Medications

While there is no known cure for Still's Disease, it is a treatable disease. Thanks to ongoing research in pharmaceuticals many patients can achieve "control" over their disease. 1999 was a great year for the introduction of a new class of drugs to combat autoimmune and inflammatory diseases such as RA, and Still's. These new drugs, referred to as biologic agents, are anti-TNF (tumor necrosis factor) and they siginifically reduce inflammation and pain.

[ Home ] [ Methotrexate ] [ Enbrel ] [ Remicade ] [ Arava ] [ Steroids ] [ Nsaids ] [ Celebrex ] [ Vioxx ] [ Pain Control ]

Here is an excerpt from an article from Dr. Cush on the treatment of AOSD:"from John J. Cush, MD, 02/19/2002 Treatment of AOSD is focused either on the systemic or articular disease. Systemic disease (fever, rash, weight loss, hepatosplenomegaly, diffuse lymphadenopathy, serositis, leukocytosis, high erythrocyte sedimentation rate/C-reactive protein/ferritin) would initially depend on corticosteroids to get rapid control of a sick patient. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in a few patients, but most with a firm diagnosis of AOSD will require prednisone 40-80 mg initially. Steroid-sparing therapy should be begun soon in most patients and may include either methotrexate, hydroxychloroquine, azathioprine, or tumor necrosis factor (TNF) inhibitors, depending on disease severity and drug safety.

Treatment of the more indolent and chronically progressive articular disease is similar to that for rheumatoid arthritis and may include methotrexate, hydroxychloroquine, sulfasalazine, gold salts, azathioprine, etanercept, infliximab, steroids, and NSAIDs as needed. But this patient does not have either systemic or articular disease that would merit these therapies. Patients with AOSD are not prone to recurrent infections (aside from risks associated with steroids and other drugs) and are not at increased risk for hepatitis C."

We have included a section for these new drugs, along with standard drugs commonly used to control Still's symptoms.

Here is a quick overview of commonly used medications for the treatment of Still's Disease:

Methotrexate is the treatment of choice because of demonstrated efficacy and long-term tolerability. Therapy should begin with 7.5 mg weekly and increasing at 1- or 2-month intervals until peak efficacy is achieved. Methotrexate is relatively contraindicated with a history of hepatitis or alcoholism. Side effects include anorexia, nausea, vomiting, abdominal cramps, elevated liver enzyme levels, myelosuppression (rare), pulmonary toxicity, hepatic fibrosis, hypersensitivity pneumonitis. Users must be closely monitored for hepatic toxicity.

Hydroxychloroquine ( Plaquenil), 200-400 mg PO qd, is recommended for patients with mild disease. This drug works slowly but has few side effects. Retinal damage is avoidable if vision is monitored every 6 or 12 months and the drug is stopped when signs of retinal toxicity appear

Etanercept ( Enbrel). After twice-weekly subcutaneous injections of etanercept (recombinant human tumor necrosis factor receptor), 25 mg, at 3 months, 62% improve. Etanercept is well tolerated and is an indicated for use alone or with methotrexate for patients with active disease that is refractory to methotrexate.

Infliximab ( Remicade) is given intravenously for use in refractory disease. Infliximab is an anti-tumor necrosis factor monoclonal antibody. Infliximab is given intravenously in dosages of 3 or 10 mg/kg, repeated at about four- to 12-week intervals.

Leflunomide ( Arava), which inhibits pyrimidine synthesis, is an oral drug considered as a possible alternative to methotrexate. The dosage is 100 mg PO daily for three days followed by a maintenance dosage of 10 to 20 mg daily. Leflunomide improves rheumatic arthritis but offers no clear advantages over methotrexate.

Corticosteroids . These drugs may relieve the symptoms of Stills, but they are potentially dangerous, with many long-term side effects. They should be reserved for severe systemic disease. Corticosteroids include prednisone, prednisolone, medrol, decadron and many others.

Nonsteroidal antiinflammatory drugs. Most patients will gain short-term symptomatic relief from treatment with NSAIDs. These drugs are generally equivalent in efficacy. NSAIDs can cause peptic ulcer disease and renal insufficiency. Nsaids include motrin, naprosyn, oruvil,

Cox-2 Inhibitors: Celebrex, Vioxx, Mobic

For more information on medications please visit:

RX LIST

MEDICINENET

DISCLAIMER:

The materials and information on this server are intended for educational and informational purposes only. The materials and information are not intended to replace the services of a trained health professional or to be a substitute for medical advice of physicians and/or other health care professionals. The International Still's Disease Foundation is not engaged in rendering medical or professional medical services. You should consult your physician on specific medical questions, particularly in matters requiring diagnosis or medical attention. The International Still's Disease Foundation makes no representations or warranties with respect to any treatment, action, application medication or preparation by any person following the information offered or provided within this website. Any information used from other websites was done so with permission from each site, with an exception to those of "public domain", whereas we believe any site without a cited reference was a "public domain site" and for our use. The International Still's Disease Foundation is a non-profit organization. This page was last updated on June 13, 2002