Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study
Objective To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still’s disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose. Methods FUO patients hospitalized between March 2015 and Septe...
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| Veröffentlicht in: | Clinical rheumatology 2019-06, Vol.38 (6), p.1699-1706 |
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| container_title | Clinical rheumatology |
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| creator | Bilgin, Emre Hayran, Mutlu Erden, Abdulsamet Armağan, Berkan Sarı, Alper Kılıç, Levent Akdoğan, Ali Karadağ, Ömer Bilgen, Şule Apraş Kiraz, Sedat Ertenli, İhsan Kalyoncu, Umut |
| description | Objective
To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still’s disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.
Methods
FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.
Results
We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30–57) and 45 (30–62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.
Conclusion
Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO. |
| doi_str_mv | 10.1007/s10067-019-04455-y |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179487702</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2179487702</sourcerecordid><originalsourceid>FETCH-LOGICAL-c375t-3336f3cb8eebec43c0f8a827df7d28a877adb5c1f4bbe1475fd6427d170dc3f73</originalsourceid><addsrcrecordid>eNp9kcFuFSEUhonR2NvqC7gwJG7coDAwlxl3ptFq0kQTdT1hmMMtlYERmDZ352vo4_kkHnurJi7cHAjnO_9_yE_II8GfCc7184J1qxkXPeNKtS3b3yEboaRifa_6u2TDteZMir47IselXHLOm64X98mR5FrwphEb8v19TksqJlCXMjW0-HkJQE3YpezrxUxropN3DjLE6k3F1rSGylIsUOmH6kP48fVbQaaAKUCvcYimegGZOrjCmhxd4-eYriNFxZ2P1Jq1QHmBZiHFna_r5CP6LzmVBWz1V0ALPu4fkHvOhAIPb88T8un1q4-nb9j5u7O3py_PmZW6rUxKuXXSjh3ACFZJy11nukZPTk8N3rQ209ha4dQ4glC6ddNWYVtoPlnptDwhTw-6uMGXFUodZl8shGAipLUMjdC9QhneIPrkH_QyrRm3v6HUlgvRSaSaA2XxSyWDG5bsZ5P3g-DDr-SGQ3IDJjfcJDfscejxrfQ6zjD9GfkdFQLyABRsxR3kv97_kf0JfpipcQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2174601183</pqid></control><display><type>article</type><title>Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study</title><source>MEDLINE</source><source>Springer Nature - Complete Springer Journals</source><creator>Bilgin, Emre ; Hayran, Mutlu ; Erden, Abdulsamet ; Armağan, Berkan ; Sarı, Alper ; Kılıç, Levent ; Akdoğan, Ali ; Karadağ, Ömer ; Bilgen, Şule Apraş ; Kiraz, Sedat ; Ertenli, İhsan ; Kalyoncu, Umut</creator><creatorcontrib>Bilgin, Emre ; Hayran, Mutlu ; Erden, Abdulsamet ; Armağan, Berkan ; Sarı, Alper ; Kılıç, Levent ; Akdoğan, Ali ; Karadağ, Ömer ; Bilgen, Şule Apraş ; Kiraz, Sedat ; Ertenli, İhsan ; Kalyoncu, Umut</creatorcontrib><description>Objective
To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still’s disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.
Methods
FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.
Results
We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30–57) and 45 (30–62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.
Conclusion
Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.</description><identifier>ISSN: 0770-3198</identifier><identifier>EISSN: 1434-9949</identifier><identifier>DOI: 10.1007/s10067-019-04455-y</identifier><identifier>PMID: 30710221</identifier><language>eng</language><publisher>London: Springer London</publisher><subject>Adult ; Algorithms ; Arthralgia ; Diagnosis, Differential ; Female ; Ferritin ; Fever ; Fever of Unknown Origin - etiology ; Humans ; L-Lactate dehydrogenase ; Laboratories ; Lactic acid ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Multivariate Analysis ; Neutrophilia ; Original Article ; Pharyngitis ; Pharynx ; Prospective Studies ; Rheumatology ; Still's Disease, Adult-Onset - complications ; Still's Disease, Adult-Onset - diagnosis</subject><ispartof>Clinical rheumatology, 2019-06, Vol.38 (6), p.1699-1706</ispartof><rights>International League of Associations for Rheumatology (ILAR) 2019</rights><rights>Clinical Rheumatology is a copyright of Springer, (2019). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c375t-3336f3cb8eebec43c0f8a827df7d28a877adb5c1f4bbe1475fd6427d170dc3f73</citedby><cites>FETCH-LOGICAL-c375t-3336f3cb8eebec43c0f8a827df7d28a877adb5c1f4bbe1475fd6427d170dc3f73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10067-019-04455-y$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10067-019-04455-y$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27903,27904,41467,42536,51297</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30710221$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Bilgin, Emre</creatorcontrib><creatorcontrib>Hayran, Mutlu</creatorcontrib><creatorcontrib>Erden, Abdulsamet</creatorcontrib><creatorcontrib>Armağan, Berkan</creatorcontrib><creatorcontrib>Sarı, Alper</creatorcontrib><creatorcontrib>Kılıç, Levent</creatorcontrib><creatorcontrib>Akdoğan, Ali</creatorcontrib><creatorcontrib>Karadağ, Ömer</creatorcontrib><creatorcontrib>Bilgen, Şule Apraş</creatorcontrib><creatorcontrib>Kiraz, Sedat</creatorcontrib><creatorcontrib>Ertenli, İhsan</creatorcontrib><creatorcontrib>Kalyoncu, Umut</creatorcontrib><title>Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study</title><title>Clinical rheumatology</title><addtitle>Clin Rheumatol</addtitle><addtitle>Clin Rheumatol</addtitle><description>Objective
To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still’s disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.
