Adult-onset Still's disease
Daily spiking fevers, a fleeting pink rash and painful joints — a rare condition that often takes a long time to recognise.
What is adult-onset Still's disease?
Adult-onset Still's disease (AOSD) is a rare inflammatory condition, usually of young adults, that causes a striking combination of daily high fevers, a salmon-pink rash and joint pain. Because it looks like a serious infection or blood cancer, people often have many tests before the diagnosis is made.
Symptoms to recognise
- Spiking fever, often above 39 °C, typically once or twice a day — usually in the evening — returning to normal in between
- A faint salmon-pink rash on the trunk and limbs that comes with the fever and fades with it
- Joint pain and swelling — wrists, knees, ankles
- Sore throat, swollen glands, enlarged liver or spleen
- Very high white cell count and markedly raised ferritin on blood tests
How it is diagnosed
AOSD is a diagnosis of exclusion. Infections (including tuberculosis and typhoid), lymphoma and other inflammatory diseases must be ruled out. Supporting features include the fever pattern, rash, high white count with neutrophils, very high ferritin, and negative ANA and rheumatoid factor. The Yamaguchi criteria are commonly used.
How it is treated
- Mild disease: NSAIDs
- Most people: steroids
- Steroid-sparing: methotrexate
- Resistant or severe disease: biologics that block IL-1 (anakinra) or IL-6 (tocilizumab) are very effective
Common questions
Is Still's disease an infection?+
Why is ferritin so high?+
Does Still's disease go away?+
Fevers and joint pain without an answer?
Prolonged fever with arthritis needs a careful, systematic assessment. Walk-in, no appointment needed.
Clinic timings & location