Background Adult onset Still Disease (AOSD) is a systemic inflammatory disease presenting various non-specific symptoms like fever, arthralgia and pharyngalgia. Those symptoms are mimicking common cold, which could lead to the delayed diagnosis. However, little is known about the profiles and development of symptoms in very early phase before diagnosis.
Objectives To clarify the clinical course of AOSD symptom development in very early phase and its effect on the diagnosis delay.
Methods Consecutive patients with AOSD with enough information in our hospital were enrolled. Initial symptoms before and at diagnosis were investigated in detail. The gradual course from the initial symptoms to the fulfilment of Yamaguchi criteria for AOSD was examined.
Results A total of 51 patients were enrolled. The mean age at diagnosis was 45.0±18.9 years old and 41 (80%) were female. All patients were met with the Yamaguchi criteria. The mean duration from the first symptom to diagnosis was 50.4 days. The duration from the first symptom to the first visit to the medical facility including a general physician was 19.1 days, and that from the first medical facility visit to the first blood test was 8.0 days. While the first symptom was arthralgia in 29 (34.1%), fever in 20 (23.5%), and eruption in 20 (23.5%), pharyngalgia in 13 (15.3%), at diagnosis, fever was found in all patients, eruption in 47 (92.2%), arthralgia in 45 (88.2%), pharyngalgia in 34 (66.7%), lymphadenopathy and/or splenomegaly in 35 (68.6%), increased white blood cell (WBC) count in 44 (86.3%), ferritin elevation in 42 (82.4%), liver enzyme elevation in 41 (80.4%), negative rheumatoid factor (RF) and anti-nucleolar antibody (ANA) in 30 (58.8%). Arthralgia developed 41.9 days prior to the diagnosis, fever 40.9 days, eruption 29.5 days, pharyngalgia 24.5 days and lymphadenopathy and/or splenomegaly 14.8 days. WBC increase was detected 17.8 days prior to the diagnosis, negative RF and ANA 15.1 days, liver enzyme elevation 14.6 days, and ferritin elevation 10.9 days. At 14 days from the first symptom, 32 (62.7%) met 3 of Yamaguchi criteria, 23 (45.1%) met 4, and 19 (37.3%) met 5. At 28 days, 40 (78.4%) met 3 of Yamaguchi criteria, 32 (62.7%) met 4, and 27 (52.9%) met 5. The duration to diagnosis was significantly shorter in the patients with eruption developing within 7 days since the first symptoms than those without (35.2 vs 74.3 days, p=0.03)
Conclusions The mean duration from the first symptom to the diagnosis of AOSD was approximately 50 days, and only a half of the patients met Yamaguchi criteria at 28 days after first symptom. The time of eruption emergence affected the early diagnosis.
Disclosure of Interest None declared
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