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Medical Edge Newspaper Column from Mayo Clinic

STILLS DISEASE MEDICATION EASES PAIN, LENGTHENS REMISSION

DEAR MAYO CLINIC: I’m an 18-year-old woman and I have a disease called JRA Still’s disease. I want to learn more about it and its treatment options. — Indonesia

ANSWER: Still’s disease is a rare form of inflammatory arthritis. Arthritis refers to inflammation of various joints — the points at which two bones meet in the body. Other symptoms of Still’s disease include swollen glands, skin rashes, fatigue, sore throat and fevers. While no one knows the exact cause of this condition, it is thought to have both genetic and environmental components.

Scientists know that people with Still’s disease produce higher than normal levels of cytokines, which are molecules that promote inflammation and cause the destruction of bone and cartilage in the joints.

There are two forms of Still’s disease. The type occurring in children is also known as systemic juvenile rheumatoid arthritis — or JRA. This form of arthritis typically affects many joints, including the small joints of the hands and feet. Additional symptoms can include growth retardation, osteoporosis, joint deformity and leg-length discrepancy. JRA also can cause fevers and rash.

Still’s disease also affects adults, although adult-onset of the disease is less common. In adults, the disease primarily affects the wrists, knees and ankles — though any joint can be involved. Scientists don’t know whether the childhood- and adult-onset forms of Still’s disease represent distinct disorders or are the same illness.

For children and adults, there typically are flare-up periods that are interspersed with remissions lasting weeks to months. About 35 percent of patients experience complete remission 10 years after diagnosis. But for most patients, symptoms of the disease are lifelong.

Physicians use several types of medications to treat Still’s disease. Nonsteroidal anti-inflammatory (NSAID) drugs such as aspirin and ibuprofen can be used to ease the pain and inflammation. Methotrexate is used in combination with NSAIDs to slow the progression of the disease and soothe its symptoms. Corticosteroids such as prednisone are used to treat severe symptoms.

The most promising drug treatments for inflammatory arthritis block the action of specific cytokines. Medications in this category include etanercept (Enbrel), infliximab (Remicade) and adalimumab (Humira). They may help decrease the joint destruction caused by Still’s and increase the length of remissions.

In addition, bone marrow transplant has been used to treat Still’s disease as a last resort for the most severe cases.

— Eric Matteson, M.D., Rheumatology, Mayo Clinic, Rochester, Minn.

Additional Resources:
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More Information on Still's Disease

READERS: A child may call it the “creepy crawlies” or “ouchies” in the legs. Parents recognize it in their children as sudden evening restlessness or difficulty falling asleep. Sometimes they attribute it to “growing pains.” Now new research shows these symptoms may indicate restless legs syndrome — an underdiagnosed condition in children.

While occasional growing pains in the legs around bedtime are nothing to worry about, growing pains every night may be restless legs syndrome. Symptoms of the disorder in children occur most often in the evening or around bedtime. They include discomfort or an uncontrollable urge to move the legs. The feeling goes away if the child becomes active.

A recent study published in the Annals of Neurology described the spectrum of restless legs syndrome in more than 500 children seen at the Mayo Clinic Sleep Disorders Center during a four-year-period. Researchers found it affected nearly 6 percent of the study population. The most common symptom is trouble getting to sleep or staying asleep. In addition, 83 percent of those with restless legs syndrome had low iron levels in the blood, which is a characteristic of adults with the disorder.

Genes also appear to play a role. Nearly two-thirds of study participants with restless legs syndrome had a parent with the condition.

If you suspect that your child may have restless legs syndrome, seek medical help. The reason: Children with the disorder can benefit from medications, which can improve their quality of life by increasing daytime attentiveness and relieving fatigue caused by poor sleep at night.

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Medical Edge from Mayo Clinic is an educational resource and doesn’t replace regular medical care. To e-mail a question, go to www.mayoclinic.org, or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite 114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.