Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder with variable clinical features. The
interleukin (IL)-1 receptor antagonist
anakinra has been proposed as an alternative effective
treatment in refractory AOSD. We
report, for the first
time in
Korea, two cases of refractory AOSD in which
anakinra treatment produced a clinical response. The first
patient had frequent clinical flare-ups with
fever,
sore throat,
myalgia, and pleuritic
chest pain despite
treatment with
methotrexate and
etanercept. In the second
patient,
treatments with various
immunosuppressive agents failed to control the
disease activity.
Treatment with
anakinra 100 mg/day was initiated in both cases. A complete clinical remission and improvement in the
laboratory parameters were observed. The
steroid dose was tapered without further clinical flare-ups.
Anakinra appears to be an effective alternative
treatment modality in
patients with AOSD refractory to conventional
disease-modifying
anti-rheumatic drugs and
corticosteroid therapy.