Adult-onset Still's disease diagnostic study of choice
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Adult-onset Still's disease |
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Differentiating Adult-onset Still’s Disease from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]
Overview
The diagnosis of adult-onset Still's disease (AOSD) is made clinically along with supporting laboratory abnormalities and exclusion of other rheumatologic disorders, malignancy and infections. Three diagnostic criteria have been established in order to aid in the diagnosis of AOSD. Yamaguchi criteria is widely adopted.
Diagnostic study of choice/ Diagnostic criteria
The diagnosis of adult-onset Still's disease is made clinically along with supporting laboratory abnormalities and exclusion of other rheumatologic disorders, malignancy and infections. Three diagnostic criteria have been established in order to aid in the diagnosis of AOSD. Yamaguchi criteria is widely adopted. The following table outlines the major criteria system for the diagnosis of AOSD:[1][2][3]
| Criteria | Yamaguchi criteria | Cush criteria | Fautrel criteria |
|---|---|---|---|
| Major criteria | Arthralgia >2 weeks | Daily fever >39° | Spiking fever ⩾39° |
| Fever >39°, intermittent, high spiking, ⩾1 week | Still's (maculopapular) rash | Arthralgia | |
| Maculopapular rash on trunk and/or extremities | WBCs >12000/ml +ESR >40 mm/1st hour | Transient erythema | |
| Leukocytosis- WBCs >10000 (>80% neutrophils) | Νegative RF and ANA | Pharyngitis | |
| - | Carpal ankylosis | Polymorphonuclear cells ⩾80% | |
| - | Glycosylated ferritin ⩽20% | ||
| Minor criteria | Sore throat | Onset age <35 years | Maculopapular rash |
| Lymphadenopathy | Arthritis | Leukocytes ⩾10×109/l | |
| Abnormal liver function tests (LDH, ALT, AST) | Prodromal sore throat | - | |
| Negative ANA and RF | Reticuloendothelial involvement or abnormal LFTs | ||
| Hepatosplenomegaly | Serositis |
References
- ↑ Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T (March 1992). "Preliminary criteria for classification of adult Still's disease". J. Rheumatol. 19 (3): 424–30. PMID 1578458.
- ↑ Cush JJ, Medsger TA, Christy WC, Herbert DC, Cooperstein LA (February 1987). "Adult-onset Still's disease. Clinical course and outcome". Arthritis Rheum. 30 (2): 186–94. PMID 3827959.
- ↑ Fautrel B, Zing E, Golmard JL, Le Moel G, Bissery A, Rioux C, Rozenberg S, Piette JC, Bourgeois P (May 2002). "Proposal for a new set of classification criteria for adult-onset still disease". Medicine (Baltimore). 81 (3): 194–200. PMID 11997716.