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Adult-Onset Still's Disease (AOSD) Relapse

Re-emergence of fever, salmon-colored rash, polyarthritis and hyperferritinemia in patients with previously controlled AOSD.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Dahiliye (İç Hastalıkları) department. Book Appointment →

What is Adult-Onset Still's Disease (AOSD) Relapse?

Adult-onset Still's disease (AOSD) is a rare systemic autoinflammatory disorder characterized by quotidian fevers, salmon-colored evanescent rash, arthritis, sore throat and marked hyperferritinemia. Relapse is defined as recurrence of these features after a period of clinical remission, either while tapering therapy or after long-term stability.

Patients may follow a monocyclic, polycyclic (relapsing-remitting) or chronic articular pattern. Relapses tend to mimic the original presentation but can also evolve toward dominant chronic arthritis or life-threatening complications such as macrophage activation syndrome.

Treatment intensification typically involves systemic corticosteroids, methotrexate and biologic therapies targeting interleukin-1 (anakinra, canakinumab) or interleukin-6 (tocilizumab), tailored to disease pattern and complications.

Symptoms

Quotidian spiking fever ≥39°C
Salmon-pink evanescent rash
Arthralgia or polyarthritis
Sore throat
Lymphadenopathy and hepatosplenomegaly
Myalgia and weight loss
Pleuritis or pericarditis

Risk Factors

Prior AOSD with polycyclic or chronic course
Rapid corticosteroid tapering
Inadequate maintenance therapy
High ferritin and glycosylated ferritin levels
Macrophage activation syndrome history
Concomitant infection triggers
Discontinuation of biologic therapy

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Recurrence of fever spikes and rash
  • New or worsening polyarthritis
  • Cytopenias or rising ferritin
  • Suspected macrophage activation syndrome
  • Hepatic or cardiopulmonary involvement
  • Loss of efficacy on current therapy

Treatment Methods

01
Reinduction with systemic corticosteroids
02
Methotrexate or cyclosporine for steroid sparing
03
Anakinra or canakinumab for IL-1 blockade
04
Tocilizumab for IL-6 blockade
05
Aggressive treatment of MAS if present
06
NSAIDs for arthralgia control
07
Long-term rheumatology follow-up

Which Department to Visit?

You can visit our Dahiliye (İç Hastalıkları) department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Dahiliye (İç Hastalıkları) Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.