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Pathophysiology · Additional topics

Still's disease

Morbus Still

Adult Still's disease is distinguished in rheumatology as a specific clinical entity within the general classification of rheumatoid arthritis. For a complete understanding of this condition, it must be considered in close connection with other variants of joint pathology, including serological types and forms with systemic visceral involvement.

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Special formAdult Still's disease is classified as a specific variant of rheumatoid arthritis.
SeropositivityDetermined by the presence of rheumatoid factor (RF+) and/or ACPA in blood serum.
Role of RFRheumatoid factor is not obligatory for pathogenesis, but influences extra-articular manifestations.
Systemic involvementThe process may involve the heart, lungs, blood vessels, and peripheral nerves.
2 min readFor medical studentsUpdated 10.10.2026
Material prepared by WhiteCoat Pro editorial team based on platform study guidesPending instructor review

Place of Still's syndrome in the diagnostic structure

According to the clinical classification, rheumatoid arthritis is subdivided into several broad categories. Adult Still's disease does not belong to typical serological variants, but is classified as a separate category — special clinical forms.

In addition to special forms, the basic classification by primary diagnosis includes:

  • Seropositive variant.
  • Seronegative variant.
  • Probable rheumatoid arthritis (a condition requiring further clinical follow-up for definitive confirmation).

Serological variants: positive and negative

The division into seropositive and seronegative types is based on the laboratory detection of specific markers in the patients' blood serum.

  1. Seropositive variant. Characterized by the detection of rheumatoid factor (RF+) and/or anti-citrullinated protein antibodies (ACPA) in the patient's serum. It is important to note that Felty's syndrome (also known as Felty syndrome) is traditionally included in this same group.
  2. Seronegative variant. In a certain proportion of patients, rheumatoid factor is completely absent.

From the perspective of pathophysiology, the presence of rheumatoid factor is not a strictly mandatory condition for triggering the pathogenic mechanisms of joint inflammation itself. However, it has been proven that this marker takes a direct part in the formation of specific extra-articular lesions—in particular, rheumatoid nodules.

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Systemic forms and organ involvement

The pathological process in rheumatoid arthritis (and its clinical forms) often extends beyond joint structures, forming systemic lesions involving various organs and systems. The classification distinguishes the following variants of extra-articular spread:

  • Respiratory system involvement: development of the so-called "rheumatoid lung".
  • Vascular pathologies: a process accompanied by specific vasculitis (rheumatoid vasculitis).
  • Heart involvement: inflammation may affect various layers of the organ, manifesting as endocarditis, myocarditis, pericarditis, or combined carditis.
  • Neurological disorders: development of polyneuropathy.
  • Other tissue lesions: formation of rheumatoid bursitis, as well as forms accompanied by the generation of rheumatoid nodules (in the pathogenesis of which rheumatoid factor participates).
How to memorize

To memorize the systemic forms, use the acronym "H-L-V-N-B": Heart (carditis), Lungs (rheumatoid lung), Vessel walls (vasculitis), Nerves (polyneuropathy), Bursitis/Nodules.

Class and exam questions

Is the presence of rheumatoid factor mandatory for the development of the disease?

No, triggering the pathogenesis of rheumatoid factor (RF) does not strictly require the presence of RF in the serum, which is confirmed by the existence of seronegative forms.

What role does rheumatoid factor play if it is not obligatory for pathogenesis?

Rheumatoid factor actively participates in the formation of extra-articular lesions, primarily rheumatoid nodules.

Which classification group does Felty's syndrome belong to?

Felty's syndrome is included in the category of seropositive rheumatoid arthritis.

Which cardiac structures can be affected in systemic forms?

All layers of the heart can be involved in the pathological process, which clinically manifests as endocarditis, myocarditis, pericarditis, or total carditis.

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What else to study on this topic

  • Morphological characteristics of joint lesions in Still's disease
  • Etiology and triggers of special clinical forms of rheumatoid arthritis
  • Detailed pathogenesis of seronegative variants of the disease
  • Outcomes and potential complications of systemic forms
  • Criteria for the transition from probable to definite rheumatoid arthritis

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