Methods
FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.
Results
We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30–57) and 45 (30–62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.
Conclusion
Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.</description><subject>Adult</subject><subject>Algorithms</subject><subject>Arthralgia</subject><subject>Diagnosis, Differential</subject><subject>Female</subject><subject>Ferritin</subject><subject>Fever</subject><subject>Fever of Unknown Origin - etiology</subject><subject>Humans</subject><subject>L-Lactate dehydrogenase</subject><subject>Laboratories</subject><subject>Lactic acid</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>Neutrophilia</subject><subject>Original Article</subject><subject>Pharyngitis</subject><subject>Pharynx</subject><subject>Prospective Studies</subject><subject>Rheumatology</subject><subject>Still's Disease, Adult-Onset - complications</subject><subject>Still's Disease, Adult-Onset - diagnosis</subject><issn>0770-3198</issn><issn>1434-9949</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kcFuFSEUhonR2NvqC7gwJG7coDAwlxl3ptFq0kQTdT1hmMMtlYERmDZ352vo4_kkHnurJi7cHAjnO_9_yE_II8GfCc7184J1qxkXPeNKtS3b3yEboaRifa_6u2TDteZMir47IselXHLOm64X98mR5FrwphEb8v19TksqJlCXMjW0-HkJQE3YpezrxUxropN3DjLE6k3F1rSGylIsUOmH6kP48fVbQaaAKUCvcYimegGZOrjCmhxd4-eYriNFxZ2P1Jq1QHmBZiHFna_r5CP6LzmVBWz1V0ALPu4fkHvOhAIPb88T8un1q4-nb9j5u7O3py_PmZW6rUxKuXXSjh3ACFZJy11nukZPTk8N3rQ209ha4dQ4glC6ddNWYVtoPlnptDwhTw-6uMGXFUodZl8shGAipLUMjdC9QhneIPrkH_QyrRm3v6HUlgvRSaSaA2XxSyWDG5bsZ5P3g-DDr-SGQ3IDJjfcJDfscejxrfQ6zjD9GfkdFQLyABRsxR3kv97_kf0JfpipcQ</recordid><startdate>20190601</startdate><enddate>20190601</enddate><creator>Bilgin, Emre</creator><creator>Hayran, Mutlu</creator><creator>Erden, Abdulsamet</creator><creator>Armağan, Berkan</creator><creator>Sarı, Alper</creator><creator>Kılıç, Levent</creator><creator>Akdoğan, Ali</creator><creator>Karadağ, Ömer</creator><creator>Bilgen, Şule Apraş</creator><creator>Kiraz, Sedat</creator><creator>Ertenli, İhsan</creator><creator>Kalyoncu, Umut</creator><general>Springer London</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7T5</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20190601</creationdate><title>Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study</title><author>Bilgin, Emre ; Hayran, Mutlu ; Erden, Abdulsamet ; Armağan, Berkan ; Sarı, Alper ; Kılıç, Levent ; Akdoğan, Ali ; Karadağ, Ömer ; Bilgen, Şule Apraş ; Kiraz, Sedat ; Ertenli, İhsan ; Kalyoncu, Umut</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c375t-3336f3cb8eebec43c0f8a827df7d28a877adb5c1f4bbe1475fd6427d170dc3f73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Algorithms</topic><topic>Arthralgia</topic><topic>Diagnosis, Differential</topic><topic>Female</topic><topic>Ferritin</topic><topic>Fever</topic><topic>Fever of Unknown Origin - etiology</topic><topic>Humans</topic><topic>L-Lactate dehydrogenase</topic><topic>Laboratories</topic><topic>Lactic acid</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>Neutrophilia</topic><topic>Original Article</topic><topic>Pharyngitis</topic><topic>Pharynx</topic><topic>Prospective Studies</topic><topic>Rheumatology</topic><topic>Still's Disease, Adult-Onset - complications</topic><topic>Still's Disease, Adult-Onset - diagnosis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Bilgin, Emre</creatorcontrib><creatorcontrib>Hayran, Mutlu</creatorcontrib><creatorcontrib>Erden, Abdulsamet</creatorcontrib><creatorcontrib>Armağan, Berkan</creatorcontrib><creatorcontrib>Sarı, Alper</creatorcontrib><creatorcontrib>Kılıç, Levent</creatorcontrib><creatorcontrib>Akdoğan, Ali</creatorcontrib><creatorcontrib>Karadağ, Ömer</creatorcontrib><creatorcontrib>Bilgen, Şule