title: Clarithromycin in adult-onset Still's disease: a study of 6 cases.
abstract: Adult-onset Still's disease (AOSD) is a rare rheumatological condition characterized by an acute systemic involvement. There are no treatment guidelines. Glucocorticoids (GC), methotrexate (MTX), cyclosporin A and biologic agents have been successfully used, often in association. We treated six cases of AOSD with clarithromycin (CM) in combination with low-mild dose of GC and MTX. Four of them were not responsive to high-dose GC added to DMARDs, while two of them were treated with low-mild dose of GC added to CM from the beginning. CM, 500 mg b.i.d., was added to a mild-low dose of GC and to MTX. The dose of the drugs was reduced (and stopped where possible) following clinical and laboratory parameters. ACR criteria were used to assess clinical improvement. At 6 months 5 patients reached ACR 70% and could stop any therapy in 6-18 months; 1 continued chronic therapy with low-dose GC added to CM and MTX to maintain ACR 50%. CM can be a useful drug for the treatment of AOSD, even in patients not responsive to high-dose GC and DMARDs. No definitive conclusion can be drawn based on the present study.
authors.affiliation: Rheumatology and Rehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Castel Goffredo, Mantua, Italy. gianantonio.saviola@fsm.it
authors.forename: Gianantonio
authors.initials: G
authors.lastname: Saviola
authors.forename: Maurizio
authors.initials: M
authors.lastname: Benucci
authors.forename: Lul
authors.initials: L
authors.lastname: Abdi-Ali
authors.forename: Paola
authors.initials: P
authors.lastname: Baiardi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Manfredi
authors.forename: Mariarosaria
authors.initials: M
authors.lastname: Bucci
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cirino
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy* / Q000473:pathology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D017291:Clarithromycin; D008727:Methotrexate