title: Is anti-TNF switching in refractory Still's disease safe and effective?
abstract: Still's disease (SD) is a rare chronic inflammatory disease characterized by polyarthritis, systemic symptoms, and elevated inflammatory markers. Of note, 74 SD cases were reported with anti-tumoral necrosis factor (TNF) therapy and the experience of switching is limited to five patients. During a 3-year period, SD cases were 1.9% of 319 rheumatic patients that received anti-TNF agents in the infusion center of our University Hospital. In this manuscript, the authors add six new cases of refractory SD who had clinical and laboratory response to TNF blockers and report the outcome of switching in five of them. Partial or complete response was achieved by four of six (66.7%) patients and three of four (75%) required switching. Regarding safety, five of six (83.3%) had adverse events. Anti-TNF treatment with switching seems to be a valid approach for refractory SD patients.
authors.affiliation: Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
authors.forename: Nadia Emi
authors.initials: NE
authors.lastname: Aikawa
authors.forename: Ana Cristina de Medeiros
authors.initials: AC
authors.lastname: Ribeiro
authors.forename: Carla Gonçalves Schain
authors.initials: CG
authors.lastname: Saad
authors.forename: Rosa Maria Rodrigues
authors.initials: RM
authors.lastname: Pereira
authors.forename: Mauricio
authors.initials: M
authors.lastname: Levy
authors.forename: Clovis A
authors.initials: CA
authors.lastname: Silva
authors.forename: Eloísa
authors.initials: E
authors.lastname: Bonfá
authors.forename: Jozélio Freire
authors.initials: JF
authors.lastname: de Carvalho
mesh_terms: D000328:Adult; D000911:Antibodies, Monoclonal / Q000009:adverse effects*; D018501:Antirheumatic Agents / Q000009:adverse effects*; D004351:Drug Resistance; D057915:Drug Substitution; D005260:Female; D006801:Humans; D008297:Male; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy*; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D055815:Young Adult
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha