Adult Still’s Disease: A Rare Cause of Fever & Joint Pain

Could ongoing fever, joint pain, and skin rashes be something more than common illness? Adult Still’s disease is a rare condition that can cause these symptoms, often making diagnosis challenging. You might notice periods of feeling unwell, followed by times of improvement, which can be confusing. Understanding what’s happening in your body is the first step towards getting the right care. 

By learning more about this condition, you can work with your healthcare team to find answers and manage your symptoms effectively, helping you feel more in control.

What is Adult Still’s Disease (AOSD)?

Adult Still’s disease (AOSD) is a rare type of inflammatory arthritis that can affect multiple parts of your body. It often presents with recurring fever, joint pain, and a distinctive salmon-pink rash. Some people experience a single episode that resolves, while others have long-term or recurring symptoms. 

This condition can sometimes lead to joint damage, especially in the wrists, if not managed promptly. Although its exact cause is unknown, treatment can help you control symptoms, reduce inflammation, and maintain your quality of life. Early medical attention improves outcomes significantly.

Types of Adult Still’s Disease

There are three main clinical patterns of AOSD:

1. Monophasic – a single episode lasting weeks to months, followed by remission;
2. Polycyclic/systemic – recurrent flares with symptom-free intervals;
3. Chronic articular – persistent arthritis that can cause long-term joint damage.

Types of Adult Still’s Disease at a Glance

Recognising your pattern is important, as it helps your healthcare provider plan the best treatment approach. While the condition is unpredictable, many people manage symptoms effectively with proper care and follow-up.

Symptoms of Adult Still’s Disease (AOSD)

When you have AOSD disease, symptoms can vary in intensity and timing. They may develop suddenly or gradually, and often mimic other illnesses.

Common AOSD symptoms include:

• High fever – Usually spikes once or twice daily, often in the late afternoon or evening.
• Skin rash – Salmon-pink, flat or slightly raised, often appearing with fever on the trunk, arms, or legs.
• Joint pain and swelling – Particularly in knees, wrists, ankles, elbows, and shoulders, lasting at least two weeks.
• Sore throat – Often an early sign, sometimes with swollen neck lymph nodes.
• Muscle pain – Can be severe, matching fever cycles.
• Fatigue – Persistent tiredness even after rest.
• Weight loss – In some cases, linked to prolonged inflammation.

Not everyone experiences all of these symptoms, and their severity can change over time. Some people notice that symptoms follow a cycle, with active phases (flares) followed by periods of improvement. Tracking when and how your symptoms occur can provide valuable information for your doctor.

Being aware of these signs and understanding their patterns can help you seek timely, accurate medical evaluation. Early diagnosis of AOSD allows treatment to begin sooner, which may prevent complications and help you maintain a better quality of life.

What Causes Adult Still’s Disease?

The exact cause of AOSD is not known. Experts believe it involves abnormal activation of the immune system (autoinflammatory), possibly triggered by infections or other environmental factors, though no single cause has been proven. In this condition, your immune system mistakenly attacks healthy tissues, causing widespread inflammation. 

Age appears to play a role, with most cases occurring in adults between 15–25 and 36–46 years old, and it affects men and women equally. Although you cannot prevent AOSD, early diagnosis and treatment can reduce its impact on your daily life and long-term health.

How Will It Affect Me?

AOSD affects each person differently. Some experience only one episode that resolves, while others face recurrent flares. Symptoms may interfere with your work, hobbies, and energy levels, especially during active phases.

Over time, untreated or chronic AOSD disease can cause joint damage and affect daily mobility. However, with timely care and symptom monitoring, many people maintain a fulfilling lifestyle, adapting routines to match their energy and comfort levels.

Complications of Adult Still’s Disease (AOSD)

While many people manage AOSD well, ongoing inflammation can sometimes lead to complications. These may include:

• Joint damage – Persistent swelling and inflammation can gradually wear down cartilage and bone, leading to stiffness, reduced mobility, and deformity, especially in wrists and knees. Over time, this can impact your ability to perform everyday activities comfortably.
• Heart inflammation – Pericarditis, inflammation of the heart’s protective lining, can cause chest pain and discomfort, while myocarditis, inflammation of the heart muscle, may affect the heart’s ability to pump efficiently, potentially leading to fatigue or shortness of breath.
• Lung issues – Inflammation may cause fluid accumulation around the lungs (pleural effusion), which can make it harder to take deep breaths. This can result in a feeling of tightness in the chest and reduced exercise tolerance.
• Macrophage activation syndrome (MAS) – A rare but serious complication where the immune system becomes dangerously overactive. It can cause high fevers, liver and spleen enlargement, low blood counts, and organ damage. MAS requires urgent hospital treatment.

