Adult-onset Still’s disease with macrophage activation syndrome successfully treated with a combination of methotrexate and etanercept

• Published in: Modern rheumatology Vol. 22; no. 1; pp. 137 - 141
• Main Authors: Maeshima, Keisuke, Ishii, Koji, Iwakura, Mikako, Akamine, Misuzu, Hamasaki, Hajime, Abe, Itomi, Haranaka, Miwa, Tatsukawa, Hiroshi, Yoshimatsu, Hironobu
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.02.2012; Informa Healthcare
• Subjects: Adolescent; Case Report; Cell activation; Clinical outcomes; Drug Synergism; Drug therapy; Drug Therapy, Combination; Etanercept; Female; Humans; Immunoglobulin G - therapeutic use; infliximab; Inhibitor drugs; Juvenile rheumatoid arthritis; Macrophage Activation Syndrome - drug therapy; Macrophage Activation Syndrome - immunology; Macrophage Activation Syndrome - pathology; Macrophages; Medicine; Medicine & Public Health; Methotrexate; Methotrexate - therapeutic use; Monoclonal antibodies; Orthopedics; Pharmacology; Receptors, Tumor Necrosis Factor - therapeutic use; Remission; Remission Induction; Rheumatoid arthritis; Rheumatology; Still's Disease, Adult-Onset - drug therapy; Still's Disease, Adult-Onset - immunology; Still's Disease, Adult-Onset - pathology; Tumor necrosis factor- alpha; Adult-onset Still’s disease; Etanercept; Methotrexate; Macrophage activation syndrome
• ISSN: 1439-7595; 1439-7609
• DOI: 10.1007/s10165-011-0477-9

We report a 16-year-old female case of intractable adult-onset Still’s disease accompanied by macrophage activation syndrome, who went into full remission after switching from infliximab to etanercept. Although the disease promptly relapsed when etanercept was discontinued, she again responded fully upon the reintroduction of etanercept. Furthermore, the effect of etanercept was apparently enhanced by combining it with a sufficient dose of methotrexate. This combination therapy should be considered as one of treatment options for the disease.