Still's vs. RA


Alot of people ask what is the difference between Still's and Rheumatoid Arthritis?   Well first I will tell you the similarities.   They are both inflammatory diseases meaning they both cause joint inflammation and swelling,  joint pain,  and both can lead to severe joint destruction.  They both cause extreme fatigue, and anemia.  The treatment for both diseases are the same.   NSAIDS are used to help inflammation and pain, steroids to suppress the inflammation and calm down flares,  DMARDS to suppress the immune system with hopes of leading to a remission, and more recently the use of Enbrel and Remicade to suppress the disease and put it in remission. 

The difference in these two diseases is that Rheumatoid Arthritis is an autoimmune disease, and still's has yet to be defined as an actual autoimmune disease.  Still's is described as a systemic inflammatory condition.  By systemic it means it effects your entire body, not just your joints.    Symptoms that you will not see in Rheumatoid Arthritis patients (in general) are the high-spiking fevers that will follow a pattern of spiking once or twice a day (usually 12 hrs apart) and at the same time each day, inflammation of the lining of the heart (pericarditis), inflammation of the lungs (pleurisy), an enlarged spleen,  a pink to salmon colored rash that will appear in cycles similar to the fevers. The rash may be very faint at times and the rash can often be brought out by rubbing of the skin.  The rash usually does not itch.  The systemic symptoms can be very severe, usually leading to hospitalization.  Most people report having temperature spikes from 105-106.5   F,  I believe the highest we have recorded among the group is 106.9.   Most everyone's temp hit at least 105 while they were spiking fevers.  Usually   high doses of prednisone or other steroids is the only way to get the fevers under control.  

70-80% of all Rheumatoid Arthritis patients test positive for a Rheumatoid Factor in their blood.  Still's Disease patients are almost always negative for the Rheumatoid Factor.  There are no specific tests for Still's Disease, however there are some helpful markers.  This is the main arugument currently for Still's disease not being autoimmune because there are no antibodies produced.  Now with that being said, there is still a possibilty with further reaearch that we may find an antibody that will give a definite diagnosis of Still's. Ferritin levels tend to be much higher for Still's patients during onset, or during a severe flare, then return to normal or near normal when disease activity calms down.   There has also been evidence of high levels of IL-6 in the serum during onset and flares.

In trying to explain Still's Disease to other people I have said, " Still's is like a combination of RA and Lupus"  Most people have heard or know about RA and Lupus and can identify with it.    Although I do go on to say that  " it's like having the worst of both diseases" !!  It sure feels that way.   Lupus patients have alot of systemic involvement, while they don't usually have high fevers, they tend to develop serious problems with their kidneys, and other organs.  They have joint pain and inflammation but tend not to develop into the destructive type of arthritis like RA.    Well with Still's Disease you get them both.

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