Exacerbation of adult‐onset Still’s disease, possibly related to elevation of serum tumor necrosis factor‐alpha after etanercept administration

Abstract

Adult-onset Still's disease (AOSD) is a systemic inflammatory disease of unknown etiology. A 44-year-old male patient presented with AOSD complicated by macrophage activation syndrome after etanercept therapy. His serum tumor necrosis factor-α (TNF-α) level was increased dramatically after etanercept therapy. The clinical course of this case suggests that the increased TNF-α level by etanercept administration might cause macrophage activation syndrome in this case.

Two Cases of Adult-onset Still's Disease Treated with Tocilizumab that Achieved Tocilizumab-free Remission

“…While some cases of MAS in AOSD patients have been successfully treated with biologics (26), the occurrence of MAS after the initiation of biologics has also been reported (18,(27)(28)(29)(30)(31)(32). AOSD is characterized by the elevation of many cytokines, such as IL-6, IL-18, and TNF-alpha.…”

Adult-Onset Still’s Disease

“…Stimulated by encouraging results from other chronic inflammatory joint diseases, especially RA, TNF inhibitors have been the first biologics used for AoSD [149][150][151][152][153][154]. However, driven by the deceptive impression that AoSD, with a predominant arthritic phenotype, is a subgroup of seronegative RA, the results from uncontrolled trials involving usually small cohorts of patients were inconsistent.…”

Characteristics of Adult-Onset Still’s Disease in the 21st Century

“…Ингибиторы ФНОα (инфликсимаб, этанерцепт, адалимумаб) были первыми ГИБП, примененными для лечения рефрактерной БСРВ. Полная ремиссия наблюдалась [66][67][68][69][70][71], но препараты недостаточно влияли на системные проявления [49,72], перевод с одного препарата на другой был неэффективным [73], более того, у двух больных, начавших лечение этанерцептом и адалимумабом, развился РГЛ, который по времени возникновения можно было связать с ними [74]. В целом ингибиторы ФНОα оказались эффективными только в лечении хронического суставного варианта БСРВ [24,61].…”