Sacro-Iliitis in Still's Disease

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Abstract
A series of pelvic X-rays from 60 patients not suffering from chronic joint disease provided normal standards for different age groups with which to compare the findings in 202 cases of Still''s disease. Sacro-iliac joint changes occurred in 24% of this series of 202 cases; they were equally distributed among males and females, and were seen more frequently in those in whom the disease started after the age of 10 years. The changes were more common in patients with a greater number of joints involved and in those who were sero-positive. Those who had been immobilized for long periods and those who had hip involvement were more often affected, despite which the prognosis in the abnormal and normal groups was equally good. The distribution of joint involvement did not resemble that seen in ankylosing spondylitis, with root joints or lower limb joints predominantly affected. Iritis, rash, nodules, family history, and trauma preceding onset were not significantly related to the occurrence of sacro-iliitis. The group with less severe sacro-iliac changes (Grade I) comprises the patients who were youngest at the time of onset of the disease, and shows no specific clinical associations. Grade II comprises those with moderately severe sacro-iliac change, who appear to be patients with classical, severe Still''s dis-ease, with nodules, sero-positivity, and the most extensive joint involvement, including that of the cervical spine. There is a preponderance of females in this grade. Grade III comprises those with fusion or extensive erosions of the sacro-iliac joints. In these patients the disease starts later, and fewer joints are involved, they also have the most hip involvement and the least neck involvement, and males predominate. Nine patients who were diagnosed on admission as cases of Still''s disease developed either ulcerative colitis (4), psoriatic arthropathy (4), or ankylosing spondylitis (one), and were therefore excluded from the series. These few cases did not differ sufficiently from the remainder in the early stages for one to be able to foretell the onset of the symptoms of the "variant" diseases, that is diarrhoea, rash, or spondylitis.