Bilgin et al reported an algorithm for distinguishing Adult-Onset Still's Disease (AOSD) from other causes of fever of unknown origin. The authors are from Hacettepe University in Ankara.
Patient selection: fever (> 38.2°C)
Parameters:
(1) arthralgia
(2) sore throat
(3) serum ferritin concentration in ng/mL
(4) upper limit of normal for serum ferritin
(5) neutrophilia
ratio of serum ferritin to upper limit of normal =
= (serum ferritin) / (upper limit of normal)
Arthralgia
Ferritin Ratio
Neutrophilia
Sore Throat
Diagnosis
no
NA
NA
NA
FUO
yes
<= 1
NA
NA
FUO
yes
1.01 to 4.99
no
no
FUO
yes
1.01 to 4.99
yes
NA
AOSD
yes
>= 5
NA
NA
AOSD
where:
• The diagnosis for neutrophilia was not given. It is presumed to be an absolute neutrophil count above the upper limit of normal.
Additional predictors:
(1) >= 3 fever peaks per day are more common with FUO.
(2) night fevers are more common in AOSD
(3) pharyngitis and rash are more common with AOSD
(4) lymphadenopathy is more common in FUO
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