Department of Internal Medicine, Division of Rheumatology, Hacettepe University Medical School, Sihhiye, 06100, Ankara, Turkey.
Department of Internal Medicine, Department of Preventive Oncology, Hacettepe University Medical School, Ankara, Turkey.
Clin Rheumatol. 2019 Jun;38(6):1699-1706. doi: 10.1007/s10067-019-04455-y. Epub 2019 Feb 1.
To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still's disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.
FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.
We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30-57) and 45 (30-62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.
Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.
确定一些临床和/或实验室参数，以区分成人Still 病（AOSD）与其他不明原因发热（FUO）的病因，并为此目的创建一个便于临床医生使用的算法。
前瞻性招募 2015 年 3 月至 2017 年 9 月期间住院的 FUO 患者。分析 2001 年至 2017 年期间在我科诊断为 AOSD 的患者。记录所有患者的临床和实验室参数。进行多变量分析以确定可能与 AOSD 与 FUO 鉴别相关的参数。
我们共招募了 69 例 AOSD 患者（51 例女性，74%）和 87 例 FUO 患者（43 例女性，49.4%）。中位年龄分别为 45（30-57）和 45（30-62）。关节痛、皮疹、咽痛、中性粒细胞增多、血清铁蛋白水平高于正常值上限的 5 倍和升高的乳酸脱氢酶水平与诊断 AOSD 的可能性相关；另一方面，每日发热峰数等于或大于 3 与诊断 AOSD 的可能性降低相关。对多变量分析得出的可能参数进行临床可行性评估后，在发热的情况下，选择了两个临床（关节痛、咽痛）和两个实验室（铁蛋白水平、中性粒细胞增多）参数来开发区分 AOSD 和 FUO 的算法。
在表现为 FUO 的患者中，如果存在关节痛、高铁蛋白血症、咽痛和中性粒细胞增多，则提示 AOSD。本研究首次在当前文献中提出了一种便于临床医生使用的算法，以区分 AOSD 与其他 FUO 病因。
