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Anti-CD-20 Therapy in Refractory Adult Still’s Disease

DOI: 10.4236/ojra.2012.22002, PP. 3-5

Keywords: Adult Still’s Disease, Anti-TNF Therapy, Anti-CD-20 Therapy, Refractory Disease

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Abstract:

Adult Still’s disease is a relatively rare form of rheumatoid arthritis with systemic inflammatory features. The prevalence is around 1.5 cases per 100,000 - 1000,000. In the current case we display a 30-year-old male patient with refractory adult still’s disease who suffered recurrent attacks of fever 39.5°C, arthritis in proximal interphalangeal joints (PIPs), wrists, tempromandibular joints (TMJs), knees and ankles, stitching chest pain, dyspnea, erythematous rash over the trunk, sore throat, weight loss (15 Kilograms in 4 months). The patients’ disease remained uncontrolled despite of synthetic disease modifying anti-rheumatic drugs and repeated intramuscular corticosteroid injections. Laboratory workup revealed erythrocyte sedimentation rate (ESR) of 95, C-reactive protein (CRP) of 100 mg/L, hemoglobin 10.5 gm%, leukocytosis 12,000/microlitre, mild elevation of liver function tests and dyslipidemia. Serology revealed negative rheumatoid factor, anti-nuclear antibody titre of 1:80, elevated serum ferritin 4000 micrograms/litre. The patient was started on rituximab (375 mg/m2), prednisolone 20 mg/day and selective Cox-2 inhibitor. Follow up for over three months following the completion of his pulse therapy, revealed no relapse of fever or fatigue, with morning stiffness of 5 - 10 minutes, VAS of 3, DAS28 of 3.8, HAQDI of 0.62, ESR 23, CRP 4.9, Hb 12.5 gm%, leucocytic count 9000/microlitre, the dose of prednisolone was successfully reduced to a dose of 5 mg/day orally. Conclusion: Anti-CD20 therapy successfully controlled systemic and articular refractory disease with sustained efficacy over a follow up period of up to 24 weeks.

References

[1]  P. Efthimiou, A. Kontzias, C. M. Ward and N. S. Ogden, “Adult-Onset Still’s Disease: Can Recent Advances in Our Understanding of Its Pathogenesis Lead to Targeted Therapy?” Nature Reviews Rheumatology, Vol. 3, No. 6, 2007, pp. 328-335. doi:10.1038/ncprheum0510
[2]  E. G. Bywaters, “Still’s Disease in the Adult,” Annals of Rheumatic Diseases, Vol. 30, No. 2, 1971, pp. 121-133. doi:10.1136/ard.30.2.121
[3]  M. B. Owlia and G. Mehrpoor, “Adult-Onset Still’s Disease: A Review,” Indian Journal of Medical Sciences, Vol. 63, No. 5, 2009, pp. 207-221.
[4]  F. Luthi, P. Zufferey, M. F. Hofer and A. K. So, “‘Adolescent-Onset Still’s Disease’: Characteristics and Outcome in Comparison with Adult-Onset Still’s Disease,” Clinical and Experimental Rheumatology, Vol. 20, No. 3, 2002, pp. 427-430.
[5]  M. Yamaguchi, A. Ohta, T. Tsunematsu, R. Kasukawa, Y. Mizushima, H. Kashiwagi, S. Kashiwazaki, K. Tanimoto, Y. Matsumoto and T. Ota, “Preliminary Criteria for Classification of Adult Still’s Disease,” The Journal of Rheumatology, Vol. 19 , No. 3, 1992, pp. 424-430.
[6]  A Kontzias and P Efthimiou, “Adult-Onset Still’s Disease: Pathogenesis, Clinical Manifestations and Therapeutic Advances,” Drugs, Vol. 68, No. 3, 2008, pp. 319-337. doi:10.2165/00003495-200868030-00005
[7]  P. Efthimiou and S. Georgy, “Pathogenesis and Management of Adult-Onset Still’s Disease,” Seminars in Arthritis and Rheumatism, Vol. 36, No. 3, 2006, pp. 144-152. doi:10.1016/j.semarthrit.2006.07.001
[8]  I. K?tter, A. Wacker, S. Koch, J. Henes, C. Richter, A. Engel, I. Günaydin and L. Kanz, “Anakinra in patients with treatment-resistant adult-onset Still’s disease: four case reports with serial cytokine measurements and a review of the literature,” Seminars in Arthritis and Rheumatism, Vol. 37, No. 3, 2007, pp. 189-197. doi:10.1016/j.semarthrit.2007.04.002
[9]  G. D. Kalliolias and S. N. Liossis, “The Future of the Il-1 Receptor Antagonist Anakinra: From Rheumatoid Arthritis to Adult-Onset Still’s Disease and Systemic-Onset Juvenile Idiopathic Arthritis,” Expert Opinion on Investigational Drugs, Vol. 17, No. 3, 2008, pp. 349-359. doi:10.1517/13543784.17.3.349
[10]  R. Thonhofer, M. Hiller, H. Just, M. Trummer, C. Siegel and C. Dejaco, “Treatment of refractory adult-onset still’s disease with tocilizumab: report of two cases and review of the literature,” Rheumatology International, Vol. 31, No. 12, 2011, pp. 1653-1656. doi:10.1007/s00296-010-1631-y
[11]  T. Naniwa, R. Ito, M. Watanabe, Y. Hayami, S. Maeda, K. Sasaki and S. Iwagaitsu, “Case Report: Successful Use of Short-Term Add-On Tocilizumab for Multirefractory Systemic Flare of Adult-Onset Still’s Disease,” Clinical Rheumatology, 14 September 2010, pp. 1-44. doi:10.1007/s10067-010-1562-8
[12]  K. Ahmadi-Simab, P. Lamprecht, C. Jankowiak and W. L. Gross, “Successful Treatment of Refractory Adult Onset Still’s Disease with Rituximab,” Annals of the Rheumatic Diseases, Vol. 65, No. 8, 2006, pp. 1117-1118. doi:10.1136/ard.2005.047621
[13]  E. Bartoloni, A. Alunno, F. Luccioli, G. Santoboni and R. Gerli, “Successful Treatment of Refractory Adult Onset Still’s Disease with Anti-CD-20 Monoclonal Antibody,” Clinical and Experimental Rheumatology, Vol. 27, No. 5, 2009, pp. 888-889.

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