A number of autoinflammatory syndromes that result from genetic mutations have been described recently. The vast majority occur in children. However, three periodic fever syndromes are important for rheumatologists who treat adults to know about. The goal of this review is to provide a concise description of each condition, and to help the clinician understand when to suspect one and how to diagnose it.
Explore this issueDecember 2017
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Adult Still’s Disease
The first of these periodic fever syndromes is Still’s disease, first described by George Frederic Still in 1897 at the Great Ormand Street Hospital in the Bloomsbury neighborhood in London. His treatise, “On a Form of Chronic Joint Disease in Children,” described 22 patients with what is now seen as the classic triad of fever, rash and joint pain.
E.G.L. Bywaters, the first to describe the syndrome in adults, was an Englishman trained in rheumatology by the legendary Walter Bauer, MD. at the Massachusetts General Hospital. When World War II broke out, Dr. Bywaters returned to England. During the bombing of London, he discovered that renal failure in crush syndrome resulted from the release of myoglobin. In 1971, he went on to describe 14 adults with a presentation similar to that described by Still, and this syndrome came to be known as adult Still’s disease (AOSD).
A daily (quotidian) fever is characteristic of AOSD and is sometimes described as a picket fence fever, spiking in the afternoon or early evening, then returning to normal. This occurs in up to 80% of AOSD patients, tends to last around four hours and often precedes the development of other manifestations. Severe supparative pharyngitis sometimes precedes fever or rash.