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Treatment of adult Still's disease

Lisa A Mandl, MD, MPH
Section Editor
James R O'Dell, MD
Deputy Editor
Paul L Romain, MD


Adult Still’s disease (ASD) is an inflammatory disorder characterized by quotidian (daily) fevers, arthritis, and an evanescent rash. Following its initial description in children by George Still in 1896, “Still’s disease” became the eponymous term for juvenile inflammatory arthritis, subsequently termed systemic juvenile idiopathic arthritis (JIA) [1,2]. In 1971, the term “adult Still’s disease” was used to describe a series of adult patients who did not fulfill criteria for classic rheumatoid arthritis (RA) but who had features similar to the children with systemic JIA [3]. (See "Systemic juvenile idiopathic arthritis: Clinical manifestations and diagnosis".)

The treatment and prognosis of ASD will be reviewed here. It is important to exclude other systemic conditions that may present with symptoms similar to ASD, such as infection and malignancy, before initiating immunosuppressive therapies. The clinical manifestations and diagnosis of ASD are presented separately. (See "Clinical manifestations and diagnosis of adult Still's disease".)


The goals of therapy include:

Controlling physical signs and symptoms of inflammation (eg, fever, rash, morning stiffness, joint pain, and swelling) and, secondarily, controlling laboratory indices of inflammation (eg, elevations in the erythrocyte sedimentation rate [ESR] and levels of C-reactive protein [CRP]) (see "Clinical manifestations and diagnosis of adult Still's disease", section on 'Clinical features')

Preventing end organ damage, including joint injury and other major organ complications (see "Clinical manifestations and diagnosis of adult Still's disease", section on 'Clinical features')

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Literature review current through: Nov 2017. | This topic last updated: Apr 22, 2016.
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