STILL'S DISEASE AND ADULT ONSET STILLS DISEASE(AOSD)

  STILLS DISEASE/ ADULT ONSET STILLS DISEASE(AOSD)

Stills disease is a rare multi-systemic autoimmune inflammatory disorder which is involves typical characteristic symptom triad of 1) HIGH SPIKING FEVER 2) JOINT PAINS 3) SALMON PINK COLORED RASHES.

The disease was named in honour of an English paediatrician named  Sir George Fredric Still, who also also described Still’s murmur/vibratory murmur(a commom benign heart sound).

The adult version of Still’s disease, that is also known as Adult onset stills disease/AOSD, was later on characterized by a British Physician, Eric George Bywaters in 1971.

The disease like IBS(Irritable Bowel Syndrome), is usually a diagnosis of exclusion.

 PATHOPHYIOLOGY OF STILL’S DISEASE

 The exact cause which leads to the production of this rare condition is not known clearly. However, the basic mechanism in the onset of the disease is same as with other systemic inflammatory disorders like SLE/Sytemic Lupus Erythematosus, to which the disease resembles closely. Basically, in every autoimmune condition the persons own immune system which normally acts to protect the body against invading pathogens, may become deranged and start working in the exact opposite manner to its normal function.ie instead of protecting the body the immune system starts attacking its own cells, thereby producing inflammation of the affected area. When this type of autoimmune attack occurs at various places and organs simultaneously it is known as systemic autoimmune inflammation. This process normally occurs when the HLA(human leukocytic antigen complex) which regarded as the brain of our immune system and that which controls the immune system and mediates it properly, goes out of order, leading to random attacks of immune system on various organs, leading to inflammation and sometimes, if more intense leading to depleting function of an organ or even organ failures.

 The above process being a general mechanism of autoimmune disorders, the specific mechanism of still’s disease is not known. However, since interleukin blockers are found to be the most effective in treatment of this disease Interleukin-1 seems to be playing in causing the disease.
                           SIGNS AND SYMPTOMS

·         Classical triad of symptoms in Still’s Disease includes:

  1) High fever

  2)Salmon pink colored rash                                                                            

  3)Joint pains

·            Moreover, one may also find enlarged, inflamed and tender lymph nodes.

·         Enlargement of liver and spleen.

·         Patient experiencing flare up reaction may also suffer marked degree of exhaustion. In such patients, fluid accumulation in heart and lungs may be found.

·         Sometimes , it may also lead to aseptic meningitis, and sensorineural deafness because of the tendency of the disease to produce direct tissue injury and loss of function. Thus here the word ASEPTIC MENINGITIS is used, because there is no bacterial or pathogenic insult, but inflammation is due to direct tissue injury.
     
                            DIAGNOSIS

·         As stated earlier, AOSD/SD is a diagnosis of exclusion, which means most of the confirmatory tests like RA FACTOR,ANTI NUCLEAR ANTIGEN etc., may be normal.

·         Hence, diagnosis is mostly depenedent on clinical assessments.

·         To make the diagnosis easy and precise a set of symptom criteria. However, confirmation of the diagnosis requires five factors out of which two must belong to the major criteria. This criteria is termed as Yamaguchi criteria.

          YAMAGUCHI CRITERIA FOR DIAGNOSIS OF STILL'S DISEASE/AOSD.

                                  PROGNOSIS

PROGNOSIS OF STILLS DISEASE SEEMS TO BE VERY FAVOURABLE, HOWEVER, EFFECT  ON LUNGS, AND HEART MAY SOMETIMES BE LIFETAKING.

     HOMOEOPATHIC APPROACH TO STILL’S DISEASE

       Homoeopathy is very effective in successfully treating these conditions. Homoeopathy not only relieve the symptoms and give relief, but also cures the condition totally modulation of the patients immunity.

Though constitutional approach seems to be the best in treating the disease, the following remedies can be considered as chief remedies for Still’s disease.

1.       Calcarea carb

2.       Calcarea ars

3.       Natrum muriaticum

4.       Sepia

5.       Arsenic album

6.       Bryonia alba

7.       Tuberculinum

8.       Phosphorous

9.       Rhus tox

10.   Silicea

11.   Colchicum

12.   Terebinth etc.