Still’s disease accounts for 10-20 percent of all cases of juvenile arthritis. It is significantly less common among adults, affecting about one in 100,000. For adults, the onset of symptoms usually occurs between the ages of 20 and 35.

Still’s disease usually begins with symptoms that affect the whole body (systemic symptoms). People with the disease often feel very tired and experience daily fevers of 40OC or higher. These fever “spikes” usually occur at about the same time every day (late afternoons and evenings) and always go away after a while. A faint salmon-coloured skin rash also appears from time to time, usually at the height of the fevers. The rash does not itch.

Poor appetite, nausea, and weight loss are common for people with Still’s disease. Often there is swelling of the lymph glands, enlargement of the spleen and liver, and sore throat. Swelling of the joints usually starts after rash and fevers have been present for some time. This usually involves many joints (polyarticular arthritis). Everyone with Still’s disease eventually develops joint pain and swelling.

The exact cause of Still’s disease is unknown. One current theory is that the disease is related to an infection with a microbe. Other theories hold that Still’s disease may be a hypersensitivity or an autoimmune disorder.

For most people with the disease, the characteristic fever and rashes usually go away after several months. The swelling of joints, however, can continue as a long-term condition and can persist into adulthood. Studies have shown that Still’s disease can disappear on its own for 35 to 40 percent of people within ten years of onset. In all other cases, patients will develop chronic arthritis.

Still’s disease can cause serious joint damage, particularly to the wrists. It can also affect normal functioning of the heart and the lungs. Treatment of the disease is targeted at specific areas of inflammation, which tend to be different for each patient.

Medicine

Many symptoms of Still’s disease can be controlled with anti-inflammatory drugs or nonsteroidal anti-inflammatory drugs (NSAIDs – pronounced En-sedz). Cortisone medications such as prednisone are also used to treat the more severe symptoms of the disease.

As Still’s disease often affects internal organs, some people with the disease require heart and lung medication as well as medication for diabetes. Pain medication is often necessary and used as required depending on the severity of symptoms.

For patients with persistent illness, the medications for Still’s disease are similar to those used to treat rheumatoid arthritis. These include hydroxychloroquine (Plaquenil), penicillamine, azathioprine (Imuran), methotrexate and cyclophosphamide. Gold injections are also used.

A new class of drugs called biological response modifiers (BRMs), including such drugs as Enbrel, Remicade, and Humira, is showing some promise for treating the disease.

A Word about Medication Safety

The need to effectively monitor new drugs once they have been approved and introduced into the market has been a key advocacy issue for The Arthritis Society for several years. This advocacy helps to ensure that unfavorable side effects are reported, documented, and addressed. For regular updates on medications available in Canada, visit www.arthritis.ca/tips/medications.

All medications have potential side effects whether they are taken by themselves or in combination with other herbal, over-the-counter and prescription medications. It is therefore important for patients to discuss the benefits and potential side effects of all their medications with their doctor.

Health Canada’s Marketed Health Products Directorate (MHPD) has also developed the MedEffect website. MedEffect’s goal is to provide centralized access to new safety information about health products in an easy to find, easy to remember location. It also aims to make it as simple and efficient as possible for health professionals and consumers to complete and submit adverse reaction reports. Finally, it helps to build awareness about the importance of submitting adverse reaction reports to identify and communicate potential risks associated with certain drugs or health products. visit MedEffect or call 1-866-234-2345 (toll-free).

Protect Your Joints

• Be kind to your body. After doing heavy work, or doing the same task over and over, stop. Slow down by doing an easy task, or by taking a rest.
• Use your back, arms and legs in safe ways to avoid stress on joints. For example, carry a heavy load close to your body.
• Use helpful tools in your daily tasks such as a cart to carry your grocery bags, or an enlarged handle that fits over a knife handle so you can hold it easily. A cane will help you to walk more safely. A grab bar, which attaches to a shower, will help you to get in and out of the tub more easily.
  Protecting your joints means using your joints in ways that avoid causing excessive stress on them. Benefits include less pain and greater ease in doing tasks. Three ways you can protect your joints are by pacing, positioning and using assistive devices.

Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on your joints and allows weakened muscles to rest.

Positioning joints wisely helps you use them in ways that avoid extra stress. For example, use larger, stronger joints to carry loads (for example, use your arms and not your fingers to carry grocery bags) and change your position frequently.

Using assistive devices, such as canes, raised chairs, and gripping and reaching aids can help simplify daily tasks. For bathing, grab-bars and shower seats can be very helpful for conserving energy and avoiding falls.

Exercise

• Exercise helps reduce pain and prevents further joint damage. It can also help you maintain a healthy weight, which puts less strain on your joints.
• Not using a sore joint will cause the muscles around it to become weak, resulting in pain.

There are three types of exercises:

• Range of motion exercises reduce stiffness and help keep your joints moving. A range of motion exercise for your shoulder would be to move your arm in a large circle.
• Strengthening exercises maintain or increase muscle strength.
• Endurance exercises strengthen your heart, give you energy and control your weight. These exercises include walking, swimming and cycling.

Appropriate and moderate exercise involving stretching and strengthening will help relieve pain and keep the muscles and tendons around affected joints flexible and strong. Low impact exercises like swimming, walking, water aerobics and stationary bicycling can all help to reduce pain while maintaining strength, flexibility and cardiovascular function. Check with your doctor or a physiotherapist before beginning an exercise program.

Rest

• Relaxing the muscles around an inflamed joint reduces pain.
• There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation tapes. Meditate or pray. Another way to relax is to imagine, or visualize a pleasant activity such as lying on the beach, or sitting in front of a fireplace.

Rest is very important for the patient with Still’s disease. By planning activities and rest times to avoid physical or emotional stress, it is possible to reduce the risk of flares. To avoid overwork, it is helpful to intersperse rest days with workdays. Daily activities should also be carefully planned to allow enough time for rest in between.