Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement

The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.


Adults Onset Stills Disease: a Review of 41 Cases

Molto1,  Anna, Riera2,  Elena, Olive1,  Alejandro, Narvaez3,  Javier, Holgado1,  Susana, Bianchi3,  Maria M., Mateo1,  Lourdes

Hospital Germans Trias i Pujol, Badalona, Spain
Hospital Universitari Mútua de Terrassa, Terrassa, Spain
Hospital Universitari de Bellvitge, Barcelona, Spain

Purpose:

To describe the clinical manifestations, treatment, evolution, prognosis and functional class of 41 patients with Adult Onset Still's Disease (AOSD)

Method:

Retrospective study (1984–2006). Multicenter study. Setting: Hospital Universitari Germans Trias i Pujol and Hospital Universitari de Bellvitge. All patients fulfilled Yamaguchi et al Classification criteria. (J Rheumatol 1992; 19: 424–430).

Results:

Forty one patients were included (15 men and 25 women). Mean age at diagnosis: 38.19 years (SD 15,59). All patients had spiking fever. Typical exanthema was present in 38 patients (92,6%). Symptoms were preceded by sore throat in 37 (90,2%). Forty patients (97,5%) had polyarthralgia and 36 (88%) had arthritis; polyarticular pattern in 29 (80,5%) and oligoarticular in 7 (19,5%). Knees, wrists and ankles were the joints more often involved. Other clinical manifestations were lymphadenopathy in 17 patients (41%), hepato/splenomegaly in 16 (39%), abdominal pain in 5 (12%), pleuritis in 6 (14,6%), pericarditis in 5 (12%) and interstitial pneumopathy in 2 (4,8%). Most of the patients had leucocytosis and neutrophilia and a remarkable elevation of ESR and CRP. Liver function abnormalities were detected in 50% of the patients. Hyperferritinemia was preset in (83%.)

The course of the disease was monocyclic in 44% of the patients and polycyclic/chronic in 56%.

ASA or NSAID controlled the disease in seven patients (17,5%) and prednisone in eleven (27,5%). Immunosupressors were required in 55% of the patients and in seven of them (17,5%) a biological treatment with TNF-a blockers or anakinra had to be added in order to control the disease.

Currently 17 patients (42,4%) are free of disease without treatment (mean duration of disease 114.74 moths. SD: 105,65) and totally asymptomatic (72.55 moths; SD 30,75). Fifteen patients had a monocyclic patterns and a polycyclic-chronic in two.

Twenty-three patients (57,5%) are still on treatment (duration of disease: 110.96 months. SD: 70,22). Three patients treated with ASA, 1 with NSAID and prednisone, 8 with NSAID, prednisone and methotrexate, 4 with methotrexate alone and 7 with NSAID, prednisone, methotrexate and a biological treatment. Four patients had a monocyclic course and 19 a polycyclic-chronic one.

Erosions were present in nine patients (22%). ACR class were as follows: 29 (72,5%) class I, 7 (17,5%) class II, 2 (5%) class III and 2 (5%) class IV.

Conclusion:

The clinical manifestations were similar to other series. A fevered polyarthritis was the most frequent clinical presentation. Patient with monocyclic course tend to have a better prognosis. Fifty six percent of the patients had a polycyclic-chronic course and required an aggressive treatment. Radiological bony erosions were present in 22% of patients. Most patients are in functional class I.

To cite this abstract, please use the following information:
Molto, Anna, Riera, Elena, Olive, Alejandro, Narvaez, Javier, Holgado, Susana, Bianchi, Maria M., et al; Adults Onset Stills Disease: a Review of 41 Cases [abstract]. Arthritis Rheum 2009;60 Suppl 10 :791
DOI: 10.1002/art.25871

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