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Clinical Manifestations of Adult‐Onset Still's Disease Presenting With Erosive Arthritis: Association With Low Levels of Ferritin and Interleukin‐18
Author(s) -
Ichida Hisae,
Kawaguchi Yasushi,
Sugiura Tomoko,
Takagi Kae,
Katsumata Yasuhiro,
Gono Takahisa,
Ota Yuko,
Kataoka Sayuri,
Kawasumi Hidenaga,
Yamanaka Hisashi
Publication year - 2014
Publication title -
arthritis care and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.032
H-Index - 163
eISSN - 2151-4658
pISSN - 2151-464X
DOI - 10.1002/acr.22194
Subject(s) - medicine , rheumatoid arthritis , polyarthritis , etiology , ferritin , rheumatoid factor , rheumatology , arthritis , disease , serum ferritin , rheumatoid nodule , gastroenterology , medical record , immunology
Objective Adult‐onset Still's disease (AOSD) is a clinical entity with a heterogeneous etiology. We have encountered patients with AOSD who had severe polyarthritis and who fulfilled the classification criteria for rheumatoid arthritis (RA); however, most patients with AOSD typically exhibit mild arthritis. In this study, we proposed 2 clinical subsets of AOSD and investigated the clinically significant characteristics of the 2 subtypes. Methods We retrospectively analyzed 71 consecutive patients with AOSD. We reviewed the medical records of all patients who were followed up for more than 2 years. We classified all of the patients with AOSD into the following 2 subsets: an RA subtype for patients who met the criteria for RA according to the American College of Rheumatology and a non‐RA subtype for patients who did not meet the criteria for RA. Results Our results indicated that the non‐RA subtype was accompanied by severe inflammatory complications, including pleuritis and hemophagocytic syndrome. In addition, the serum ferritin and serum interleukin‐18 (IL‐18) levels were significantly higher in patients with the non‐RA subtype than in those with the RA subtype. Interestingly, only 1 patient with the RA subtype had anti–cyclic citrullinated peptide antibodies and 1 patient with the non‐RA subtype had rheumatoid factor. These findings distinguish these patients from patients with true RA. Conclusion There were 2 subsets of patients with AOSD in the examined population. Patients with high levels of IL‐18 or ferritin presented with severe systemic inflammatory disorders (non‐RA subtype) and patients with low levels of IL‐18 or ferritin developed severe arthritis (RA subtype).