Adults
Adult-onset Still's disease (AOSD)
Daily spiking fevers, evanescent salmon rash, sore throat, arthritis and a very high ferritin.
What to look for
- Quotidian (daily, spiking) fevers, often 39 °C or higher
- Evanescent salmon-pink rash that comes with the fever
- Sore throat, arthralgia or arthritis, serositis, lymphadenopathy, splenomegaly
- Neutrophilic leukocytosis, raised liver tests, very high ferritin (glycosylated fraction under 20% if measured)
What to do
- Send CBC, metabolic panel with liver tests, ferritin, CRP/ESR and LDH.
- It is a diagnosis of exclusion. Rule out infection, malignancy (especially lymphoma) and drug reactions.
- EULAR/PReS 2024 favors early IL-1 or IL-6 blockade over prolonged glucocorticoids.
- Cytopenias with a rising ferritin may signal MAS, which is emergent.
About this urgency level
Early specialist assessment changes outcomes. Send the usual workup with the referral, but don't hold the referral while waiting for results.
Timeframes are typical targets. Local pathways, capacity and clinical judgment come first.