The nature of Still's disease: With Report of a Case Article Swipe
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· 1945
· Open Access
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· DOI: https://doi.org/10.1136/adc.20.104.155
· OA: W2044509830
The following case of Still's disease is reported because of the unusually full pathological data that were available and because of the light these throw on the nature of the disease.Still's disease is defined clinically as a form of chronic arthritis with swelling of the lymph glands and spleen.The swellings of the joints and lymph glands are usually multiple and symmetrical.The disease generally starts before the second dentition (Still, 1897;Simonetti, 1930) but sometimes occurs in adults (Strauss, 1926;Micheli and Gamna, 1928).The onset is usually insidious but sometimes acute and often accompanied by fever.The course is chronic; intermissions of fever may be associated with regression of the swellings of the joints, glands and spleen but both fever and the other changes often recur (Still, 1897; Simonetti, 1930; Bini, 1935).To the three cardinal signs may be added, in order of frequency: anaemia, muscular atrophy, cachexia, pericarditis, pleurisy, exophthalmos (Bini, 1935) and exanthemata (Simonetti, 1930).Case report S. W., a boy aged four years, was admitted to St. Mary's Hospital, Manchester, in April, 1943.The course of the disease was as follows: November, 1942, the knees were stiff and painful but the patient walked fairly well.April, 1943, there was a fusi- form swelling of knees, elbows, metacarpophalangeal and interphalangeal joints of the hands; these were not tender nor were the joints fixed.Muscle wasting was severe and there was loss of weight.May, 1943, a bout of intermittent pyrexia lasting a fortnight, temperature ranging from 1000 to 1060 F.The joints were painful.Towards the end of the attack and following it for about a week there was a papular eruption all over the body.June, 1943, there was a brief recrudescence of rash in another bout of pyrexia.August, 1943, an enlarged gland was found in the right groin, and about a week later many small glands were palpable in neck and axillae.September, 1943, the left hip was almost fixed and the right was adducted and flexed.Both knees were held in 60°flexion, reducible to 200; there seemed to be an effusion.There was a valgus deformity of the right ankle and a flexion deformity and swelling of both wrists.November, 1943, the spleen was felt for the first on July
