RESUMO
BACKGROUND: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. AIM: To report our experience with Adult Still's disease. MATERIAL AND METHODS: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago. RESULTS: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80% had odynophagia, 80% had an evanescent rash, 70% had myalgias, 50% had lymph node enlargement and 40% had splenomegaly. Laboratory showed leukocytosis in 80% and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80%, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80% required steroids and 35% required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and leflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. CONCLUSIONS: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.
Assuntos
Doença de Still de Início Tardio/diagnóstico , Adolescente , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Biomarcadores/sangue , Feminino , Ferritinas/sangue , Febre de Causa Desconhecida/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doença de Still de Início Tardio/sangue , Doença de Still de Início Tardio/tratamento farmacológico , Adulto JovemRESUMO
Background: Adult Still's disease is an inflammatory disorder characterized by quotidian fevers, and an evanescent rash. Its presentation can be acute or subacute. Aim: To report our experience with Adult Still's disease. Material and methods: Systematic retrospective review of medical records of nine men and 11 women aged between 17 and 57 years, with Still's disease, followed in two public hospitals of Metropolitan Santiago. Results: Eighty percent of patients had a prior different diagnosis. All presented with fever and joint involvement. Eighty percent had malaise, 80 percent had odynophagia, 80 percent had an evanescent rash, 70 percent had myalgias, 50 percent had lymph node enlargement and 40 percent had splenomegaly. Laboratory showed ¡eukocytosis in 80 percent and a high erythrocyte sedimentation rate in all. High ferritin levels were detected in 80 percent, and became an important diagnosis clue. Initial treatment was based on non steroidal antiinflammatory drugs, however 80 percent required steroids and 35 percent required methotrexate. Azathioprine, sulphalazine, hydroxychloroquine and ¡eflunomide were used occasionally. Eleven patients had a single episode, nine had a relapsing disease and four had a chronic or persistent mode. Conclusions: Adult Still's disease must be suspected in patients with fever of unknown origin. An early diagnosis and adequate treatment of the disease are associated with a favorable evolution and prognosis.