The Spectrum of Still's Disease: A Comparative Analysis of Phenotypic Forms in a Cohort of 238 Patients

Still's disease (SD) is a heterogeneous autoinflammatory disorder for which several phenotypes have been described. We conducted a retrospective study to re-evaluate the dichotomous view of the disease, to compare the juvenile and adult forms, and to look for prognostic factors. We collected da...

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Published in:Journal of clinical medicine 2022-11, Vol.11 (22), p.6703
Main Authors: Neau, Pierre-Antoine, El-Jammal, Thomas, Javaux, Clément, Fournier, Nicolas, Chol, Orlane, Adelaïde, Léopold, Ly, Kim Heang, Gerfaud-Valentin, Mathieu, Perard, Laurent, Fouillet-Desjonqueres, Marine, Le Scanff, Julie, Vignot, Emmanuelle, Hot, Arnaud, Belot, Alexandre, Durieu, Isabelle, Sève, Pascal, Jamilloux, Yvan
Format: Article
Language:English
Subjects:
Arthritis
Biopsy
Bone marrow
Classification
Disease
Generalized linear models
Lymphatic system
Multivariate analysis
Patients
Remission (Medicine)
Rheumatology
Variables
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Summary:Still's disease (SD) is a heterogeneous autoinflammatory disorder for which several phenotypes have been described. We conducted a retrospective study to re-evaluate the dichotomous view of the disease, to compare the juvenile and adult forms, and to look for prognostic factors. We collected data from ten French centers, seeking patients with a diagnosis of adult-onset SD (AOSD) or systemic juvenile idiopathic arthritis (sJIA). We identified 238 patients, 152 (64%) of whom had AOSD while 86 (36%) had sJIA. The median age at SD onset was 26.6 years. In patients with identifiable patterns, the course of SD was systemic in 159 patients (74%), chronic in 55 (26%). Sore throat and myalgia were more frequent in patients with AOSD. Abnormal liver tests, serum ferritin and C-reactive protein levels were higher in AOSD group. Fever and skin rash were predictive of complete remission or recovery and high lactate dehydrogenase level was a poor prognosis factor. Symptoms such as splenomegaly, skin rash, high polymorphonuclear neutrophils count and macrophage activation syndrome were predictive of a systemic phenotype. Overall, there were no major differences between sJIA and AOSD. Our results are consistent with the "biphasic" model of an autoinflammatory disease that can progress to chronic arthritis if not treated early.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm11226703