Is Still's disease serious?

Still's disease is a type of juvenile arthritis caused by a systemic type. It is divided into juvenile Still's disease and adult Still's disease because of different age groups. People with this disease generally show symptoms such as fever, rash, sore throat, joint pain, swollen lymph nodes, etc. In severe cases, it may be accompanied by systemic damage. The incidence rate of this disease is similar in men and women. It is almost prevalent throughout the world, and the 16 to 35 year old group is a high-risk group. Is Still's disease serious? Let’s take a look at it together:

The clinical manifestations of this disease are complex and diverse, often involving multiple systems. Symptoms include fever, rash, joint pain, followed by sore throat, swollen lymph nodes, hepatomegaly, splenomegaly and serositis.

1. Fever

Fever is one of the important manifestations of this disease. Seen in almost all patients. It is usually a sudden high fever, with one peak a day, and occasionally two peaks a day. The main symptom is high fever, with body temperature often exceeding 39°C, generally reaching a peak in the afternoon or evening. Some patients may start with low- to moderate-grade fever and develop high fever after 2 to 4 weeks. Some patients have irregular body temperature and may have high fever at any time of the day. The most common type of high fever is remittent fever, and others include irregular fever and retained fever. About half of the patients experience chills before fever, but chills are rare. The fever may last from several days to several years and recur repeatedly. When fever occurs, symptoms of rash, sore throat, muscle and joint pain will worsen. After the fever subsides, the rash may disappear and the above symptoms may be alleviated. Although most patients have long-term fever, their general condition is good and they have no obvious symptoms of poisoning.

2. Skin rash

Rash is another major manifestation of this disease. More than 85% of patients develop transient rash during the course of the disease. It manifests as diffuse congested red maculopapules, sometimes with mild itching, generally distributed on the neck, trunk and extensor sides of the limbs. The rash has variable morphology and some patients may also present with urticaria, erythema nodosum or hemorrhages. The time of appearance of the rash is irregular, usually appearing in the evening when the fever occurs and disappearing in the early morning when the fever subsides, that is, it is characterized by disappearing during the day and appearing at night. It is transient and leaves no trace after the rash disappears, but in a few cases large areas of pigmentation may remain.

3. Joint and muscle symptoms

Joint pain and arthritis are one of the main clinical manifestations of this disease, but they can be so mild that they are easily overlooked. The onset is generally insidious, with symptoms such as pain, swelling, and tenderness in the joints and soft tissues around the joints. Some patients develop joint symptoms only after having fever for many days or months. Most patients do not have residual joint deformities. A small number of patients with multiple joints and proximal interphalangeal joints may also develop chronic joint damage.

4. Sore throat

It occurs in 50% of patients, often early in the course of the disease and sometimes persists throughout the course of the disease. Sore throat may occur or worsen during fever and improve after the fever subsides. Examination of the pharynx revealed pharyngeal congestion, hyperplasia of lymphoid follicles in the posterior pharyngeal wall, and enlarged tonsils. Throat swab culture was negative, and antibiotic treatment was ineffective for this type of pharyngitis.

5. Swollen lymph nodes

In the early stages of the disease, there is often enlargement of superficial lymph nodes throughout the body, especially in the armpits and groin, which are significantly symmetrically distributed, soft and slightly tender, without adhesions and of varying sizes. Some patients experience enlarged hilar and mesenteric lymph nodes, which can cause non-fixed abdominal pain. Mesenteric lymph node necrosis can cause severe abdominal pain. After the body temperature returns to normal, the swollen lymph nodes shrink or disappear.

6. Hepatosplenomegaly

About half of the patients have mild to moderate liver enlargement and soft texture. About 3/4 of patients have abnormal liver function and elevated alanine aminotransferase. Some patients have jaundice, but alkaline phosphatase, γ-glutamyl transpeptidase and creatine phosphokinase are generally normal. After symptoms are relieved, the liver can return to normal. A small number of patients experience enzyme-bile separation and subacute severe hepatitis. Acute liver failure, leading to death. The spleen is mildly to moderately enlarged, soft in texture, with smooth edges, and returns to normal after the disease resolves.

Of course, in addition to the common phenomena mentioned above, Still's disease also has some other rare phenomena. Once discovered, they must be treated in time, otherwise serious consequences will occur.