Clinical Manifestations but not Cytokine Profiles Differentiate Adult-onset Still’s Disease and Sepsis

Rau, Monika; Schiller, Martin; Krienke, Stefan; Heyder, Petra; Lorenz, Hannes; Blank, Norbert

doi:10.3899/jrheum.100247

Cited by 148 publications

(132 citation statements)

References 33 publications

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“…The items proposed were fever, evanescent rash, pleuritis, pneumonia, pericarditis, hepatomegaly or abnormal liver function tests, splenomegaly, lymphadenopathy, white blood cells >15,000/mm 3 , sore throat, myalgias and abdominal pain. This score was later on improved by Rau et al [35] who replaced 'splenomegaly' and 'abdominal pain' with 'ferritin serum levels ‡3000 mg/l', and 'arthritis'. This change raised the quality of such criteria introducing two of the most important parameters that mirror disease activity.…”

Section: Severe Course and Life-threatening Complicationsmentioning

confidence: 95%

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Presentation and diagnosis of adult-onset Still’s disease: the implications of current and emerging markers in overcoming the diagnostic challenge

Colafrancesco¹,

Priori²,

Valesini³

2015

Expert Review of Clinical Immunology

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Adult-onset Still's disease (AOSD) is a known cause of fever of unknown origin. It is characterized by a triad of symptoms: spiking fever (>39°C), salmon-colored rash and arthritis/arthralgia. On a predisposing genetic background, several conditions may act as trigger for disease and among these, infectious agents are the most important. Nowadays, a dichotomous view of AOSD has been introduced which distinguishes this entity in two subsets according to the clinical features and laboratory aspects: systemic or articular. As AOSD is a diagnosis of exclusion, specific biomarkers able to facilitate differential diagnosis are needed. A number of possible biomarkers have been proposed that will be discussed in detail in this review: ferritin, IL-18, procalcitonin, s100 proteins and sCD163.

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Section: Severe Course and Life-threatening Complicationsmentioning

confidence: 95%

“…[60] S100A8/A9 11,770 ± 8840 ng/ml 36 [85] 57.11 ± 25.38 ng/ml 25 [84] 0.5-9 ng/ml 18 [35] S100A12 547.9 ± 148.4 ng/ml 37 [86] Procalcitonin 0.09-71 ng/ml 5 [70] 2-10 ng/ml 1 [72] 0-1.4 ng/ml 38 [73] SD: Standard deviations.…”

Section: Biomarkersmentioning

confidence: 99%

Presentation and diagnosis of adult-onset Still’s disease: the implications of current and emerging markers in overcoming the diagnostic challenge

Colafrancesco¹,

Priori²,

Valesini³

2015

Expert Review of Clinical Immunology

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“…Serum cytokine levels of IL-1ß, IL-6, IL-8, IL-10, IL-12, IL-18, IFN-γ, TNF-α, and calprotectin are elevated both in patients with acute AOSD and sepsis 21 .…”

Section: Epidemiologymentioning

confidence: 99%

Adult-Onset Still's Disease: A Review

Fong

Lui

2013

Proceedings of Singapore Healthcare

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Adult-onset Still's disease (AOSD) is an uncommon inflammatory condition characterised by high fever, leukocytosis with neutrophilia, arthralgia and skin rash. Diagnosis is often clinical, and it is always necessary to exclude common disease mimics such as infections, malignancies and other rheumatic diseases. Ferritin and glycosylated ferritin are useful adjuncts to aid in the diagnosis of AOSD. Important complications to consider include fulminant hepatitis, disseminated intravascular coagulopathy and hemophagocytic syndrome. Mainstay treatment of AOSD is often with glucocorticoids. Other agents that can also be used include methotrexate, and biologic therapy, such as tumor necrosis factor-α (TNF-α) blockers and interleukin-1 (IL-1) inhibitors. A retrospective review of patients diagnosed with AOSD admitted to Singapore General Hospital (SGH) was performed, and their disease characteristics and laboratory findings were compared with that of previous published cohorts.

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“…All cases in this research were collected from 2006 to 2011 and some reference indexes value (serum ferritin and calcitonin zymogen) can't be analysed because methods were inconsistent, while these indexes were very important factors for discriminating infectious diseases from non-infectious diseases. [14][15][16][17] The sensitivity was low due to lack of indexes with high sensitivity and specificity. The disease spectrum of FUO in China is different from Europe and America.…”

Section: Discussionmentioning

confidence: 99%

A Clinical Analysis of 293 FUO Patients, A Diagnostic Model Discriminating infectious Diseases from Non-infectious Diseases

Zhou¹,

Xu²,

Tan³

et al. 2014

Infection International

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Objective A diagnostic model was established to discriminate infectious diseases from non-infectious diseases. Methods The clinical data of patients with fever of unknown origin (FUO) hospitalized in Xiangya Hospital Central South University, from January, 2006 to April, 2011 were retrospectively analyzed. Patients enrolled were divided into two groups. The first group was used to develop a diagnostic model: independent variables were recorded and considered in a logistic regression analysis to identify infectious and non-infectious diseases (αin = 0.05, αout = 0.10). The second group was used to evaluate the diagnostic model and make ROC analysis. Results The diagnostic rate of 143 patients in the first group was 87.4%, the diagnosis included infectious disease (52.4%), connective tissue diseases (16.8%), neoplastic disease (16.1%) and miscellaneous (2.1%). The diagnostic rate of 168 patients in the second group was 88.4%, and the diagnosis was similar to the first group. Logistic regression analysis showed that decreased white blood cell count (WBC < 4.0×109/L), higher lactate dehydrogenase level (LDH > 320 U/L) and lymphadenectasis were independent risk factors associated with non-infectious diseases. The odds ratios were 14.74, 5.84 and 5.11 (P ≤ 0.01) , respectively. In ROC analysis, the sensitivity and specificity of the positive predictive values was 62.1% and 89.1%, respectively, while that of negative predicting values were 75% and 81.7%, respectively (AUC = 0.76, P = 0.00). Conclusions The combination of WBC < 4.0×109/L, LDH > 320 U/L and lymphadenectasis may be useful in discriminating infectious diseases from non-infectious diseases in patients hospitalized as FUO.

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Clinical Manifestations but not Cytokine Profiles Differentiate Adult-onset Still’s Disease and Sepsis

Cited by 148 publications

References 33 publications

Presentation and diagnosis of adult-onset Still’s disease: the implications of current and emerging markers in overcoming the diagnostic challenge

Presentation and diagnosis of adult-onset Still’s disease: the implications of current and emerging markers in overcoming the diagnostic challenge

Adult-Onset Still's Disease: A Review

A Clinical Analysis of 293 FUO Patients, A Diagnostic Model Discriminating infectious Diseases from Non-infectious Diseases

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