Best of 2022: Five Mistakes When Diagnosing Still’s Disease

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Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.

Best of 2022: Myths & Misconceptions with Febrile Disorders

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Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations.

Still's disease: paediatrics to adults, a continuum or not?

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Still’s disease is a rare inflammatory disorder, affecting less than 1 person per 2000 people. This disease may occur in both children and adults, namely as systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still’s disease (AOSD). The paediatric form was described by George Still in 1896, whereas the adult variant later by Eric Bywaters in 1971. However only the adult disease is identified by the name of Still.

The Still’s Continua

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The concept of a “Still’s disease continuum” that encompasses both sJIA and AOSD is based on the many common clinical, genetic and laboratory features shared by both sJIA and AOSD.

AOSD: complicated disease or a disease with complications?

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Many clinicians may not have seen a case of AOSD during training, which overall leads to several delays in referrals and appropriate diagnosis for AOSD patients. AOSD is an autoinflammatory disease where innate immunity plays a primary role and is characterized by seemingly unprovoked inflammation, but without the high-titer autoantibodies or antigen specific T cells seen in autoimmune diseases.

Myths & Misconceptions with Febrile Disorders

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Still’s disease and autoinflammatory disorders are rare conditions unified by recurrent fevers and inflammation of skin, joints, and other organs. While labs often support the diagnosis, these conditions are best diagnosed by genetic testing, or by specific criteria (in the absence of a genetic test). The following is a table that lists common misconceptions (myths) and their clarifying explanations.

Five Mistakes When Diagnosing Still’s Disease

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Adult-onset Still's presents an interesting and diagnostic challenge when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.

Q Fever - The Intersection of Rheum and ID

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Today in clinic, I saw a patient with longstanding seropositive, erosive rheumatoid arthritis who had been treated with etanercept for over 10 years. She had undergone valve replacement years ago for regurgitation.

“The Big Sick” Movie Review

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It's Monday morning and my first patient is a newly diagnosed rheumatoid. This is his first visit back after starting methotrexate 6 weeks ago. Despite doing great and in remission with only one active joint, he asks, “Are sure this is RA? Or could this be Still’s disease?” Admittedly, this is a weird second-visit question, but I was impressed.  

5 Mistakes When Diagnosing Adult-Onset Still’s Disease

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Adult-onset Still's posses a interestng and diagnostic challeng when encountered. Here are 5 tips to improve your diagnostic acumen for this febrile disorder.