Treatments for Still’s Disease & RA

 

Medications

(To be updated soon)

Methotrexate - Enbrel - Remicade -  Arava  - NSAIDs/Cox-2 - Steroids

Additional forms of disease Management

 Pain Control

Physical & Occupational Therapy

Coping with Medications (NEW ARTICLE)

While there is no known cure for Still’s Disease, it is a treatable disease.  Thanks to ongoing research in pharmaceuticals many patients can achieve “control” over their disease.  1999 was a great year for the introduction of a new class of drugs to combat autoimmune and inflammatory diseases such as RA, and Still’s.  These new drugs, referred to as biologic agents,  are anti-TNF (tumor necrosis factor) and they significantly reduce inflammation and pain.

Here is an excerpt from an article from Dr. Cush on the treatment of AOSD: John J. Cush, MD, 02/19/2002

Treatment of AOSD is focused either on the systemic or articular disease. Systemic disease (fever, rash, weight loss, hepatosplenomegaly, diffuse lymphadenopathy, serositis, leukocytosis, high erythrocyte sedimentation rate/C-reactive protein/ferritin) would initially depend on corticosteroids to get rapid control of a sick patient. Nonsteroidal anti-inflammatory drugs (NSAIDs) may be effective in a few patients, but most with a firm diagnosis of AOSD will require prednisone 40-80 mg initially. Steroid-sparing therapy should be begun soon in most patients and may include either methotrexate, hydroxychloroquine, azathioprine, or tumor necrosis factor (TNF) inhibitors, depending on disease severity and drug safety.

Treatment of the more indolent and chronically progressive articular disease is similar to that for rheumatoid arthritis and may include methotrexate, hydroxychloroquine, sulfasalazine, gold salts, azathioprine, etanercept, infliximab, steroids, and NSAIDs as needed. But this patient does not have either systemic or articular disease that would merit these therapies. Patients with AOSD are not prone to recurrent infections (aside from risks associated with steroids and other drugs) and are not at increased risk for hepatitis C.

We have included a section for these new drugs, along with standard drugs commonly used to control Still’s symptoms.

Here is a quick overview of commonly used medications for the treatment of Still’s Disease:

Methotrexate has often been the treatment of choice because of demonstrated efficacy and long-term tolerance. Therapy should begin with 7.5 mg weekly and increasing at 1- or 2-month intervals until peak efficacy is achieved. Methotrexate is relatively contraindicated with a history of hepatitis or alcoholism. Side effects include anorexia, nausea, vomiting, abdominal cramps, elevated liver enzyme levels, myelosuppression (rare), pulmonary toxicity, hepatic fibrosis, hypersensitivity pneumonitis. Users must be closely monitored for hepatic toxicity.

Hydroxychloroquine (Plaquenil), 200-400 mg PO qd, is recommended for patients with mild disease. This drug works slowly but has few side effects. Retinal damage is avoidable if vision is monitored every 6 or 12 months and the drug is stopped when signs of retinal toxicity appear

Etanercept (Enbrel). After twice-weekly subcutaneous injections of etanercept (recombinant human tumor necrosis factor receptor), 25 mg, at 3 months, 62% improve. Etanercept is well tolerated and is an indicated for use alone or with methotrexate for patients with active disease that is refractory to methotrexate.

Infliximab ( Remicade) is given intravenously for use in refractory disease. Infliximab is an anti-tumor necrosis factor monoclonal antibody. Infliximab is given intravenously in dosages of 3 or 10 mg/kg, repeated at about four- to 12-week intervals.

Janssen Biotech, Inc. Patient Support Programs

We offer Janssen AccessOne® Support as an integrated system designed to provide support to physician offices and personalized care coordination services to patients, including referral to a patient assistance program and identification of alternate sources of funding.

Call the following numbers for the respective products to reach the customized support hotline, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET.

  • AccessOne® Support
1-888-ACCESS-1 (1-888 222-3771)

Leflunomide ( Arava), which inhibits pyrimidine synthesis, is an oral drug considered as a possible alternative to methotrexate. The dosage is 100 mg PO daily for three days followed by a maintenance dosage of 10 to 20 mg daily. Leflunomide improves rheumatic arthritis but offers no clear advantages over methotrexate.

Corticosteroids. These drugs may relieve the symptoms of Stills, but they are potentially dangerous, with many long-term side effects. They should be reserved for severe systemic disease. Corticosteroids include prednisone, prednisolone, medrol, decadron and many others.

Nonsteroidal anti-inflammatory drugs. Most patients will gain short-term symptomatic relief from treatment with NSAIDs. These drugs are generally equivalent in efficacy. NSAIDs can cause peptic ulcer disease and renal insufficiency. Nsaids include motrin, naprosyn, oruvil,

Cox-2 Inhibitors:  Celebrex, Vioxx, Mobic

For more information on medications please visit:

ARTHRITIS FOUNDATION DRUG GUIDE Published Sept. 2013

ARTHRITIS FOUNDATION SUPPLEMENT GUIDE Published Sept. 2013

RX LIST

MEDICINENET

8 Facts About Vitamin D and Rheumatoid  Arthritis

 

Therapies

COMMING SOON

Physical Therapy - Occupational Therapy - Biofeedback Therapy - More

We feel these tools and therapies can be an equally important part of any patients care.

There are many forms of therapies that can be used to; reduce pain, calm a persons anxieties, help cope with the diagnoses of a chronic condition(s), aid in recovery, add strength to regain and or maintain joint/muscle strength and mobility, and to help ease the daily activities of life.

Check back as we add to this section and feel free to use our enquiry page if you wish to see anything of particular interest or share your knowledge. No article or information posted in this section will be in any order of treatment preference.

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Video Series on
Still's Disease

History Manifestations
Diagnoses Management

Presented By
Dr. John J. Cush


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