Adult-onset Still's disease diagnostic study of choice: Difference between revisions

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==Overview==
==Overview==
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 [[diagnosis]] of adult-onset Still's disease (AOSD) is made clinically along with supporting laboratory abnormalities and exclusion of other [[Rheumatologic disease|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==
==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:<ref name="pmid1578458">{{cite journal |vauthors=Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T |title=Preliminary criteria for classification of adult Still's disease |journal=J. Rheumatol. |volume=19 |issue=3 |pages=424–30 |date=March 1992 |pmid=1578458 |doi= |url=}}</ref><ref name="pmid3827959">{{cite journal |vauthors=Cush JJ, Medsger TA, Christy WC, Herbert DC, Cooperstein LA |title=Adult-onset Still's disease. Clinical course and outcome |journal=Arthritis Rheum. |volume=30 |issue=2 |pages=186–94 |date=February 1987 |pmid=3827959 |doi= |url=}}</ref><ref name="pmid11997716">{{cite journal |vauthors=Fautrel B, Zing E, Golmard JL, Le Moel G, Bissery A, Rioux C, Rozenberg S, Piette JC, Bourgeois P |title=Proposal for a new set of classification criteria for adult-onset still disease |journal=Medicine (Baltimore) |volume=81 |issue=3 |pages=194–200 |date=May 2002 |pmid=11997716 |doi= |url=}}</ref>
The [[diagnosis]] of adult-onset Still's disease is made clinically along with supporting laboratory abnormalities and exclusion of other [[Rheumatologic disease|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:<ref name="pmid1578458">{{cite journal |vauthors=Yamaguchi M, Ohta A, Tsunematsu T, Kasukawa R, Mizushima Y, Kashiwagi H, Kashiwazaki S, Tanimoto K, Matsumoto Y, Ota T |title=Preliminary criteria for classification of adult Still's disease |journal=J. Rheumatol. |volume=19 |issue=3 |pages=424–30 |date=March 1992 |pmid=1578458 |doi= |url=}}</ref><ref name="pmid3827959">{{cite journal |vauthors=Cush JJ, Medsger TA, Christy WC, Herbert DC, Cooperstein LA |title=Adult-onset Still's disease. Clinical course and outcome |journal=Arthritis Rheum. |volume=30 |issue=2 |pages=186–94 |date=February 1987 |pmid=3827959 |doi= |url=}}</ref><ref name="pmid11997716">{{cite journal |vauthors=Fautrel B, Zing E, Golmard JL, Le Moel G, Bissery A, Rioux C, Rozenberg S, Piette JC, Bourgeois P |title=Proposal for a new set of classification criteria for adult-onset still disease |journal=Medicine (Baltimore) |volume=81 |issue=3 |pages=194–200 |date=May 2002 |pmid=11997716 |doi= |url=}}</ref>
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Criteria'''
! align="center" style="background:#4479BA; color: #FFFFFF;" + |'''Criteria'''
Line 15: Line 15:
|-
|-
| rowspan="6" |Major criteria
| rowspan="6" |Major criteria
| colspan="1" rowspan="1" |Arthralgia >2 weeks
| colspan="1" rowspan="1" |[[Arthralgia]] >2 weeks
| colspan="1" rowspan="1" |Daily fever >39°
| colspan="1" rowspan="1" |Daily [[fever]] >39°
| colspan="1" rowspan="1" |Spiking fever ⩾39°
| colspan="1" rowspan="1" |Spiking [[fever]] ⩾39°
|-
|-
| colspan="1" rowspan="1" |Fever >39°, intermittent, high spiking, ⩾1 week
| colspan="1" rowspan="1" |[[Fever]] >39°, intermittent, high spiking, ⩾1 week
| colspan="1" rowspan="1" |Still's (maculopapular) rash
