Efficacy of tight control strategy in the treatment of adult-onset Still disease

Clin Rheumatol. 2021 Oct;40(10):3941-3949. doi: 10.1007/s10067-021-05758-9. Epub 2021 May 10.

Abstract

Background: Adult-onset Still's disease (AOSD) characterized by a high spiking fever, skin rash, arthritis, and leukocytosis. The aim of the present study was considering the long-term outcomes of patients with AOSD who were treated with tight control strategy with disease modifying anti-rheumatic drugs (DMARDs).

Methods: Fifty-six patients with AOSD treated with tight control strategy were included. Four levels of remission were defined. Remission on-treatment was defined as the clinical remission, patient global assessment (PGA) ≤ 1, and prednisolone dose ≤ 5 mg/day for at least 6 months. Remission off-treatment was defined as the clinical remission and PGA ≤ 1 for at least 6 months as well as discontinuation of prednisolone, DMARDs, and biologics. Sustained remission on-treatment was defined as the clinical remission, PGA ≤ 1, and prednisolone dose ≤ 5 mg/day for ≥ 5 years. Sustained remission off-treatment was defined as the clinical remission and PGA ≤ 1 for ≥ 5 years as well as discontinuation of prednisolone, DMARDs, and biologics.

Results: Throughout a median follow-up of 47 months, remission on-treatment and off-treatment were obtained in 94.6% and 44.6% of patients, respectively. Sustained remission on-treatment and off-treatment were obtained in 79.2 and 8.3% of patients, respectively. Glucocorticoids (GCs) and DMARDs were discontinued in 66.1% and 48.2% of the patients, respectively. Apart from the older age of the patients in the on-GCs group, no significant differences were observed between the groups.

Conclusion: Our study showed that using DMARDs with tight control strategy at the presentation of AOSD may control disease activity successfully. Key Points • Using DMARDs with tight control strategy at the presentation of adult-onset Still's disease may control disease activity successfully.

Keywords: Adult-onset Still’s disease; Remission; Tight control strategy; Treat to target strategy; Treatment.

MeSH terms

  • Adult
  • Aged
  • Antirheumatic Agents* / therapeutic use
  • Glucocorticoids / therapeutic use
  • Humans
  • Prednisolone / therapeutic use
  • Remission Induction
  • Still's Disease, Adult-Onset* / drug therapy

Substances

  • Antirheumatic Agents
  • Glucocorticoids
  • Prednisolone