Department of Internal Medicine, Cairo University Hospitals, Giza, Egypt.
Abstract: (2648 Views)
Adult Onset Still’s Disease (AOSD) is a rare systemic inflammatory disease of unrecognized etiology and pathogenesis that presents in 5% to 10% of patients as Fever of Unknown Origin (FUO) accompanied by systemic manifestations. We reported a compelling case of a 39-year-old African male who presented with a one-month duration FUO along with skin rash, sore throat, and arthralgia. After an extensive workup, potential differential diagnoses were ruled out, and the patient was diagnosed with AOSD based on the Yamaguchi criteria.
After the application of Ultrasound (US) and exercises on both ankles as well as left knee, left elbow, and left wrist, there was an improvement of Visual Analogue Scale by 66.6%, Five Repetition Sit to Stand Test (FRSTS) improved 50%, Timed Up and Go (TUG) test improved 87.5%, and there was also an improvement in the 36-Item Short Form Survey (SF-36), and muscle testing. This result was due to the anti-inflammatory effect of the US, leading to decrease pain and improve function in the individuals.
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● Joint pain occurs in two-thirds of patients, which starts concomitantly with fever.
● The treatment of AOSD is mainly centered on the use of non-steroidal anti-inflammatory drugs.
● Ultrasonic enhance soft tissue healing decreases the inflammatory response, increases blood flow, increases metabolic activity, and decreases pain.
● US and exercises for two weeks decrease pain and increase physical performance on patient with AOSD.
Plain Language Summary
Adult Onset Still’s Disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology. It is an immunologic disorder affects women slightly more than men. Its prevalence is estimated to be 1.5 cases per 100 000 to 1.5 cases per 1000 000. Joint pain occurs in two-thirds of patients. The arthralgia starts concomitantly with fever, involves any joint, and may migrate at the beginning and become more stable during the disease. A poor prognosis is associated in AOSD patients with poly articular onset. There is a strong causal relationship between joint damage and subsequent disability. Moreover, AOSD patients may experience several severe complications associated with a decrease in life expectancy. The treatment of AOSD is mainly centered on the use of non-steroidal anti-inflammatory drugs, steroids, and disease-modifying ant rheumatic drugs. Ultrasound is based on the application of high frequency sound waves to the tissues of the body in order to obtain mechanical or thermal effects. These effects aim to enhance soft tissue healing, decrease the inflammatory response, increase blood flow, increase metabolic activity, and decrease pain. Moreover, there is some evidence that ultrasonic energy stimulates the repair of joint cartilage in animal models of cartilage injury. Low-intensity pulsed ultrasound may exert a protective effect on articular cartilage by increasing proteoglycan synthesis and counteracting the catabolic activity of pro-inflammatory cytokines, together with positive effects also by inhibiting subchondral bone sclerosis, particularly in early osteoarthritis stages. Low-intensity pulsed ultrasound may also stimulate chondrocyte proliferation and matrix production, with dose-dependent effects and greater attenuation of cartilage degeneration in the early osteoarthritis phases.
Type of Study:
case report |
Subject:
General Received: 2019/06/12 | Accepted: 2020/01/1 | Published: 2020/05/31
