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Treatments and drugs
By Mayo Clinic staffDoctors use a variety of drugs to treat adult Still's disease. The type of drug you'll take depends on the severity of your symptoms and whether you experience side effects.
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These drugs, such as aspirin, ibuprofen (Advil, Motrin, others) or naproxen (Aleve, Anaprox, others), help reduce inflammation. They are often useful for controlling mild symptoms. If you take NSAIDs, you'll need regular blood tests to monitor your liver function, because high doses of NSAIDs can damage your liver.
- Glucocorticoids. People with high-fever spikes, severe joint symptoms or complications with their internal organs might require glucocorticoids, such as prednisone. Glucocorticoids are corticosteroid medications that help subdue your body's immune response. While glucocorticoids are often a successful treatment for adult Still's disease, these drugs may lower your body's resistance to infections and will increase your risk of developing osteoporosis.
- Methotrexate. The medication methotrexate (Rheumatrex, Trexall) has been used successfully in a small series of people to treat adult Still's disease. It may also be used as a "steroid-sparing agent," meaning that if you take methotrexate, smaller doses of corticosteroids may be able to control your disease.
Biologic response modifiers
Several drugs that are not standard therapy for adult Still's disease have been reported to help some people with this condition. One group inhibits tumor necrosis factor-alpha (TNF-alpha), an immune system cell involved in inflammation. TNF blockers include infliximab (Remicade), adalimumab (Humira) and etanercept (Enbrel). Although small studies have shown some promise, it's unknown whether TNF blockers provide long-term benefit in controlling the disease.
Other medications, including rituximab (Rituxan), cyclosporine (Sandimmune, Gengraf, Neoral) and anakinra (Kineret), also have been used successfully in the treatment of adult Still's disease in small groups of people.
Outlook
Even with treatment, it's difficult to predict the course of adult Still's disease. Some people might only experience a single episode, while for others adult Still's disease may develop into a chronic condition. About one-third of people with the disorder fall into each of the following groups:
- Recovery. In some cases, the signs and symptoms disappear within one year and do not recur.
- Occasional flare-ups. People with this form of the condition experience unpredictable eruptions of their signs and symptoms but feel normal between episodes.
- Chronic arthritis. The chronic form of adult Still's disease may last for years and cause debilitating arthritis. Fortunately, most people with chronic adult Still's disease retain good function.
- Mandl LA, et al. Clinical manifestations and diagnosis of adult Still's disease. http://www.uptodate.com/home/index.html. Accessed July 31, 2010.
- Mandl LA, et al. Treatment of adult Still's disease. http://www.uptodate.com/home/index.html. Accessed July 31, 2010.
- Mackowiak PA, et al. Fever of unknown origin. In: Mandell GL, et al. Mandell, Bennett, & Dolin: Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa.: Churchill Livingstone Elsevier; 2005. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-443-06839-3..00051-5--s0150&uniq=212324663&isbn=978-0-443-06839-3&sid=1032482890. Accessed July 31, 2010.
- Adams BD, et al. Arthritis. In: Marx JA, et al., eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 6th ed. St. Louis, Mo.: Mosby; 2006. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-0-323-05472-0..00114-6--s0525&uniq=212324663&isbn=978-0-323-05472-0&sid=1032485935. Accessed July 31, 2010.
- Kavanaugh A, et al. The locomotor system. In: Bope ET, et al. Conn's Current Therapy 2010. 61st ed. Philadelphia, Pa.: Saunders Elsevier; 2009. http://www.mdconsult.com/book/player/book.do?method=display&type=bookPage&decorator=header&eid=4-u1.0-B978-1-4160-6642-2..00015-6--s0120&displayedEid=4-u1.0-B978-1-4160-6642-2..00015-6--s0130&uniq=212413180&isbn=978-1-4160-6642-2&sid=1032716124. Accessed July 31, 2010.
- Altman RD. Juvenile Idiopathic Arthritis (JIA). The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/print/sec04/ch034/ch034c.html. Accessed July 31, 2010.
- Chang-Miller A (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 16, 2010.
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