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Still's Disease

Pediatrics Expert Advice from Shari Nethersole, M.D.

Q: One of my students has just been diagnosed with Still's disease. What can you tell me about this illness?

A: Still's Disease is a form of Juvenile Rheumatoid Arthritis (JRA). JRA is a connective tissue disease whose cause is not completely understood. There is some sort of immune dysregulation in the body that causes a number of inflammatory processes to occur. In particular the joints can become inflamed and painful. Swelling often occurs in the knees, wrists, fingers, and ankles, but other joints can be affected as well. JRA can affect children of any age but the median age is five years; Still's disease occurs with equal frequency in boys and girls, while most other forms of JRA occur more commonly in girls.

In Still's disease the whole body seems to react to the inflammatory stimulus, causing fever, rash, swollen lymph nodes, enlarged liver, and spleen as well as possible swollen joints. The heart and lungs can be involved in the inflammatory process as well. While the diffuse inflammatory symptoms do generally resolve over time, children with Still's disease tend to get more persistent joint symptoms later on.

There are many treatments for JRA, and many children who have it eventually "outgrow" it and don't continue to have symptoms as an adult. Anti-inflammatory medications and physical therapy are the usual treatments. A small percentage of children with JRA have persistent and debilitating symptoms into adulthood. They may require continued medication and/or surgery, and can have permanent disability due to loss of the joint function.

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Shari Nethersole is a physician at Children's Hospital, Boston, and an instructor in Pediatrics at Harvard Medical School. She graduated from Yale University and Harvard Medical School, and did her internship and residency at Children's Hospital, Boston. As a pediatrician, she tries to work with parents to identify and address their concerns.


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