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Expand the differential…think beyond rheumatoid arthritis
  1. Cody Schwartz,
  2. Altelisha Taylor,
  3. Zareen Zaidi
  1. Internal Medicine, UF Health Shands Hospital, Gainesville, Florida, USA
  1. Correspondence to Dr Cody Schwartz, cody.schwartz{at}


A 31-year-old male patient with severe, migratory arthralgias presented to our academic medical centre after being erroneously diagnosed and treated for rheumatoid arthritis for over 1 year. Multiple immunomodulatory therapies for rheumatoid arthritis were attempted with no relief of symptoms. Eventually, the pain was so bothersome that the patient became bedridden for 1 month prior to presenting to our facility. Our assessment revealed that the patient met the diagnostic criteria, known as the Yamaguchi criteria, needed to diagnose adult-onset Still’s disease. Yamaguchi criteria include migratory inflammatory arthritis, quotidian fevers, leucocytosis and a salmon-coloured maculopapular rash. These signs and symptoms may go unnoticed or overlooked if adult-onset Still’s disease is not considered. The patient was treated with anakinra (a recombinant human IL-1 receptor antagonist) and had rapid improvement in his symptoms, with the restoration of mobility.

  • biological agents
  • drugs: musculoskeletal and joint diseases
  • connective tissue disease
  • rheumatoid arthritis
  • musculoskeletal syndromes
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  • Contributors CS was the main author of the case report. He planned, wrote and edited the article. AT was the second author of the case report. She developed an abstract and helped write the case report. ZZ reviewed the case report offering editing and updates to be added.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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