Re: Adult Onset Still's Disease and Still's Disease in the child

December 28, 2000

Hi georgina,

I thought it was interesting that you asked about a sore throat. When

Tori was first diagnosed at 18 months she had been ill with an upper

respiratory infection (ears, throat, etc) what was left after the

antibodics were over was Still's . This recent flare-up which started

just prior to Halloween was also preceeded by a severe sore throat -

that same evening, she couldn't walk and her JRA symptons continued to

flare uncontrollably. I feel that this sore throat was viral and

triggered her flare-up? It's the only thing that had changed, no

different foods or environmental issues seemed to be different. It's

so good to be able to speak to other people about this - I feel like

a tremendous amount of relief just reading everyone's messages.

Thanks for responding so quickly to new members. - Tori's mom

-- In egroups, Georgina <gmckin@g...> wrote:

> I found this an interesting article, particularly because it states

that

> there are fewer complaints of sore throat in childhood-onset Stills

vs.

> adult onset. My son had a severe sore throat at disease onset. We

> thought that might be the reason he lost interest in eating and even

> complained of pain while drinking fluids. His pediatrician even

scoped

> his throat, thinking in the beginning that Josh might have a tumor

in

> his neck/throat area. Did any other systemic JRA children

represented

> here have a sore throat when their JRA first presented?

>

> Take care,

> Georgina

>

> http://members.tripod.com/stilligans/aosdvs.htm

>

> 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.

>

----------------------------------------------------------------------

----

> Comparison of clinical features of childhood and adult onset 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

> ISBN: 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, Tokyo.

> ------------------------------------------------------------

> Clinical study of Still's disease as a distinct disease

entity

> 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 TRUNCATED AT 250 WORDS)

December 29, 2000

Georgina,

About the sore throat issue. My son has had sore throat with his flare ups.

But not initially with the disease onset. When he gets like that I have

to take him to the hospital and they start him on a pulse of solimetrol (for

3 days). It is like if his throat wants to close up on him. It is very

scary.

Changing the subject, about the eczema - my son has had itching for the past

4 years off and on (especially in the winter). The only time he gets relief

is when he is in the warm tub. I then towel dry him, but lightly leaving

his skin moist then applying eucerin. It helps at the moment, but

eventually he starts itching again. We have tried so many creams, the last

of them was elocon. But they haven't helped.

Changing the subject once again, I have a question I have always wondered

how high is too high for a sed rate? My son just had his blood work done

last Friday his sed rate is 95. I know the norm is 0-10. But with children

having jra, do most kids have it this high? I am just curious. Thanks!

-

>From: Georgina <gmckin@...>

>Reply- egroups

>a JRA List < egroups>

>Subject: Adult Onset Still's Disease and Still's Disease in the child

>Date: Thu, 28 Dec 2000 13:38:12 +0000

>

>I found this an interesting article, particularly because it states that

>there are fewer complaints of sore throat in childhood-onset Stills vs.

>adult onset. My son had a severe sore throat at disease onset. We

>thought that might be the reason he lost interest in eating and even

>complained of pain while drinking fluids. His pediatrician even scoped

>his throat, thinking in the beginning that Josh might have a tumor in

>his neck/throat area. Did any other systemic JRA children represented

>here have a sore throat when their JRA first presented?

>

>Take care,

>Georgina

>

>http://members.tripod.com/stilligans/aosdvs.htm

>

>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.

>--------------------------------------------------------------------------

>Comparison of clinical features of childhood and adult onset 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

>ISBN: 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, Tokyo.

>------------------------------------------------------------

>Clinical study of Still's disease as a distinct disease entity

>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 TRUNCATED AT 250 WORDS)

_________________________________________________________________

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December 29, 2000

Dear Georgina, You bet, n first started with the sore throat. It was

the worse sore throat in her life. And then when she re-flared, she got it

again. She now says that most mornings she wakes up with a sore throat, and

then it slowly goes away. I don't know if it is allergies, but she thinks

it is her " arthritis " sore throat. If it is, she has no other increasing

symtoms.

As to the Joints in Motion marathon--I was supposed to participate, but I

had to back out due to the death of my father. Eleven people went from

Oregon and they all completed it. Some of them had so much fun, that they

are now planning to do Dublin. The arthritis foundation was very nice, and

rolled my donations over and now I will run May 10th in Vancouver, B.C. I

have never been a runner before, and it remains to be seen if I could run

the entire 26 miles. The longest I have gone is 15 miles in my training for

Hawaii. My daughter, n, is my honoree. See ya.