Background/Purpose: The peak age at the onset of adult Still’s disease (ASD) has been between 20 and 35 years old. However, the proportion of elderly-onset ASD (EOASD) is increasing in Japan, a country of super-aged society. Therefore, we investigated the clinical features of EOASD in comparison with non-elderly-onset ASD.

Methods: A total of 20 patients with the diagnosis of ASD according to the classification criteria by Yamaguchi et al. between May 2013 and October 2018 in our department were enrolled in this study. Their medical records were intensively reviewed for demographics, clinical manifestations, laboratory data, treatments received and outcome.

Results: Six patients with the age of onset ≥ 65 years (median 71 years old, 5 women) and 14 patients < 65 years (median 38 years old, 12 women). There were no between-group differences in the frequency of fever, sore throat, arthralgia, leukocytosis, liver function abnormality, seronegativity and serum ferritin levels. However, typical rash (50% versus 92%) and lymphadenopathy (50% versus 92%) tended to be less frequently observed in EOASD as compared with non-elderly-onset ASD, and as a result, the number of fulfilled items of Yamaguchi criteria was significantly smaller in EOASD than non-elderly-onset ASD (the median value of 5.5 and 7.5, respectively, p=0.0036). With regard to the treatment, glucocorticoids were administered in 19 patients (initial daily dose of prednisolone 50 mg/day for both groups), and tocilizumab was added in 20% and 35% of EOASD and non-elderly-onset ASD patients respectively. The prognosis was fair except for one patient with non-elderly-onset ASD developing fatal sepsis.

Conclusion: EOASD was not rare (30% of ASD) and showed comparable clinical features and outcomes with non-elderly-onset ASD.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-features-of-elderly-onset-adult-stills-disease/