Still’s disease

Published on 02/04/2015 by admin

Filed under Internal Medicine

Last modified 02/04/2015

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135 Still’s disease

Instruction

Examine this patient’s joints.

Look at this patient.

Salient features

History

• Maculopapular rash

• History of fever in the initial stages of the disease

• Joint pains, swelling, determine onset and course

• Sore throat.

Examination

• Micrognathia

• Joints usually involved are upper cervical apophyseal joints, carpometacarpal joints and terminal interphalangeal joints (Fig. 135.1)

• Splenomegaly and lymph node enlargement

• Eyes (Fig. 135.2).

image

Fig. 135.1 Hands and wrists in a girl with rheumatoid factor-negative polyarticular juvenile rheumatoid arthritis. There is symmetric involvement of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints.

(With permission from Kliegman et al. 2007.)

image

Fig. 135.2 Chronic anterior uveitis in juvenile rheumatoid arthritis, with small irregular pupil, well-developed cataract and early band keratopathy at the medial and lateral margins of the cornea.

(With permission from Kliegman et al. 2007.)

Diagnosis

This patient has micrognathia, arthropathy of terminal interphalangeal joints and a past history of maculopapular rash (lesion) caused by Still’s disease (aetiology).

Notes

• The classic triad of Still’s disease is fever, oligoarticular arthritis and an evanescent salmon-coloured rash (which typically appears with the fever spikes), although the rash is persistent in up to one-third of patients.

• A sore throat is characteristic.

• Elevated ferritin levels, leukocyte counts, serum liver enzyme, and ESR are common.

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