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Adult Onset Still's Disease and Still's Disease in the child, what's the difference there?  Well not much!  They are believed to be the same disease. The difference is the age at which you get the disease.  Still's Disease was originally named for a specific type of jra, called systemic jra.  Jra has 3 classifications, poly-articular, paui-articular, and systemic.  The systemic form of jra became known also as Still's Disease.  In 1971, a doctor recognized the same symptoms in adults.   Their disease also began in adulthood, not when they were a child. These patients were given the diagnosis of Adult-Onset Still's Disease, referring to the fact that they were adults at the time of the onset of Still's.

Most Rheumatologist's characterize the age for AOSD as ages 17 and older at onset, with the majority being 18-35.   If you are 16 or younger at the time of onset it's considered systemic jra, or Still's Disease.

There is one symptom however that is more prevalent in AOSD and that is a severe sore throat.  Most adult members of the group report having the sore throat right before or at their onset.  The sore throat doesn't seem to be a big factor with the children.  Dr. Cush has noted this difference in one of his studies.

Systemic Jra is rare, it's seen in approximately 20% of all cases of jra.   AOSD is even more rare and unfortunately many doctors are not familiar with it.   Many cases of Adult Still's go undiagnosed for years.  This is one of the things we hope to change.

NEWTINY.GIF (1058 bytes)    Comparison of clinical features of childhood and adult onset     NEWTINY.GIF (1058 bytes)             Still's disease

Tanaka S  Matsumoto Y  Ohnishi H  
 Maeda M  Nishioka K  Kashiwazaki S  
 Watanabe N  

In: Ryumachi (1991 Oct) 31(5):511-8

ISSN: 0300-9157  (Published in Japanese)

Physical findings, laboratory data, treatments and prognosis were  investigated in detail using 26 Japanese childhood Still's disease  (CHSD) patients and 19 Japanese adult onset Still's disease (AOSD)  patients as the subjects. High spiking fever and arthritis were
 present in all the patients. Seventy and seven percent of CHSD and 53  percent of AOSD had polyarthritis (the number of joints involved  being 5 or more during the first 6 months of the disease). A  comparison of the groups showed no significant difference in the
 initial systemic manifestations except for sore throat (CHSD: AOSD;  19%: 68%). Initial laboratory data were the same for these groups  except for serum iron levels (CHSD: AOSD; 20.8 +/- 13.7 micrograms/dl: 83.0 +/- 54.2 micrograms/dl). As to joints and  physical prognosis, the results were also the same for CHSD and AOSD  under the similar treatment.

On the basis of these data, we conclude  that CHSD and AOSD are of the same disease entity so far as the  present clinical features are concerned.

Institutional address:
       Department of Pediatrics
       Kyorin University School of Medicine


NEWTINY.GIF (1058 bytes)    Clinical study of Still's disease as a distinct disease entity     NEWTINY.GIF (1058 bytes)   

Ohta A  Yamaguchi M  

In: Ryumachi (1993 Oct) 33(5):410-5

ISSN: 0300-9157  (Published in Japanese)

There seems to be yet unresolved questions as to whether child-onset  and adult-onset Still's disease are truly the same disease and  whether adult-onset Still's disease is a disease entity independent  of other rheumatic diseases in the adult. In order to clarify these  issues, we have analyzed statistically the clinical features of  Still's disease of various age-onset and also compared the features
 of adult-onset Still's disease with those of other rheumatic diseases  having similar manifestations. Clinical data used for the study were  those collected from 32 institutions in Japan through questionnaire
 method by Adult Still's Disease Research Committee, and the patients  with adult Still's disease and with other rheumatic diseases were  definitely diagnosed by the Committee. When the sensitivity of each  of total 90 clinical items was compared between child-onset adult
 Still's disease (11 cases) and adult-onset Still's disease (77
 cases), and between young adult-onset (16-35 years) Still's disease  (48 cases) and aged adult-onset (45 years or older) Still's disease  (15 cases), only 7-9% of the items showed significant difference by  chi 2-test. This was the same range as when the sensitivity of the  clinical items obtained from the literature of child-onset Still's
 disease (26 cases) was compared with that of adult-onset Still's  disease (77 cases). On contrary to this range, over half of the items  showed the significant difference in sensitivity when adult-onset  Still's disease was compared with other rheumatic diseases such as  seronegative rheumatoid arthritis (31 cases), malignant rheumatoid
 arthritis (25 cases), and polyarteritis nodosa (31 cases).(ABSTRACT

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