Course of Still’s disease | Morbus Still

Course of Still’s disease

In most cases, the disease begins with recurrent fever attacks and rashes as well as tiredness and exhaustion. Joint complaints often manifest themselves months after the first symptoms appear. The course of the disease and the prognosis vary greatly from individual to individual.In some cases, the disease completely recedes in childhood and adolescence, in others it remains for life.

A distinction is then made between a course in which the symptoms occur in recurrent attacks, between which symptom-free weeks, months or even years can lie, and a chronic course in which the symptoms persist permanently. In about 20-30% of the affected patients, the disease is permanently suppressed (remission). About 40% of the patients suffer from only mild chronic joint inflammation, which is easily manageable with drug therapy and supportive physiotherapy. Symptoms on the organs can reappear in relapses, but can also be completely absent for years. There are also cases in which the disease can hardly be controlled by therapy and is accompanied by increasing joint destruction and complications in the organs.

Healing chances with the Morbus Still

Still’s disease cannot be cured. At least not in the conventional sense. There are patients who can be transferred to a stage of remission through therapy. In this case, remission means that no more symptoms occur, so the disease is completely under control. However, since it can flare up again at any time, it cannot be called a cure in the conventional sense.

Can Still’s disease also be fatal?

Yes, there are complications in the course of the disease that can lead to a fatal outcome. These include in particular the so-called macrophage activation syndrome, also known as hemophagocytic lymphohistiocytosis. In this case, a massive inflammatory reaction of the immune system occurs in the course of Still’s disease or in the course of a viral infection under an immunosuppressive therapy of Still’s disease.

This leads to persistent fever, splenomegaly and various blood count changes. Diagnosis is not always easy, since the clinical symptoms mentioned, i.e. fever and splenomegaly, also occur in non-complicative Still’s disease. Only the blood count changes then point in the direction of a macrophage activation syndrome.

Therapeutically, a high-dose cortisone shock therapy, immunosuppressive drugs and biologicals are used. The lethality of macrophage activation syndrome is extremely high without appropriate therapy. But even under therapy, the lethality rate is up to 40%.