Clinical and immunological feature, therapeutic response and prognosis of adult onset Still's disease / 中华风湿病学杂志

ABSTRACT

Objective To investigate the clinical and immunological features,therapeutic response as well as prognosis of adult onset Still's disease (AOSD).Methods AOSD was diagnosed in 137 patients referred to our department.Clinical and immunological data were retrospectively analyzed.Therapeutic response and prognosis were systemically reviewed during the follow-up period.Intergroup incidence divergence was analyzed by chi-square test.Cox regression analysis was adopted to determine factors related with relapse.Results Fever,rash and arthritis were the cardinal clinical features of AOSD patients.Elevated inflammatory indices including ferritin (128 suhjects,97.1％ ) along with neutrophilia and liver dysfunction were the main laboratory findings.Ninety-eight patients were followed up and 75％ (73 subjects) had achieved complete remission after 4 weeks treatment.Forty-one patients (42％) who had achieved remission relapsed during follow-up period.Combination of glucocorticoid steroid and disease modifying antirheumatic drugs (DMARDs) were more effective than glucocorticoid steroid only in inducing remission and preventing relapse.More patients received glucocorticoid combined with methotrcxate and hydroxychloroquine achieved remission (8 of 8 patients) than patients who were treated with glucocorticoid and methotrexate (25 of 28 patients,89％ ) and those treated with glucocorticoid and hydroxychloroquine (14 of 16 patients,88％ ).Patients with glucocorticoid were more likely to suffer disease recurrence than those who took glucocorticoid combined with DMARDs (61％ vs 29％,P=0.004).Cox regression analysis suggested that methotrexate had protec-tive effect against recurrence [RR=0.418,95％CI (0.192-0.909),P=0.028].5％ of patients were diagnosed to other diseases during the follow up period.Conclusion Initial treatment with combined glucocorticoid and DMARDs is beneficial to induce remission and prevent reoccurrence.Methotrcxate has a protective effect against recurrence.