calca-protein--human and Still-s-Disease--Adult-Onset

Early differentiation between infection and aseptic inflammation is difficult and is a challenge often faced in the rheumatology practice. Procalcitonin (PCT) is a biomarker that is preferentially induced in patients with bacterial infections, and a growing body of evidence supports its use for improving diagnosis of bacterial infections and guiding antibiotic therapy. In this article, we review the evidence for the use of PCT measurement in rheumatology practice. Several studies have examined the use of PCT to assist in the differentiation between septic and non-septic arthritis in patients with an inflamed joint and found it to be a sensitive and specific marker of infection. A number of studies in patients with diverse inflammatory rheumatic diseases have provided useful information regarding the usefulness of PCT in these patients. In summary, PCT when used in the appropriate clinical setting can be a useful adjunct to currently available laboratory infection markers, though further studies are warranted. Furthermore, PCT results should be interpreted in parallel with the clinical assessment.

Topics: Anti-Bacterial Agents; Arthritis; Arthritis, Infectious; Arthritis, Rheumatoid; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Early Diagnosis; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Prosthesis-Related Infections; Protein Precursors; Still's Disease, Adult-Onset; Systemic Vasculitis

Adult-onset Still's disease (AOSD) is a known cause of fever of unknown origin. It is characterized by a triad of symptoms: spiking fever (>39°C), salmon-colored rash and arthritis/arthralgia. On a predisposing genetic background, several conditions may act as trigger for disease and among these, infectious agents are the most important. Nowadays, a dichotomous view of AOSD has been introduced which distinguishes this entity in two subsets according to the clinical features and laboratory aspects: systemic or articular. As AOSD is a diagnosis of exclusion, specific biomarkers able to facilitate differential diagnosis are needed. A number of possible biomarkers have been proposed that will be discussed in detail in this review: ferritin, IL-18, procalcitonin, s100 proteins and sCD163.

Topics: Animals; Antigens, CD; Antigens, Differentiation, Myelomonocytic; Arthritis; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Diagnosis, Differential; Exanthema; Ferritins; Fever; Genetic Predisposition to Disease; Humans; Infections; Interleukin-18; Protein Precursors; Receptors, Cell Surface; S100 Proteins; Still's Disease, Adult-Onset

The diagnosis of adult onset Still's disease is difficult in the absence of definite clinical and laboratory criteria. A delayed diagnosis of adult onset Still's disease was made in a 23-year-old female who developed multi-organ failure and disseminated intravascular coagulation with fingertip auto-amputation during a febrile illness considered septic due to the persistence of elevated serum procalcitonin concentration.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Disseminated Intravascular Coagulation; Female; Humans; Multiple Organ Failure; Protein Precursors; Shock, Septic; Still's Disease, Adult-Onset; Young Adult

Topics: Adult; Bacterial Infections; Biomarkers; Calcitonin; Calcitonin Gene-Related Peptide; Cytokines; Diagnosis, Differential; Humans; Protein Precursors; ROC Curve; Sensitivity and Specificity; Still's Disease, Adult-Onset

Only two cases of adult-onset Still's disease associated with shock have been previously described. We report a case of shock in a man with adult-onset Still's disease and discuss the relationship between the two processes by assessing tumor necrosis factor-alpha, procalcitonin and interleukin-6 concentrations.

Topics: Calcitonin; Calcitonin Gene-Related Peptide; Fatal Outcome; Humans; Interleukin-6; Male; Middle Aged; Protein Precursors; Shock, Septic; Still's Disease, Adult-Onset; Tumor Necrosis Factor-alpha