【Professor Lin Jin】Special topic of adult Still's disease: Rheumatologists should always be aware of differential diagnosis

Adult onset Still disease (AOSD) is a group of clinical syndromes of unknown etiology, mainly characterized by high fever, transient rash, arthritis, arthralgia, sore throat, and elevated white blood cell count, often accompanied by Liver, spleen, and lymph node enlargement
.

Adult onset Still disease (AOSD) is a group of clinical syndromes of unknown etiology, mainly characterized by high fever, transient rash, arthritis, arthralgia, sore throat, and elevated white blood cell count, often accompanied by Liver, spleen, and lymph node enlargement
.

Today, Mays interviewed Professor Lin Jin from the Department of Rheumatology and Immunology of the First Affiliated Hospital of Zhejiang University School of Medicine to answer our questions about adult Still's disease
.

Today Mays interviewed from Immunization

 

0 There is still a long way to go in the study of adult Still's disease.
What do you think is the urgent problem to be solved in this disease?

There is still a long way to go in the study of adult Still's disease.
What do you think is the urgent problem to be solved in this disease? There is still a long way to go in the study of adult Still's disease.
What do you think is the urgent problem to be solved in this disease?

1. No specific diagnostic method for adult Still's disease

No specific diagnostic method for adult Still's disease

There is no specific method for the diagnosis of Still 's disease in adults

1. The clinical manifestations are complex and diverse, so that the first diagnosis of the patient is not in the rheumatology department

The clinical manifestations are complex and diverse, so that the first diagnosis of the patient is not in the rheumatology department

The clinical manifestations are complex and diverse, resulting in the patient's first diagnosis not being in the rheumatology department .

, Interpretation of the classification criteria of adult Still's disease : American Cush criteria VS Japanese criteria

Interpretation of classification criteria for adult Still's disease : Interpretation of American Cush criteria VS Japanese criteria

 

Interpretation of American Cush Standard

Prerequisites	Any 2 of the following are also required
①Fever ≥39℃	①White blood cells≥15x109/L
②Joint pain or arthritis	② Rash
③RF<1:80	③ Pleurisy or pericarditis
④Anti-nuclear antibody <1:100	④ Hepatomegaly or spleen or lymphadenopathy

PrerequisitesAny 2 of the following are also required①Fever ≥39℃①White blood cells≥15x109/L    ②Joint pain or arthritis ② Rash     ③RF<1:80 ③ Pleurisy or pericarditis    ④Anti-nuclear antibody <1:100 ④ Hepatomegaly or spleen or lymphadenopathy     Prerequisites Any 2 of the following are also required     Prerequisites Any 2 of the following are also required     ①Fever ≥39℃ ①White blood cells≥15x109/L     ①Fever ≥39℃ ①White blood cells≥15x109/L    ②Joint pain or arthritis ② Rash    ②Joint pain or arthritis ② Rash     ③RF<1:80 ③ Pleurisy or pericarditis     ③RF<1:80 ③ Pleurisy or pericarditis    ④Anti-nuclear antibody <1:100 ④ Hepatomegaly or spleen or lymphadenopathy    ④Anti-nuclear antibody <1:100 ④ Hepatomegaly or spleen or lymphadenopathy Interpretation of Japanese standards for blood vessels

Main conditions:	Secondary conditions:
①Fever ≥39℃ and last for more than 1 week	① sore throat
②Arthralgia persists for more than 2 weeks	② lymph node and (or) spleen enlargement
③ Typical rash	③ abnormal liver function
④ Leukocytes≥10x109/L	④RF and antinuclear antibody negative

Main conditions: Secondary conditions:   ①Fever ≥39℃ and last for more than 1 week    ① sore throat  ②Arthralgia persists for more than 2 weeks    ② lymph node and (or) spleen enlargement   ③ Typical rash    ③ abnormal liver function   ④ Leukocytes≥10x109/L    ④RF and antinuclear antibody negative Main conditions: Secondary conditions: Main conditions: Secondary conditions:   ①Fever ≥39℃ and last for more than 1 week    ① sore throat   ①Fever ≥39℃ and last for more than 1 week    ① sore throat  ②Arthralgia persists for more than 2 weeks    ② lymph node and (or) spleen enlargement  ②Arthralgia persists for more than 2 weeks    ② lymph node and (or) spleen enlargement   ③ Typical rash    ③ abnormal liver function   ③ Typical rash    ③ abnormal liver function   ④ Leukocytes≥10x109/L    ④RF and antinuclear antibody negative   ④ Leukocytes≥10x109/L    ④RF and antinuclear antibody negative

exclude:

1. Infectious diseases (especially sepsis and infectious mononucleosis)

2. Malignant tumors (especially malignant lymphoma , sepsis)

3. Other rheumatic diseases (especially multiple aneurysms, etc. )

Diagnosis: 5 or more conditions (at least 2 major conditions) are met to make the diagnosis .

     1.

Liver involvement is a common clinical symptom of adult Still's disease.

1.
Primary liver damage caused by viral infection

1.
Primary liver damage caused by viral infection 1.
Primary liver damage caused by viral infection

China is a big country with hepatitis B.
According to statistics , there are about 70 million cases of hepatitis B virus infection in China.
Therefore, when patients with abnormal liver function indicators should pay attention to exclude the infection caused by hepatitis B and other hepatitis viruses
.

China is a big country with hepatitis B.
According to statistics , there are about 70 million cases of hepatitis B virus infection in China.
Therefore, when patients with abnormal liver function indicators should pay attention to exclude the infection caused by hepatitis B and other hepatitis viruses
.

statistics

Infections caused by viruses often have fever and increased white blood cells.
At this time, attention should be paid to excluding EB virus infection, enterovirus infection, cytomegalovirus infection and liver damage caused by some common viral infections
.

Moreover, adult patients with Still's disease often require long-term use of glucocorticoids and immunosuppressants, which also increase the risk of viral infection and liver damage

Infections caused by viruses often have fever and increased white blood cells.

2.

3.
Beware of Hemophagocytic Syndrome

3.
Be wary of hemophagocytic syndrome 3.
Be wary of hemophagocytic syndrome

Clinicians should be alert to hemophagocytic syndrome, which is one of the worsening manifestations of adult Still's disease, and can even be life-threatening, when a patient has a sudden increase in body temperature, liver damage, increased jaundice, and thrombocytopenia
.

Adult Still's disease is more common in young women, and most patients require pregnancy
.

How should doctors deal with such patients?

Adult Still's disease is more common in young women, and most patients require pregnancy

2.
Patients can wait for the disease to recover before trying to prepare for pregnancy

As a senior in the Department of Rheumatology and Immunology, what experiences in diagnosis and treatment can you share with doctors who are just entering the clinic?

As a senior in the Department of Rheumatology and Immunology, what experiences in diagnosis and treatment can you share with doctors who are just entering the clinic?

1.
Avoid Overdiagnosis

1.
Avoid Overdiagnosis 1.
Avoid Overdiagnosis

Rheumatology and immunology is a very challenging discipline with complex and diverse clinical manifestations, so the differential diagnosis of diseases is a test of the professional ability of doctors
.

Clinicians can easily fall into the trap of overdiagnosis when making a diagnosis

 

 

2.
Always maintain a spirit of questioning

2.
Always maintain the spirit of questioning 2.
Always maintain the spirit of questioning

Rheumatic immune diseases are complex and diverse, and the symptoms are often not typical enough to be easily confused with other diseases
.

In the process of clinical diagnosis, it is often encountered that patients need multidisciplinary consultation.

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