By staying alert to changes in symptoms and working closely with your healthcare team, you can reduce the risk of these outcomes.

How is Adult Still’s Disease Diagnosed?

Diagnosing AOSD can be challenging because symptoms often overlap with other conditions such as lupus, rheumatoid arthritis, or certain cancers. Your doctor will likely start with a detailed medical history and physical examination.

Blood tests often show high inflammatory markers and very high ferritin levels (sometimes thousands of ng/mL), which strongly support but do not confirm the diagnosis. AOSD is a diagnosis of exclusion, meaning other infections, cancers, and autoimmune diseases must be ruled out first.

Treatment of Adult Still’s Disease (AOSD)

Managing AOSD focuses on controlling inflammation, relieving symptoms, and preventing joint damage. Treatment plans are tailored to your needs, depending on severity and frequency of flares.

Common AOSD treatment options include:

• Non-steroidal anti-inflammatory drugs (NSAIDs) – Help reduce fever, pain, and inflammation during mild cases.
• Corticosteroids – Such as prednisone, used to quickly control inflammation when NSAIDs are not enough.
• Disease-modifying antirheumatic drugs (DMARDs) – Like methotrexate, useful in persistent or severe cases to prevent joint damage.
• Biologic therapies – Target specific immune system proteins involved in inflammation, such as IL-1 or IL-6 inhibitors.
• Lifestyle adjustments – Regular exercise, balanced diet, and adequate rest to support overall health.

Your doctor will closely track your progress through regular check-ups and tests. They may adjust medications to maintain effectiveness and minimise possible side effects. Early, targeted intervention not only helps manage symptoms but also lowers the risk of complications.

With the right combination of medical treatment and lifestyle care, many people with AOSD can lead active, fulfilling lives. Working closely with your healthcare team ensures you have the best possible support in managing Still syndrome over the long term.

Lifestyle and Home Remedies

Alongside medical treatment, certain lifestyle habits can help you cope better with AOSD. These steps aim to support your physical and emotional wellbeing:

• Gentle physical activity – Low-impact exercises like swimming or walking help maintain joint mobility and muscle strength.
• Balanced diet – Eating nutrient-rich foods supports immune health and energy levels.
• Adequate rest – Listen to your body and take breaks during flares.
• Heat or cold therapy – Warm compresses or cold packs can ease joint discomfort.
• Stress management – Practices like meditation, breathing exercises, or hobbies can improve emotional resilience.
• Regular check-ups – Staying in touch with your healthcare team ensures timely adjustments to treatment.

These measures work best when combined with your prescribed medical plan, helping you feel more in control of your AOSD journey.

Conclusion

Living with AOSD can be challenging, but understanding your symptoms and working closely with your healthcare provider can make a real difference. Early diagnosis, regular monitoring, and the right treatment plan help prevent complications and improve daily comfort.

Reliable testing plays a key role in managing this condition. Metropolis Healthcare, with its NABL and CAP-accredited labs, experienced pathologists, and convenient home collection services, offers accurate, timely results you can trust – helping you and your doctor make informed decisions for better health outcomes.

FAQs

Q1. What does Adult-onset Still’s disease feel like?

It often feels like recurring high fevers, painful swollen joints, muscle aches, fatigue, and a salmon-pink rash. Discomfort may come and go in cycles, sometimes making daily activities difficult during flare-ups before easing again temporarily.

Q2. Is Adult-onset Still’s disease curable?

There is no known permanent cure. However, many people achieve remission (symptom-free periods) with treatment. Some have only one episode, while others may have chronic disease that requires long-term management. Treatment aims to control inflammation, relieve pain, and prevent complications. With the right care, many people achieve remission and lead fulfilling lives despite the condition’s chronic nature.