Abstract
Adult-onset Still’s disease (AOSD) is an inflammatory disease of unknown etiology. AOSD is typically characterized by a spiking fever, arthritis, rashes, leukocytosis, and involvement of various organs.
We report a case of a 59-year-old Japanese male presenting rapid and progressive polyarthritis. He complained of bilateral knee joint pain and swelling of 3 months duration which was accompanied by a fever over 39°C for one month. On admission, he showed arthritis on bilateral MP, PIP, wrist, knee, and foot joints. X-ray study revealed distinct erosion of bilateral wrist joints and PIP joints even a few months after the disease onset. Laboratory tests showed CRP 8.95 mg/dl, FDP 14.0 μg/ml, and ferritin1 143 nm/ml. Rheumatoid factor, anti-CCP antibody or anti-nuclear antibody was negative. The patients’ disease was diagnosed as AOSD because his clinical manifestation fulfilled the diagnostic criteria proposed by Cush et al. He was treated successfully with prednisolone and Methotrexate. Recently, anti-cytokine therapy was reported to be introduced for AOSD; i.e. anti-interleukin (IL)-6 receptor antibody or anti-IL-1 antibody, and serum IL-6 level was increased in this patient.
We discussed the early progression of arthritic joint destruction in the wrists in a patient with AOSD. We propose that early intervention of arthritis may be useful for such conditions.
