Tweet)
Misdiagnosis of Still's Disease High fever, strange rashes, scary labs often lead to a consideration of Still's disease (AOSD or systemic JIA). Yet the dramatic onset of a systemic disorder may overlap with another, and possibly rarer, systemic disorder that should not be https://t.co/pSfSahO5Nw
Dr. John Cush RheumNow ( View Tweet)
Misdiagnosis of Still's Disease High fever, strange rashes, scary labs often lead to a consideration of Still's disease (AOSD or systemic JIA). Yet the dramatic onset of a systemic disorder may overlap with another, and possibly as rare, systemic disorder that should not be https://t.co/mCbNBAt9T5
Dr. John Cush RheumNow ( View Tweet)
Substudy of 131 Still’s dz pts from the Autoinflammatory Dz (AIDA) registry. 38% underdosed w/ canakinumab (CAN) vs 62% appropriately dosed (300 mg q4wks or 4 mg/kg). Underdosed CAN had lower odds of long-term remission & D/C CAN (3.9% vs 19%) https://t.co/l94zB9NkKv https://t.co/FQTrCWZLQI

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Dr. John Cush RheumNow ( View Tweet)
Substudy of 131 Still’s dz pts from the Autoinflammatory Dz (AIDA) registry. 38% underdosed w/ canakinumab (CAN) vs 62% appropriately dosed (300 mg q4wks or 4 mg/kg). Underdosed CAN had lower odds of long-term remission & D/C CAN (3.9% vs 19%) https://t.co/l94zB9NkKv https://t.co/D8FNUXS0nv

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Dr. John Cush RheumNow ( View Tweet)
Retrospective study, 41 pediatric Behcets Dz pts looked at Inflam. indices (NLR, SII, PIV, CRP/albumin) vs controls. BD systemic involvement in 68%, CNS dz in 10%, Vascular Dz in 12% & major organ dz 46%. Inflamm indices significantly higher in BD w/ systemic, CNS, & Vasc https://t.co/wHiBIaOWWU
Dr. John Cush RheumNow ( View Tweet)
Chinese cohort of 209 AOSD pts identifed 49 (23%) w/ lung dz (by CXR), yet 69% were asymptomatic. Significcant risk factors for AOSD-LD were pleuritis, MAS (HR 2.62), & Dz relapse (HR 2.6). Imaging patterns: acute exudative pattern most prevalent, followed by interstitial and https://t.co/2IPJWRJicP
Dr. John Cush RheumNow ( View Tweet)
51 yoM w/ 2 yrs of FUO, unintentional 32-kg wt loss, LN, diffuse myalgias, but no GI Sxs or arthralgia. Neg MRIs, CT, PET scan, EGD, colonoscopy. Abnl labs: CRP 173 mg/L, ESR 46, anemia & ^ WBC. Cell-free DNA next-generation sequencing dx Tropheryma whipplei, & Whipple disease https://t.co/nJLa4l7Ers
Dr. John Cush RheumNow ( View Tweet)
2 Still's dz cohorts (96 Shanghai, 28 Erlangen0 compared response to biolgics vs DMARDs (MTX, CNI,JAKi). in 124 AOSD pts, biologic had more sustained event-free remission and event-free state (P 0.0065, P 0.0096) & more steroid D/C vs MTX/CNI (p < 0.05). https://t.co/lJaI9nhPYr

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Dr. John Cush RheumNow ( View Tweet)

ICYMI: VEXAS Syndrome - A Review Beck et al has published a review of the VEXAS syndrome in The Lancet, focusing on the pathogenesis, spectrum, and treatment strategies. https://t.co/K9IMLBdCGI https://t.co/LJdnRflzsU

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Dr. John Cush RheumNow ( View Tweet)
From Cytokine Endotypes to Clinical Reality in Still’s Disease Recent EULAR 2026 data highlight a paradigm shift in Still’s disease from syndromic management to biologically informed precision therapy. https://t.co/fBtkDLPJNE https://t.co/y8NBW6VHHa

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Dr. John Cush RheumNow ( View Tweet)
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