Therapeutic responses and prognosis in adult-onset Still's disease.

Abstract

To date, the treatment of adult-onset Still's disease (AOSD) has been largely empirical; therefore, this study was conducted to investigate the response to therapy and prognostic factors of AOSD. Fifty-four Korean patients with AOSD were enrolled based on Yamaguchi's criteria. We retrospectively analyzed the treatments and prognosis. Thirty-nine patients (72.2%) were female, and the average age at disease onset was 37.3 years. Twenty-nine patients had a monocyclic disease (53.7%), five had a polycyclic (9.3%) and fifteen had a chronic articular disease (27.7%) and five died (9.3%). The elevated ESR and corticosteroids refractoriness were associated with poor prognosis (P = 0.023 and P = 0.009, respectively). The patients that died were older than those survived (49.2 ± 11.8 vs. 42.2 ± 14 year old, P = 0.024). Forty-two patients were treated with non-steroidal anti-inflammatory drugs; however, they also needed corticosteroids and intravenous immunoglobulin (IVIG). Among 50 patients treated with high-dose corticosteroids, 21 patients (42%) were resistant to corticosteroids and treated with IVIG or anti-tumor necrosis factor (TNF) agents. Of the 23 patients medicated with IVIG, the prognosis was better in IVIG-responsive patients, indicating a therapeutic effect. Methotrexate was the most commonly used disease modifying anti-rheumatic drugs (27 patients, 50%), and the corticosteroid requirements were lower in the methotrexate-responsive patients. Approximately half of AOSD patients had a poor prognosis and were corticosteroids resistance. An elevated ESR and non-response to corticosteroids were associated with poor prognosis. Patients who died were older than those survived.

• Authors: Hyoun-Ah Kim, Jun-Mo Sung, Chang-Hee Suh
• Journal: Rheumatology international (Rheumatol Int) Vol. 32 Issue 5 Pg. 1291-8 (May 2012) ISSN: 1437-160X [Electronic] Germany
• PMID: 21274538 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Immunoglobulins, Intravenous
• Immunosuppressive Agents

Topics

• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Age Factors
• Anti-Inflammatory Agents, Non-Steroidal (therapeutic use)
• Blood Sedimentation
• Chi-Square Distribution
• Drug Resistance
• Drug Therapy, Combination
• Female
• Humans
• Immunoglobulins, Intravenous (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Male
• Middle Aged
• Predictive Value of Tests
• Republic of Korea
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Still's Disease, Adult-Onset (complications, diagnosis, drug therapy, mortality)
• Survival Analysis
• Time Factors
• Treatment Outcome