Apraş</creatorcontrib><creatorcontrib>Kiraz, Sedat</creatorcontrib><creatorcontrib>Ertenli, İhsan</creatorcontrib><creatorcontrib>Kalyoncu, Umut</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Immunology Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical rheumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Bilgin, Emre</au><au>Hayran, Mutlu</au><au>Erden, Abdulsamet</au><au>Armağan, Berkan</au><au>Sarı, Alper</au><au>Kılıç, Levent</au><au>Akdoğan, Ali</au><au>Karadağ, Ömer</au><au>Bilgen, Şule Apraş</au><au>Kiraz, Sedat</au><au>Ertenli, İhsan</au><au>Kalyoncu, Umut</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study</atitle><jtitle>Clinical rheumatology</jtitle><stitle>Clin Rheumatol</stitle><addtitle>Clin Rheumatol</addtitle><date>2019-06-01</date><risdate>2019</risdate><volume>38</volume><issue>6</issue><spage>1699</spage><epage>1706</epage><pages>1699-1706</pages><issn>0770-3198</issn><eissn>1434-9949</eissn><abstract>Objective
To identify several clinical and/or laboratory parameters which can differentiate adult-onset Still’s disease (AOSD) from other causes of fever of unknown origin (FUO) and create a clinician-friendly algorithm for this purpose.
Methods
FUO patients hospitalized between March 2015 and September 2017 were recruited prospectively. AOSD patients diagnosed between 2001 and 2017 in our department were analyzed. Clinical and laboratory parameters were recorded for all patients. A multivariate analysis was performed to identify possible parameters related to the discrimination of AOSD from FUO.
Results
We recruited 69 AOSD patients (51 females, 74%) and 87 patients (43 females, 49.4%) evaluated for FUO. Median ages were 45 (30–57) and 45 (30–62), respectively. Arthralgia, rash, sore throat, neutrophilia, serum ferritin level higher than 5 times of the upper limit, and elevated lactate dehydrogenase levels were associated with the likelihood of diagnosing AOSD; on the other hand, the number of daily fever peaks equal or greater than 3 was associated with the unlikelihood of diagnosing AOSD. After the clinical feasibility assessment of possible parameters derived from the multivariate analysis, in the setting of fever, two clinical (arthralgia, sore throat) and two laboratory (ferritin level, neutrophilia) parameters were selected to develop an algorithm for discrimination of AOSD and FUO.
Conclusion
Presence of arthralgia, hyperferritinemia, sore throat, and neutrophilia suggests AOSD in patients presenting as FUO. This study proposes a clinician-friendly algorithm for the first time in current literature to discriminate AOSD from other causes of FUO.</abstract><cop>London</cop><pub>Springer London</pub><pmid>30710221</pmid><doi>10.1007/s10067-019-04455-y</doi><tpages>8</tpages></addata></record> |
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| ispartof | Clinical rheumatology, 2019-06, Vol.38 (6), p.1699-1706 |
| issn | 0770-3198 1434-9949 |
| language | eng |
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| source | MEDLINE; Springer Nature - Complete Springer Journals |
| subjects | Adult Algorithms Arthralgia Diagnosis, Differential Female Ferritin Fever Fever of Unknown Origin - etiology Humans L-Lactate dehydrogenase Laboratories Lactic acid Male Medicine Medicine & Public Health Middle Aged Multivariate Analysis Neutrophilia Original Article Pharyngitis Pharynx Prospective Studies Rheumatology Still's Disease, Adult-Onset - complications Still's Disease, Adult-Onset - diagnosis |
| title | Proposal for a simple algorithm to differentiate adult-onset Still’s disease with other fever of unknown origin causes: a longitudinal prospective study |
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