M44 — November 2012 — Still's Disease

Intro: Sometimes doctors have to be detectives to stop the villain that's making their patient's lives miserable. And sometimes, when the condition is rarely seen and the body's own defenses are to blame… it takes a specialist. Here's Dennis Douda for Mayo Clinic News Network.

"I play volleyball, soccer, golf…"

Bethany Pautsch has loved sports all her life. But, she feared her athletic days were over when she was incapacitated by a mystery illness.

As it progressed, I couldn't get out of bed. I wouldn't be able to lift up my arms.

For a year Bethany battled severe and painful symptoms that made doctors suspect everything from strep infections to mononucleosis… blood diseases and rheumatoid arthritis. Not until she saw Mayo Clinic rheumatologist Timothy Bongartz did she get an answer. She has a rare condition called Still's Disease.

Drains you. It feels like having a very bad flu. But in addition, she had a violent — very violent immune reaction to her joints, resulting in very rapid destruction, especially of her — her hips.

Dr. Bongartz explained to Bethany that her immune system had started attacking her joints. The cause is not known. Still's patients tend to have high fevers, arthritis and a rash. Symptoms may also include throat pain, swollen lymph nodes, high white blood cell counts or high levels of ferritin, a protein that binds to iron. Because there's no simple test for it, diagnosis involves a process of elimination, ruling out diseases it mimics like other forms of arthritis.

In Still's disease, you often see very prominent involvement of the wrist with severe narrowing of the joint space, and the knuckle joints are, you know, barely affected.

Bethany needed joint replacement surgery in both of her hips to get her back on her feet. But only after Doctor Bongartz first brought her condition under control. Regular IV infusions of a biologic drug that tames her over-active immune system may be a life-long necessity.

I'm not really sure, but even if I just have to do the infusion once a month, it — I'm able to live a healthy life so it's fine. Small price to pay.

I'm healthy again. I'm able to do all the things I was able to do before I got sick and I have my life back.

For the Mayo Clinic News Network, I'm Dennis Douda.

Anchor tag:

Still's Disease is rare, affecting only about 2-people in a million each year. It can strike children but most often appears in young adults, but can affect people into their 50's.

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