You don’t meet criteria for Still’s disease (AOSD or sJIA), now what should you do or consider?

What you do or consider next can be addressed according to what stage of the disease you are at – either A) Hospitalized Febrile Disease, or B) Outpatient “Still’s” Disease.

1. Hospitalized patients: the diagnosis of Still’s disease is easier and more certain if you have been hospitalized for high fevers, multi-organ dysfunction and worrisome labs showing high inflammation.  Moreover, more testing, imaging and consultations with specialists in the hospital can facilitate the correct diagnosis. Thus, if you were NOT diagnosed with Still’s disease after several days of evaluation in the hospital, a Still’s diagnosis is unlikely.  It is possible that if you are in the first 6-12 weeks of symptoms, you may not have the requisite findings to make a Still’s diagnosis.  Thus, some patients can still be diagnosed with time (usually months).
2. Outpatient “Still’s”: Many patients are often given a diagnosis of “Still’s” by clinicians who may not be familiar with this diagnosis or the diagnostic criteria.  For those not in the hospital, a diagnosis of Still’s cannot be seriously considered without having the “Triad Symptoms” of 1) Daily Spiking Fevers >102F; 2) Intermittent JRA rash; and 3) Polyarthritis.  Moreover, it’s very unlikely to have this diagnosis if you have: Fevers <101F, rash on the face, WBC < 3.0, only one swollen joint, age over 60 yrs., and a good response to prednisone 10-20 mg per day.