Læknablaðið : fylgirit - 01.05.1978, Blaðsíða 16

the impression that this is anything but a difficult
and capricious disease requiring vigorous and
continuous care of the many articular, systemic,
ocular, and psychologic problems as they arise.
It has been shown that early comprehensive
management is apparently related to a favorable
prognosis - a concept first proposed by Dr.
Barbara Ansell of Liondon. In our series,
children treated during the first year of disease
also did comparatively better (only 5 per cent in
classes III and IV) than those seen 2 to 4 or
more years after onset (16 to 20 per cent).
Incidentally, this impression appears to be con-
firmed in our second group of 100 patients who
have now been followed for up to 13 years.
Other long-term studies report a mortality of
2 to 5%. Most deaths occur in patients with
prolonged active polyarthritis and is due primar-
ily to secondary amyloidosis.
In the most recent reporting of patients followed
for 10 years or more, remission has been
observed in at least 5CF/o while normal function
has been noted in at least 70/o. Occasionally,
however, a patient in remission for as long as
20 years will have a severe exacerbation as an
adult, resulting in joint destruction and severe
disabílity for the first time.
In our series, a poor prognosis has been
associated with - an unremitting course of poly-
arthritis, progressive hip involvement, subcu-
taneous nodules, and undue delay in comprehen-
sive care.
The long-term prognosis of this disease is
mitigated only by early diagnosis and the avail-
ability of a multidisciplinary approach to manage
ment. Couple this with regular followup care
and consistent home treatment from steadily
supportive parents and the outlook is optimal.
Clearly, we have come a long way in our
understanding of Still's disease since the
earliest writings by George Frederick Still.
We can now look to the future for answers to
unresolved issues, such as etiology, by young
investigators like this young chap, my son John
who as an infant was already reading my article
on rash in the Journal of Pediatrics.
CONFERENCE IN PROGRESS
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