Remicade in AOSD

SUCCESSFUL THERAPY WITH INFLIXIMAB IN REFRACTORY ADULT ONSET STILL'S DISEASE.

Elena Aurrecoechea, Ricardo Blanco, Senen Gonzalez, Victor M Martinez-Taboada, Vicente Rodriguez-Valverde Santander, Cantabria, Spain Objective: Non steroidal antiinflammatory drugs (NSAIDs) and corticosteroids (CS) therapy are the initial therapy for Adult Onset Still's Disease (aosd). In refractory cases or when the dose of corticosteroid is unacceptably high, other Disease Modifying Antirheumatic Drugs (DMARDs) have been used with diverging results. Despite these therapies, a significant proportion of patients respond poorly following a disabling course. We report two patients with aosd, refractory to aggressive therapy, treated successfully with Infliximab.

Patients: Two patients with aosd refractory to standard therapy and severe steroid side effects are described (see Table). They were started on Infliximab at a dose of 3 mg/kg following the standard schedule proposed for RA (infusion on weeks 0, 2, 6 and then every 8 weeks). Results: Shortly after the first infusion both patients experienced a significant clinical response. The main clinical and laboratory data as well as the initial response therapy are shown in the table

Conclusion: The rapid and pronounced improvement of our two patients with Infliximab support the efficacy of TNF-blocking therapy in patients with aosd refractory to conventional therapy. Prospective controlled studies are needed to confirm the current anecdotal experience with TNF-blocking therapy in the treatment of refractory aosd.

Keywords: Still's Disease, Adult-Onset; Infliximab; ACR/SLICC Damage Scores Patient 1 Patient 2 Sex/Age Male/28 Female/22 aosd Duration 2 yrs 2 yrs Previous DMARDs Methotrexate, chloroquine, azathioprine Methrotexate, chloroquine Steroid side effects Cushing, acne, myopathy Cushing, hip osteonecrosis Clinical and lab data previous to infliximab fever, polyarthritis, rash. ESR 104 mm/1hr (n:<20). CRP 3.3 mg/dl (n:<.5). Ferritin 2827 ng/ml (n:25-310) polyarthritis, anorexia. ESR 64 mm/1hr. CRP 13.3 mg/dl. Ferritin 302 ng/ml. 14000 leukocytes/mm3 Clinical and lab data after 2 months of infliximab Asymptomatic. ESR 29 mm/1hr. CRP 4.4 mg/dl. Ferritin 265 ng/ml. Arthralgias. ESR 25 mm/1hr. CRP 4.3mg/dl. Ferritin 138 ng/ml. 11400 leukocytes/mm3 Session Info. : Poster Session: Miscellaneous Rheumatic Diseases (12:30 - 2:00 PM) Board Number: 105

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