Still's disease in adults and children: causes, symptoms, treatment

The most important role in the treatment of a rare disease is played by diagnostics, which makes it possible to differentiate the disease with a number of other disorders with health. Treatment of the disease is long, but the prognosis in patients who turned to a specialist on time, in most cases good.

History of the disease

For the first time about the disease learned in 1897 thanks to the doctor George Still. But at this time, Still's disease was considered only one form of rheumatoid arthritis. It was not until 1971 that Eric Bywaters published research highlighting the disease from a series of problems with similar symptoms.

Medical statistics show that both men and women can equally get a rare disease. However, the majority of patients who consulted a doctor with symptoms of Still's disease and who received a confirmatory diagnosis are children under 16 years of age. Given the young age of most patients, the diagnosis becomes more complicated, since it is difficult for parents who first noticed symptoms in a child to believe in having such an "age" problem.

Causes of the disease

So far, the etiology of the development of the disease is unclear. Numerous studies aimed at identifying the factor that provoked Still's disease in adults and children have not yielded results. According to the generally accepted hypothesis, the disease is the result of exposure to the body of infectious or viral agents, but there is no evidence to support this claim.

Doctors tried to associate the disease with pregnancy, the use of medications, including female hormones, stress and other factors. According to some data, Still's disease belongs to autoimmune disorders. Only the fact that in the active phase the disease is characterized by changes in the concentration of cytokines has been reliably proven. Perhaps in the future, medicine will be able to identify the cause of the disease, thereby simplifying its diagnosis and speeding up the recovery of patients.

Symptoms of Still's disease in adults

Still's disease, the symptoms of which are similar to a number of other diseases, are diagnosed according to several indicators:

• The fever that occurs with Still's disease differs from the fever inherent in a number of infectious diseases by its inconsistency. Traditionally, the temperature during the day is kept within normal limits, but twice a day it rises to 39 degrees and above. At the same time, in a fifth of patients, there is no reduction in temperature and improvement in the patient's well-being, which significantly complicates the diagnosis.
• At the peak of temperature rise, the patient exhibits skin rashes, represented by pink papules or maculae. Most often, the rash is located on the trunk and in the proximal parts of the extremities, less often - the rash is represented on the face. In a third of patients, the rash rises above the skin, appearing mainly in the areas of friction and squeezing. A similar symptom is called the Kebner phenomenon. Not always the rash is accompanied by itching, and its rather pale pink color and periodic disappearance make the symptom invisible to the patient. Doctors for the exact diagnosis are forced to subject the patient to heat, which activates the appearance of rashes. It can be a warm shower or the application of warm wipes. Atypical manifestations of the disease are: alopecia, erythema nodosum, petechial hemorrhages. But in practice, such symptoms are extremely rare.

• The initial stage of Still's disease is characterized by the appearance of myalgias and arthralgias. At first, only one joint is affected. Over time, the disease covers other joints, assuming the nature of polyarthritis. First of all, knee, ankle, wrist, hip, temporomandibular, metatarsophalangeal joints are affected. But the peculiarity of the disease, the most typical for most cases, is the development of arthritis of distal interphalangeal joints of the hands. This is what makes it possible to differentiate Still's disease from rheumatic fever, red systemic lupus erythematosus or rheumatoid arthritis.
• In 65% of cases, lymphadenopathy occurs against the background of the disease. In half of patients, cervical lymph nodes increase. In some cases, lymphadenitis takes a necrotic character.
• At the beginning of the disease, patients notice a marked burning in the throat, which is permanent.
• For Still's disease, cardiopulmonary manifestations are also characteristic, such as aseptic pneumonitis, cardiac tamponade, valve vegetations, respiratory distress syndromes.
• In patients, ophthalmic disorders are noted. This is a complicated cataract, ribbon-like degeneration of the cornea, iridocyclitis.

Still's disease in children

The symptomatology of the disease in children does not differ from the adult. However, the manifestations of Still's disease in childhood can be lubricated, which leads to late diagnosis and untimely treatment. Sometimes polyarthritis in childhood leads to disability. To avoid this, parents should be extremely attentive to the physical condition of the child. And at the first symptoms of the disease, contact a qualified specialist. Launched Still's disease in children can provoke a disproportionate growth of the limbs, which will require surgical intervention.

Diagnosis of the disease

Since the specific symptoms of the disease are practically absent, diagnosis is difficult. In every twentieth case, Still's disease is treated as an unexplained fever. In a number of cases, a diagnosis of sepsis is made. And only after a series of unsuccessful courses of antibacterial therapy and a number of additional tests, doctors come to the conclusion that this is the Still's disease of adults. Treatment and rehabilitation - procedures are long and require constant medical supervision. The same applies to children.

When the diagnosis is made, symptoms like heat, swelling of the joints, enlarged lymph nodes and sore throats, as well as other indicators obtained with the help of echocardiograms, computed tomography and ultrasound are taken into account. Required and a blood test, showing the level of platelets and leukocytes. With Still's disease, the patient is characterized by a decrease in the level of red blood cells. In adults, C-reactive protein and ferritin are elevated. In this case, the tests for antinuclear antibodies and rheumatoid factor are usually negative.

Treatment during remission

Complex and stage-by-stage treatment is carried out both in the active phase of the disease and during the remission period. In the first case, the procedures are performed in a hospital, in the second - patients receive the necessary therapy, being outpatient or in a sanatorium. Therapy includes medication, physiotherapy, physiotherapy and massage.

Treatment during an exacerbation of the disease

During the exacerbation of the disease, patients take NSAIDs, immunosuppressants, glucocorticoids. Treatment is always lengthy. That is why both the patient himself and his relatives need to stock up with a large dose of patience. Still's disease in adults and children is a serious disease, and it can be managed only with timely diagnosis and correctly prescribed treatment.

Forecast

After treatment, there are three possible forms of the disease. The best of them is spontaneous recovery, observed in a third of patients with a rare diagnosis. A third of patients have a recurring form of the disease. The most difficult option is chronic Still's disease in adults. Treatment, recovery and rehabilitation in this case can include not only traditional therapy, but also arthroplasty, which allows to restore the joints destroyed by the disease.