There is no specific diagnostic method for adult Steele’s disease, and its diagnosis is based on exclusionary diagnosis.
Many diagnostic or classification criteria have been developed both domestically and internationally, but there is still no universally accepted standard. The most recommended criteria are the American Cush criteria and the Japanese criteria (i.e. Yamaguch criteria).
1.Cush criteria
Prerequisites.
① Fever ≥ 39℃.
②Arthralgia or arthritis.
③ rheumatoid factor.
④Anti-nuclear antibody.
Any 2 of the following are also required.
① blood leukocytes ≥ 15×l09/L.
② rash.
③ pleurisy or pericarditis.
④hepatomegaly or splenomegaly or lymph node enlargement.
2.Japanese standard
Main conditions.
① fever ≥ 39℃ and lasting for more than 1 week.
②Arthralgia lasting for more than 2 weeks.
③ typical skin rash.
④Blood leukocytes ≥15×109/L.
Secondary conditions.
① sore throat.
②Lymph nodes and/or splenomegaly.
③ abnormal liver function.
④ Negative RF and ANA.
This criterion requires exclusion of: infectious disease, malignancy, and other rheumatic diseases. Diagnosis can be made when 5 or more conditions (including at least 2 major conditions) are met.
Diagnostic points: The disease should be suspected if the following clinical manifestations and positive laboratory test results are present
① Fever is the most prominent symptom of the disease. The typical fever pattern is flaccid fever, usually once a day.
②Rash is common on the trunk and extremities, but can also be seen on the face as an orange-red rash or maculopapular rash, usually accompanied by fever, and is transient.
(③) There is usually arthralgia and/or arthritis, with early oligoarthritis or polyarthritis developing. Myalgic symptoms are also common.
④Peripheral blood leukocytes are significantly elevated, mainly neutrophils, and blood cultures are negative.
⑤Serological tests: most patients are negative for RF and ANA.
⑥Multiple antibiotic treatments were ineffective, while glucocorticoid therapy was effective.