title: Biological treatment in adult-onset Still's disease.
abstract: Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder that is characterised by high spiking fever, arthritis or arthralgia, and evanescent rash. Many other systemic manifestations may occur. Pathogenesis of AOSD remains partially unknown but a major role has been recently attributed to pro-inflammatory Th1 cytokines, including tumour necrosis factor-α (TNF-α), interleukin (IL)-1, IL-6 and IL-18. Despite limited evidence, mainly based on observational studies and the extrapolation to AOSD of the results of a few controlled studies that have been conducted in children with systemic juvenile idiopathic arthritis, biological agents represent a major therapeutic advances for patients with AOSD refractory to conventional treatment or presenting life-threatening manifestations. Both IL-1 and IL-6 blockade may be more effective than TNF-α blockers. Although debatable, therapeutic strategies are proposed.
authors.affiliation: Université Paris Descartes, Paris Sorbonne Cité, Assistance Publique - Hôpitaux de Paris, Hôpital européen Georges Pompidou, Service de médecine interne, Paris, France. jacques.pouchot@egp.aphp.fr
authors.forename: Jacques
authors.initials: J
authors.lastname: Pouchot
authors.forename: Jean-Benoît
authors.initials: JB
authors.lastname: Arlet
mesh_terms: D000068879:Adalimumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D016207:Cytokines / Q000627:therapeutic use; D000068800:Etanercept; D005076:Exanthema / Q000150:complications / Q000473:pathology; D006801:Humans; D007074:Immunoglobulin G / Q000627:therapeutic use; D000069285:Infliximab; D053590:Interleukin 1 Receptor Antagonist Protein / Q000627:therapeutic use; D007375:Interleukin-1 / Q000037:antagonists & inhibitors; D020382:Interleukin-18 / Q000037:antagonists & inhibitors; D008727:Methotrexate / Q000627:therapeutic use; D035583:Rare Diseases / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D018124:Receptors, Tumor Necrosis Factor / Q000627:therapeutic use; D016706:Still's Disease, Adult-Onset / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors; D000093242:Interleukin-6 Inhibitors
chemical_list: D000068879:Adalimumab; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D016207:Cytokines; D000068800:Etanercept; D007074:Immunoglobulin G; D000069285:Infliximab; D053590:Interleukin 1 Receptor Antagonist Protein; D007375:Interleukin-1; D020382:Interleukin-18; D008727:Methotrexate; D018124:Receptors, Tumor Necrosis Factor; D014409:Tumor Necrosis Factor-alpha; D000093242:Interleukin-6 Inhibitors