Efficacy of abatacept in a refractory case of adult-onset Still's disease.

CER687
2010 Vol.28, N°2
PI 0265, PF 0267
Case Reports

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PMID: 20483052 [PubMed]

Received: 29/10/2009
Accepted : 19/01/2010
In Press: 13/05/2010
Published: 13/05/2010

Abstract

Adult-onset Still`s disease (AOSD) is a systemic inflammatory disorder, characterized by spiking fever, skin rash, and arthritis. First-line treatment consists of corticosteroids. Methotrexate is commonly used in resistant cases or as a steroid-sparing drug. The availability of biologic drugs in the rheumatic diseases, such as anti-TNFs and IL-1ra, has allowed to treat very refractory cases of AOSD and provided new clues for the pathophysiology. However, anakinra and anti-TNFs may also fail or may be contraindicated in AOSD, and other treatment strategies are then necessary. Given that T cell activation may be a relevant part of the AOSD pathophysiology, abatacept, CTLA4IgFc, was administered in a 57-year-old man with AOSD failing traditional DMARDs and to anti-IL-1 and anti-TNF therapies, with a good outcome.