Revisão sistemática: doença de Still no adulto, um verdadeiro desafio diagnóstico

Abstract

Adult-onset Still’s disease is a rare inflammatory condition characterized by daily high fever, transient skin rash, and joint manifestations, whose nonspecific presentation can hinder early diagnosis. The clinical picture often includes markedly elevated inflammatory markers, hyperferritinemia, and, in some cases, lymphadenopathy, serositis, and pulmonary involvement, reflecting intense activation of the innate immune system. These findings may mimic severe infections, malignancies, or other autoimmune diseases, frequently leading to prolonged investigations before diagnostic clarification. Diagnosis depends on the combination of clinical and laboratory findings, with exclusion of infections, neoplasms, and other inflammatory causes, requiring careful evaluation in patients with persistent fever and significant inflammation. Treatment is based on the use of immunosuppressive agents such as corticosteroids, methotrexate, and biological therapies targeting IL-1 and IL-6, which have demonstrated high efficacy in rapidly controlling inflammatory activity and reducing the need for steroids. Moreover, these therapies have contributed to decreasing systemic complications and preventing progression to chronic forms. This work reviews the main clinical, diagnostic, and therapeutic aspects of the disease, emphasizing the importance of early diagnosis to allow timely interventions, optimize clinical management, and reduce adverse outcomes.