| colspan="1" rowspan="1" |Still's ([[maculopapular]]) rash
| colspan="1" rowspan="1" |Arthralgia
| colspan="1" rowspan="1" |[[Arthralgia]]
|-
|-
| colspan="1" rowspan="1" |Maculopapular rash on trunks and/or extremities
| colspan="1" rowspan="1" |[[Maculopapular rash]] on [[trunk]] and/or [[extremities]]
| colspan="1" rowspan="1" |WBCs >12000/ml +ESR >40 mm/1st hour
| colspan="1" rowspan="1" |[[White blood cells|WBCs]] >12000/ml +[[ESR]] >40 mm/1st hour
| colspan="1" rowspan="1" |Transient erythema
| colspan="1" rowspan="1" |Transient [[erythema]]
|-
|-
| colspan="1" rowspan="1" |Leukocytosis- WBCs >10000 (>80% neutrophils)
| colspan="1" rowspan="1" |[[Leukocytosis]]- WBCs >10000 (>80% [[neutrophils]])
| colspan="1" rowspan="1" |Νegative RF and ANA
| colspan="1" rowspan="1" |Νegative [[RF]] and [[Antinuclear antibodies|ANA]]
| colspan="1" rowspan="1" |Pharyngitis
| colspan="1" rowspan="1" |[[Pharyngitis]]
|-
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Carpal ankylosis
| colspan="1" rowspan="1" |[[Carpal bones|Carpal]] [[ankylosis]]
| colspan="1" rowspan="1" |Polymorphonuclear cells ⩾80%
| colspan="1" rowspan="1" |[[Polymorphonuclear cells]] ⩾80%
|-
|-
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |Glycosylated ferritin ⩽20%
| colspan="1" rowspan="1" |Glycosylated [[ferritin]] ⩽20%
|-
|-
| rowspan="6" |Minor criteria
| rowspan="6" |Minor criteria
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| colspan="1" rowspan="1" |Sore throat
| colspan="1" rowspan="1" |Sore throat
| colspan="1" rowspan="1" |Onset age <35 years
| colspan="1" rowspan="1" |Onset age <35 years
| colspan="1" rowspan="1" |Maculopapular rash
| colspan="1" rowspan="1" |[[Maculopapular rash]]
|-
|-
| colspan="1" rowspan="1" |Lymphadenopathy
| colspan="1" rowspan="1" |Lymphadenopathy
| colspan="1" rowspan="1" |Arthritis
| colspan="1" rowspan="1" |[[Arthritis]]
| colspan="1" rowspan="1" |Leucocytes ⩾10×109/l
| colspan="1" rowspan="1" |[[Leukocytes]] ⩾10×109/l
|-
|-
| colspan="1" rowspan="1" |Abnormal liver function tests (LDH, ALT, AST)
| colspan="1" rowspan="1" |Abnormal liver function tests ([[Lactate dehydrogenase|LDH]], [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]])
| colspan="1" rowspan="1" |Prodromal sore throat
| colspan="1" rowspan="1" |Prodromal [[sore throat]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
|-
| colspan="1" rowspan="1" |Negative ANA and RF
| colspan="1" rowspan="1" |Negative [[Antinuclear antibodies|ANA]] and [[RF]]
| colspan="1" rowspan="1" |Reticuloendothelial involvement or abnormal LFTs
| colspan="1" rowspan="1" |[[Reticuloendothelial system|Reticuloendothelial]] involvement or abnormal [[Liver function tests|LFTs]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|-
|-
| colspan="1" rowspan="1" |Hepatosplenomegaly
| colspan="1" rowspan="1" |[[Hepatosplenomegaly]]
| colspan="1" rowspan="1" |Serositis
| colspan="1" rowspan="1" |[[Serositis]]
| colspan="1" rowspan="1" |
| colspan="1" rowspan="1" |
|}
|}

Revision as of 13:31, 23 April 2018

Adult-onset Still's disease

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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

  1. ↑ 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.
  2. ↑ 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.
  3. ↑ 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.

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