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Successful treatment of adult-onset Still's disease refractory to TNF and IL-1 blockade by IL-6 receptor blockade
  1. Juergen Rech1,
  2. Monika Ronneberger1,
  3. Matthias Englbrecht1,
  4. Stephanie Finzel1,
  5. Julia Katzenbeisser1,
  6. Karin Manger2,
  7. Bernhard Manger1,
  8. Georg Schett1
  1. 1Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2Rheumatology Outpatient Clinic, Bamberg, Germany
  1. Correspondence to Dr Juergen Rech, Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Ulmenweg 18, Erlangen 91054, Germany; juergen.rech{at}uk-erlangen.de

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Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder of unknown aetiology.1 Based on the substantial acute phase responses observed in AOSD, we hypothesised that blockade of the interleukin 6R (IL-6R), neutralising the induction of the acute phase response by IL-6, could be a useful treatment in multidrug-resistant AOSD. We here report on three patients with AOSD who were refractory to standard treatment and cytokine blockade with anakinra and tumour necrosis factor (TNF) blockers and were subjected to treatment with tocilizumab. The characteristics of these three patients are summarised in table 1.

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Table 1

Characteristics of patients

Patient 1

A 19-year-old woman was first diagnosed with AOSD in July 2006. Prednisone therapy was started, but multiple relapses occurred during the following 2 years requiring …

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