A case of refractory adult-onset Still's disease treated with anakinra.
Adult-onset Still's disease (AOSD) often presents both a diagnostic and a therapeutic challenge. We report a 40-year-old Chinese woman, in whom multiple adjustments of drug combinations were required before successful control of the patient's disabling symptoms. The patient failed multiple therapies including non-steroidal anti-inflammatory drugs, glucocorticoid, methotrexate (MTX), cyclosporine, leflunomide and infliximab. Treatment was complicated by hyperglycemia, glucocorticoid-induced osteoporosis, worsening hypertension and vaginal candidiasis. She suffered recurrent hospitalisation for active disease, developed carpal joint erosions and lost her employment over the course of 1 year. In view of refractoriness to multiple conventional therapies, anakinra was initiated in combination with MTX with a rapid and sustained improvement in clinical and laboratory parameters over 12 months. However, radiographic damage ensued despite aggressive therapies.
Lahiri
Manjari
M
Division of Rheumatology, Department of Medicine, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore. manjari_lahiri@nuhs.edu.sg
Teng
Gim-Gee
GG
D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use*; D012720:Severity of Illness Index; D016706:Still's Disease, Adult-Onset / Q000175:diagnosis / Q000188:drug therapy*; D017211:Treatment Failure
D000894:Anti-Inflammatory Agents, Non-Steroidal; D018501:Antirheumatic Agents; D005938:Glucocorticoids; D053590:Interleukin 1 Receptor Antagonist Protein