Methotrexate treatment in patients with adult onset Still's disease---retrospective study of 13 Japanese cases

doi:10.1136/ard.56.2.144

Annals of the Rheumatic Diseases 1997;56:144-148; doi:10.1136/ard.56.2.144

Ann Rheum Dis 1997;56:144-148 ( February )

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Methotrexate treatment in patients with adult onset Still's disease $---$ retrospective study of 13 Japanese cases Takao Fujii, Masashi Akizuki, Hideto Kameda, Mami Matsumura, Michito Hirakata, Tadashi Yoshida, Taeko Shinozawa, Tsuneyo Mimori

Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo 160, Japan

Correspondence to: Takao Fujii MD, Section of Rheumatology, Department of Internal Medicine, Yale University School of Medicine, 605 LCI, 333 Cedar Street, New Haven, CT 06520-8031, USA

Accepted for publication 22 November 1996

OBJECTIVE $---$ To evaluate methotrexate treatment in patients with active adult onset Still's disease(AOSD).
METHODS $---$ Methotrexate was initially given as a single weekly oral dose of 5 mg and adjusted individually afterwards in 13 patientswith active AOSD. Symptoms and laboratory findings wereinvestigated.
RESULTS $---$ Signs of AOSD activity disappeared (remission) in eight patients between 3 and 16 weeks after starting methotrexate. In thesepatients, significant improvements in C reactive protein, erythrocytesedimentation rate, white blood count, and serum ferritin wereobserved at 8, 12, 14, and 16 weeks after starting methotrexate,respectively. In six of these eight patients, steroids or non-steroidalanti-inflammatory drugs could be reduced or discontinued. In fourpatients methotrexate was not effective despite 12 or 16 weeksof treatment, and one patient discontinued treatment after 2 weeksbecause of severe nausea. Five patients suffered from adversereactions, including acute interstitial pneumonia (one patient)and liver toxicity (two patients). Five out of eight patientssuccessfully treated with methotrexate were HLA-DR4 positive (fourhomozygotes), and all the unsuccessfully treated patients wereDR2positive.
CONCLUSIONS $---$ Methotrexate is useful for controlling disease activity in AOSD, not only for refractory patients but also for patients whohave never taken steroids or for those with steroid associatedtoxicity. However, serious adverse reactions can occur, as withrheumatoid arthritis. It is important to determine the criticalfactors, such as the immunogenetic background, that are associatedwith response to methotrexatetreatment.

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