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Clinical features of elderly-onset Adult-onset Still's disease
Akihito Maruyama1, Ayako Kokuzawa2, Yusuke Yamauchi3
1Department of Rheumatology, Faculty of Medicine, Saga University, Saga, Japan.
Modern Rheumatology
|September 29, 2020
Summary
Elderly-onset Adult-onset Still's disease (AOSD) presents with fewer skin rashes but more complications and higher ferritin levels. This patient group experiences poorer prognoses compared to younger individuals with AOSD.
Area of Science:
- Rheumatology
- Internal Medicine
- Clinical Immunology
Background:
- Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder.
- Characterizing AOSD in elderly patients is crucial for understanding disease heterogeneity.
Purpose of the Study:
- To delineate the distinct clinical characteristics of elderly-onset AOSD.
- To compare the presentation, treatment, and prognosis of elderly-onset AOSD with younger-onset AOSD.
Main Methods:
- Patients were stratified into elderly-onset (>60 years) and younger-onset (≤60 years) groups.
- Clinical features, treatment strategies, and patient outcomes were analyzed and compared between the two groups.
Main Results:
- Elderly-onset AOSD patients exhibited less frequent typical skin rashes (21.3% vs 58.9%) but higher rates of pleuritis (27.7% vs 7.4%) and disseminated intravascular coagulation (19.1% vs 2.1%).
- Serum ferritin levels were significantly elevated in the elderly group (median 12,700 ng/ml vs 2526 ng/ml).
- Poorer overall survival, AOSD-related survival, and lower rates of drug-free remission were observed in elderly-onset AOSD patients.
Conclusions:
- Elderly-onset AOSD is characterized by atypical skin manifestations, increased risk of complications like DIC, elevated ferritin, and worse prognosis.
- These findings highlight the need for tailored management strategies for elderly patients diagnosed with AOSD.
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