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 has been 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.
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,
For more information on medications please visit:
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