From the Guidelines
Adult-onset Still's disease (AOSD) is characterized by a triad of symptoms including high-spiking fevers, a characteristic salmon-pink rash, and arthritis/arthralgias, with fever being the most common symptom, occurring in 95.7% of patients 1. The fever in AOSD is typically transient, lasting under 4 hours, and is most commonly quotidian or double quotidian in pattern, with the highest temperatures seen in the late afternoon or early evening.
- Key symptoms of AOSD include:
- High-spiking fevers exceeding 39°C
- A characteristic salmon-pink, maculopapular rash, predominantly found on the proximal limbs and trunk
- Arthralgia and arthritis, found in the majority of patients, with incidences ranging from 64% to 100%
- Other common symptoms such as sore throat, myalgias, lymphadenopathy, and splenomegaly The rash in AOSD is often accompanied by fever, can be mildly pruritic, and may be confused with a drug allergy, with an incidence ranging from 51% to 87% 1. Arthralgia and arthritis are found in the majority of patients with AOSD, with the joints most frequently affected being the knees, wrists, and ankles, although involvement of other joints has also been described 1. The clinical manifestations of AOSD can be summarized as a combination of systemic and articular symptoms, with fever being the most common and consistent symptom across different studies 1.
From the Research
Symptoms of Adult-Onset Still's Disease (AOSD)
The symptoms of AOSD can be diverse and may vary from patient to patient. Some common symptoms include:
- High spiking fevers 2, 3, 4, 5, 6
- Evanescent rash synchronous with fever 3, 4, 5, 6
- Polyarthritis or diffuse arthralgias 3, 4, 6
- Lymphadenopathy 5, 6
- Hepatosplenomegaly 5, 6
- Hyperferritinemia 5, 6
- Leukocytosis 6
- Multiorgan involvement may develop according to the hyper-inflammatory extent 3
Clinical Course
The clinical course of AOSD can be divided into three significant patterns, each with a different prognosis: