Steroid-resistant adult-onset Still's disease which showed a quick response to methotrexate.
A case of steroid-resistant adult-onset Still's disease is herein reported. The patient consulted us because of night fever, arthralgia and evanescent rashes. She was diagnosed with adult-onset Still's disease, with a C-reactive protein (CRP) value of 29.5 mg/dL and serum ferritin level of 4500 ng/mL. The fever, rashes and arthralgia disappeared after medication of medium-dose oral prednisolone, however, the CRP value persisted at high levels, and the serum ferritin level nevertheless increased by 5200 ng/mL. Following the pulse therapy with corticosteroid, the CRP value decreased once but thereafter returned to a high level again. The serum ferritin level did not respond during that therapy. Finally, 10 days after starting the administration of methotrexate, the CRP value dramatically decreased from 7 mg/dL to 0.16 mg/dL, and thereafter the serum ferritin level started to decline, which thus enabled us to eventually taper the dose of oral prednisolone.
Okamoto
Osamu
O
Dermatology, Department of Anatomy, Biology and Medicine, Faculty of Medicine, Oita University, Oita, Japan. ookamoto@med.oita-u.ac.jp
Oishi
Masaki
M
Fujiwara
Sakuhei
S
D018501:Antirheumatic Agents / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use*; D008875:Middle Aged; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*
D018501:Antirheumatic Agents; D005938:Glucocorticoids; D008727:Methotrexate