Title:Refractory Adult-onset Still’s Disease Treated with a Combination of
Methotrexate and Etanercept
Volume: 20
Issue: 2
Author(s): Georges El Hasbani*, Yaser Ahmad and Michael Cassetta
Affiliation:
- Department of Internal Medicine, Quinnipiac University, Hartford Healthcare, St. Vincent’s Medical Center, Bridgeport,
06606, USA
Keywords:
Still’s disease, refractory treatment, pharmacotherapy, (TNF)-alpha inhibitor, interleukin (IL)-1 therapy, combination of methotrexate and Etanercept.
Abstract:
Background: Adult-onset Still’s disease (AOSD) is a challenging diagnosis because of
the variability in clinical presentation and lack of gold-standard diagnostic investigations. Even after
diagnosis, the treatment is challenging, especially when the disease is refractory to first-line
therapy. Multiple pharmacotherapeutic options exist for refractory AOSD, but treatment failures
still occur. Etanercept, a Tumor necrosis factor (TNF)-alpha inhibitor, is one of the options that
has been rarely used for refractory AOSD, with various outcomes ranging from no response to
complete remission.
Case Presentation: In this case, we highlight how a previously healthy lady had refractory AOSD
to glucocorticoids, methotrexate, and hydroxychloroquine combination therapy. There was no response
to interleukin (IL)-1 therapy, which necessitated a switch to a combination of etanercept,
low-dose methotrexate, and low-dose glucocorticoids with complete remission for a total of three-
-year follow-up.
Conclusion: The combination of methotrexate and Etanercept can maintain remission in patients
with refractory AOSD.
