Adult-Onset Still’s Disease

Adult-onset Still’s disease is a clinical syndrome of unknown etiology characterized primarily by fever, joint pain and/or arthritis, myalgia, rash, sore throat, and lymph node enlargement, accompanied by an increased peripheral blood granulocyte count and involvement of multiple organ systems.

TCM Pattern Differentiation and Medication Reference

|Common Symptoms

Clinical description:

Fever, aversion to wind or chills, aching pain in multiple joints and muscles throughout the body, sweating, headache, dry mouth and thirst, sore throat, painful swollen lymph nodes, red tongue tip and edges, thin white or thin yellow coating, and a floating, tense or rapid pulse.

In everyday terms:

  • You may develop a fever and feel uncomfortably hot as your temperature rises.
  • Wind may make you feel uncomfortable, or you may also feel cold and shivery.
  • Multiple joints and muscles throughout your body may ache, with greater discomfort during movement or when pressed.
  • You may sweat, soaking your clothes.
  • You may have a headache with a feeling of pressure and discomfort.
  • Your mouth may feel dry and thirsty, and your mouth or throat may feel dry when speaking or swallowing.
  • Your throat may hurt, with greater discomfort when swallowing or speaking.
  • Painful lumps or nodules may appear, such as along the sides of the neck.
  • The edges and tip of your tongue may look red when you stick it out.
  • The coating on your tongue may be thin and white or pale yellow.
  • On pulse examination, the pulse may feel superficial and tense, or faster than usual.

|Treatment Approach

Clinical description:

Dispel wind, clear heat, diffuse the Lung, and release pathogenic factors from the exterior.

In everyday terms:

  • Dispel wind → Help disperse external wind pathogens, potentially easing headache, body aches, aversion to wind, and migrating aches.
  • Clear heat → Clear internal heat, potentially easing fever, sore throat, thirst, facial flushing, and restlessness.
  • Diffuse the Lung → Promote the free flow of Lung qi, potentially easing nasal congestion, cough, chest tightness, and shortness of breath.
  • Release pathogenic factors from the exterior → In TCM theory, help release pathogenic factors from the body’s exterior through sweating or rash eruption, with the aim of shortening the course of illness and reducing discomfort.

|Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

|Common Symptoms

Clinical description:

Persistent high fever, no aversion to cold but aversion to heat, burning joint pain, sweating, intense thirst with a preference for cold drinks, flushed face, restlessness, or impaired consciousness and delirious speech; widespread red rash; sore throat; yellow urine; dry, hard stools; a red tongue with a yellow coating or a deep-red tongue with little coating; and a slippery, rapid or surging, rapid pulse.

In everyday terms:

  • Your temperature may be very high and remain elevated without easing.
  • You may not feel cold; instead, you may feel hot and more uncomfortable in a warm environment.
  • Your joints may feel as if they are burning, with more pain when touched or moved.
  • You may sweat, soaking your clothes.
  • You may be extremely thirsty and strongly prefer cold drinks.
  • Your face may look red and feel hot.
  • You may feel restless and agitated, and find it difficult to sit still or feel calm.
  • You may become confused or even speak incoherently.
  • Red, spot-like rashes may appear over several areas of your body.
  • Your throat may hurt, with greater discomfort when swallowing or speaking.
  • Your urine may be yellow and darker than usual.
  • Your stools may be dry and hard, making bowel movements difficult.
  • Your tongue may look red with a yellow coating, or deep red with very little coating.
  • On pulse examination, the pulse may feel smooth and fast, or full and fast.

|Treatment Approach

Clinical description:

Clear heat from the qi level, cool the blood, drain fire, and resolve toxins.

In everyday terms:

  • Clear qi-level heat → In TCM theory, clear heat at the qi level to ease fever, thirst, restlessness, and sore throat.
  • Cool the blood → In TCM theory, reduce heat at the blood level and ease signs such as rash, a tendency to bleed, and a deep-red tongue.
  • Drain fire → In TCM theory, clear excessive fire to ease facial flushing, mouth ulcers, and red eyes or a sore throat.
  • Resolve toxins → In TCM theory, clear “toxic pathogens” associated with inflammation and help reduce redness, swelling, and suppuration in sores, supporting relief of swelling and pain and healing.

|Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

|Common Symptoms

Clinical description:

Afternoon tidal fever, swollen and painful joints that feel hot or warm to the touch, widespread rash that may become ulcerated and suppurate in severe cases, bitter taste, sore throat, persistent swollen lymph nodes, poor appetite and nausea, yellow-red urine, sticky stools that are difficult to pass, a yellow, greasy tongue coating, and a slippery, rapid pulse.

