成人史提爾氏疾病

Adult Still's Disease

成人史提爾氏疾病為一臨床症狀診斷之病，最早的發病特徵為長期敗血性發燒、多發性關節痛或關節炎、皮膚紅疹、紅血球沉降速率上昇。本文就台大醫院就最近一年來四個和過去八年之兩個成人史提爾氏疾病提出報告。全部六個病人皆有長期之敗血性發燒至攝氏三十九度，且有關節痛或關節炎及典型皮膚紅疹，關節炎不對稱發作，只同時侵犯幾個關節，且住院一到四個星期關節炎才明顯，其中五個病人有喉痛，三個有肝脾腫大及肝功能異常，一個有肋膜及心包膜炎，實驗室檢查六個病人皆有貧血、高紅血球沉降速率、四個病人有白血球增多現象。類風濕性因子四個陰性二個低濃度（40倍）陽性，抗核抗體、紅斑狼瘡細胞、抗去氧核糖核蛋白抗體、抗核糖核蛋白抗體，在五個受檢病人皆為陰性。五個病人對大量之Indomethacin都有很好的治療效果。

Common early findings in adult still's disease are prolonged 'septic fever', 'polyarthralyia or polyarthritis' and an elevated erythrocyte sedimentation rate. We report the clinic and laboratory features in six adults who were eventually diagnosed as Still's disease in National Taiwan University Hospital. Although there is no pathognomonic abnormalities, the conditions can be readily recognized by the striking constellation of clinic and laboratory abnormalities. All six patients had prolonged spiking fever up to 39°C, typical rashes and arthralgia/ arthritis. The arthritis was asymmetric, involved only a few joints simultaneously and appeared within one to four weeks of admission. Five patients had a sore throat, three had hepatosplenomeguly and abnormal liver function tests, one had pleurisy and pericarditis . The laboratory features included anemia and high erythrocyte sedimentation rate in all six patients. Leukocytosis was detected in four patients. Rheumatoid factors were negative in four cases and low titer (40X) in two cases. Antinuclear antibodies (ANA), anti-nuclear ribonucleoprotein antibodies (Anti- RNP), anti- Sm antibodies (non- nucleic acid protein) were all negative in five examined cases. All six cases responded well to therapy with high dose indomethacin. This is not an uncommon disease, as was once thought, and awareness of it will avoid unnecessary diagnostic procedures or delay initial therapy. (J Rheumatol ROC 1984; 1:24-33) .