Adult-onset Still's disease differential diagnosis
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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
Differentiating Adult-onset Still's disease from Other Diseases
Adult-onset Still's disease (AOSD) should be differentiated from other causes of fever and polyarthralgia/arthritis of the peripheral skeleton. The differentials include the following:[1][2][3][4]
| Arthritis Type | Clinical Features | Body Distribution | Key Signs | Laboratory Abnormalities | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| History of Psoriasis | Symmetric joint involvement | Asymmetric joint involvement | Enthesopathy | Dactylitis | Nail Dystrophy | Human immunodeficiency virus association | Upper extremity-hands | Lower extremity | Sacroiliac joints | Spine | Osteopenia | Joint Space | Ankylosis | Periostitis | Soft tissue swelling | ESR | Rheumatoid factor (RF) | HLA-B27 | |
| Psoriatic arthritis | + | + | ++ | + | + | + | + | +++ (DIP/PIP) | +++ | ++ (Unilateral) | ++ | - | ++ (Widening) | ++ | +++ (Fluffy) | ++ | + | - | 30-75% |
| Rheumatoid arthritis | - | ++ | + | - | - | - | - | +++ | +++ | + (Unilateral) | ++(Cervical) | +++ | +++ (Narrowing) | + | + (Linear) | +++ | +++ | +++ | 6-8% |
| Reactive arthritis (Reiter's syndrome) | - | +++ | - | + | + | - | - | ++ | +++ | ++ (Unilateral) | + | + | + (Narrowing) | - | +++ (Fluffy) | ++ | ++ | - | 75% |
Key:+ : Infrequently present, ++ : Frequently present, +++ : Always present, - : Absent
References
- ↑ Helliwell PS, Taylor WJ (March 2005). "Classification and diagnostic criteria for psoriatic arthritis". Ann. Rheum. Dis. 64 Suppl 2: ii3–8. doi:10.1136/ard.2004.032318. PMC 1766878. PMID 15708931.
- ↑ McEwen C, DiTata D, Lingg C, Porini A, Good A, Rankin T (1971). "Ankylosing spondylitis and spondylitis accompanying ulcerative colitis, regional enteritis, psoriasis and Reiter's disease. A comparative study". Arthritis Rheum. 14 (3): 291–318. PMID 5562018.
- ↑ Helliwell PS, Hickling P, Wright V (March 1998). "Do the radiological changes of classic ankylosing spondylitis differ from the changes found in the spondylitis associated with inflammatory bowel disease, psoriasis, and reactive arthritis?". Ann. Rheum. Dis. 57 (3): 135–40. PMC 1752543. PMID 9640127.
- ↑ Moll JM, Haslock I, Macrae IF, Wright V (September 1974). "Associations between ankylosing spondylitis, psoriatic arthritis, Reiter's disease, the intestinal arthropathies, and Behcet's syndrome". Medicine (Baltimore). 53 (5): 343–64. PMID 4604133.