In everyday terms:

  • You may have recurring fever in the afternoon or evening, with your temperature rising in episodes.
  • Your joints may become swollen and painful, causing discomfort with movement.
  • The affected area may feel hot or burning when touched.
  • Many rashes may appear over widespread areas of your body.
  • In severe cases, the rash may break down and ooze pus.
  • You may have a bitter taste in your mouth or an unpleasant taste.
  • Your throat may hurt, with greater discomfort when swallowing or speaking.
  • Swollen lumps, such as along the sides of your neck, may persist without going away.
  • You may have a poor appetite and feel nauseated easily, or feel like vomiting when you see food.
  • Your urine may be yellowish-red and darker than usual.
  • Your stools may feel sticky and difficult to pass, with a lingering feeling of incomplete evacuation.
  • Your tongue coating may look yellow and greasy.
  • On pulse examination, the pulse may feel smooth and somewhat rapid.

|Treatment Approach

Clinical description:

Clear heat, promote urination to dispel dampness, resolve toxins, and free the channels and collaterals.

In everyday terms:

  • Clear heat → In TCM theory, clear internal heat to ease redness, swelling, burning sensations, sore throat, thirst, and restlessness.
  • Promote urination to dispel dampness → In TCM theory, help eliminate dampness through urine or sweat and ease feelings of heaviness and stickiness, swelling and oozing, and difficulty urinating.
  • Resolve toxins → In TCM theory, clear “toxic pathogens” associated with inflammation and help reduce redness, swelling, heat, pain, and suppuration in sores, supporting healing.
  • Free the channels and collaterals → In TCM theory, promote the flow of qi and blood through the channels and microcirculation, potentially improving numbness, stiffness, pulling pain, and restricted movement.

|Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

|Common Symptoms

Clinical description:

Fever in the afternoon or at night, night sweats or spontaneous sweating, joint pain, possible fatigue and weakness, flushed complexion, heat in the palms and soles, a red tongue with little coating, and a deep, thready pulse.

In everyday terms:

  • You may develop a fever in the afternoon or at night, with a more noticeable rise in temperature during these times.
  • You may sweat at night or also experience involuntary sweating during the day.
  • Your joints may hurt, with discomfort during movement or when pressed.
  • You may feel tired and weak, with little energy for activities.
  • Your face may become flushed, with warm, red cheeks.
  • Your palms and soles may feel hot to the touch.
  • Your tongue may look somewhat red, with little or no obvious coating.
  • On pulse examination, the pulse may be easier to feel with deeper pressure and may feel thready.

|Treatment Approach

Clinical description:

Use sweet, warm methods to supplement qi, nourish yin, and clear heat.

In everyday terms:

  • Sweet and warm → In TCM theory, use sweet, mildly warm properties to gently support and replenish, support digestion, and ease tension or spasmodic discomfort.
  • Supplement qi → In TCM theory, support physical strength and organ function, and ease shortness of breath, weakness, and fatigue.
  • Nourish yin → In TCM theory, replenish yin fluids, body fluids, and blood to ease dry mouth and throat, tidal fever, night sweats, and restlessness or feeling overheated.
  • Clear heat → In TCM theory, reduce signs of internal heat, potentially easing redness, swelling, burning sensations, sore throat, thirst, and restlessness.

|Related Products

The products below are provided for informational purposes only and do not constitute medical advice or a prescription. Follow the product packaging and package insert, and use under the guidance of a physician or pharmacist.

References

  1. Rheumatology Branch of the Chinese Medical Association. Guidelines for the diagnosis and treatment of adult-onset Still’s disease (draft) [J]. Chinese Journal of Rheumatology, 2004, 8(1): 54-55.
  2. Lian Fan, Yang Xiuyan, Liang Liuqin, et al. Diagnostic value of serum ferritin levels in adult-onset Still’s disease [J]. Chinese Journal of Rheumatology, 2005, 9(2): 338-341.
  3. Wang Chengde, Shen Pi’an, Hu Yinqi. Practical Traditional Chinese Medicine Rheumatology [M]. 2nd ed. Beijing: People’s Medical Publishing House, 2009.