Continuous fever, rash does not go away...Beware of adult Still's disease

The high fever has been repeated for many years, and the body temperature often exceeds 39 degrees, and the highest is even more than 40 degrees .

Xiao Liu suddenly felt pain all over after work and was very uncomfortable.

(Source: Photograph Network)

At first I thought it was just a small cold, but after taking medicine or infusion of anti-inflammatory injections, I was bedridden, and my muscles and joints were so painful that I couldn't bear it

After tossing to the hospital many times, he was finally diagnosed as "adult Still's disease

Adult Still's disease, a confusing disease, what kind of disease is it? is it serious?

Adult Still's disease is a group of syndromes whose main manifestations are high fever, arthralgia (inflammation), skin rash, and elevated white blood cells , and the etiology and pathogenesis are not yet clear.

At present, there is still a lack of specific diagnosis for the diagnosis of the disease in clinical practice, and most of them use exclusive means (ie, restriction except for other related diseases)

25% progress to destructive polyarthritis, which behaves like rheumatoid arthritis

The age of onset is more common in young people, mostly 18-35 years old

Triad: high fever (every day) + transient rash + chronic polyarthritis (often hands and feet)

(1) Fever: Fever is ≥39℃ and lasts for more than 1 week.

(2) Skin rash: The typical skin rash of adult Still's disease is salmon pink with mild itching, which is obvious in fever

(3) Arthritis: usually arthralgia and/or arthritis, oligoarthritis in the early stage, polyarthritis can also develop, and myalgia symptoms are also common

In addition to the typical manifestations, there may be sore throat, lymph nodes and (or) hepatosplenomegaly, and severe cases may be accompanied by system damage

There is no specific diagnosis method for this disease, and it is based on the exclusionary diagnosis.

① Fever ≥39℃ and lasts for more than 1 week;

② Joint pain lasts for more than 2 weeks;

③ Typical skin rash;

④ White blood cells ≥15×109/L

① Sore throat;

② Enlarged lymph nodes and (or) spleen;

③ Abnormal liver function;

④ Rheumatoid factor and antinuclear antibody are negative

Exclude infectious diseases, malignant tumors, and other connective tissue diseases

Meet 5 or more conditions (including at least two main conditions), and exclude other diseases, can be diagnosed as the disease
.

PS: Elevated serum ferritin and decreased glycosylated ferritin are of great significance for the diagnosis of this disease, especially serum ferritin has certain significance for judging disease activity and evaluating treatment effects
.

Western medicine treatment

Adult Still's disease is no uniform treatment options, on the main clinical applications are: non-steroidal anti-inflammatory drugs, corticosteroids, immune suppression drugs into three categories
.

The treatment of acute fever and inflammation stage can firstly use non-steroidal anti-inflammatory drugs alone; for those who are not relieved by non-steroidal anti-inflammatory drugs alone, glucocorticoids can be added;

For those who still do not relieve or relapse with hormone reduction , add anti-rheumatic drugs to change the condition.
Methotrexate is the first choice.
The disease control is not satisfactory.
On the basis of methotrexate, combined with other anti-rheumatic drugs, some refractory or critically ill patients, It can be combined with glucocorticoid shock therapy, and if necessary, give biological treatment
.

Chinese treatment

Traditional Chinese medicine believes that the disease belongs to the categories of "febrile disease", "heat arthralgia", "internal injury and fever", and "deficiency"
.
Syndrome Differentiation and Treatment:

①Fever type

Symptoms: high fever persists, scarlet fever-like rash on the skin, burning in the palpitation, joint swelling and pain, irritability and thirst, red tongue, yellow coating, slippery pulse or chords
.

Treatment method : clearing away heat and detoxification, cooling blood to reduce spots
.

②Yin deficiency and fire prosperous type

Symptoms: Intermittent fever, heavier at night, joint soreness, rash now and then, scorched lips, dry mouth, red tongue, little or no moss, thin pulse
.

Treatment method: nourishing yin and reducing fire, cooling blood and detoxification
.

Finally, Dr.
Huang Runyue reminded everyone, if there is a fever and high fever, what is the anti-fever medicine? It's useless! Anti-inflammatory drugs? It's useless! Accompanied by symptoms such as skin rash, joint pain, etc.
, it is necessary to be vigilant if they are suffering from adult Still's disease
.
At this time, you should go to the Department of Rheumatology and Immunology for examination in time, confirm the diagnosis in time, and standardize the treatment!