Medications & Treatments for Still’s Disease & RA

Methotrexate - Enbrel - Remicade -  Arava 

NSAIDs/Cox-2 Steroids - Kineret  - Actemra

Coping with Medications


There are new and additional medications used in the treatment of Still’s disease. Please, do not think your care is inadequate if your doctor suggests another medication not listed here.

We will be adding more medications used in the treatment of Still’s disease.



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.

As more funding is available and more patients participate in programs for research and development of new treatments; hope for us and future generations of those that suffer this often debilitating disease increases by the year.

If you would like to further research and awareness of Still’s disease &  other medical conditions, you can use Reg4All sponsored by Genetic Alliance. You decide which doctors or researchers have access to your information and how much you share. Through sharing, there will be answers. You and your families history can make the difference.

PLEASE SHARE



Excerpt from Dr. Cush article 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 .



A quick overview of commonly used medications for the treatment of Still’s Disease. The medications below are in no particular prescribing order. Please discuss all options with your rheumatologist when deciding on a treatment plan. There are more medications used in 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.

Kineret® (anakinra) for injection, for subcutaneous use, is an interleukin-1 receptor antagonist (IL-1ra) used to:

  • Reduce the signs and symptoms, and slow the damage of moderate to severe active rheumatoid arthritis (RA) in people age 18 years and older when 1 or more other drugs for RA have not worked.

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.

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



Additional Forms of Disease Management

Pain Management

Physical & Occupational Therapy Coming

Biofeedback

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

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



Check back as we add to these sections and feel free to use our Contact page if you wish to see anything of particular interest or share your knowledge.

No article or information posted in this section is in any order of treatment preference.

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4 PART VIDEO SERIES
ON
STILL'S DISEASE

History - Manifestations
Diagnoses - Management

Presented By
Dr. John J. Cush


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