Exploring Best Practices for Diagnosis & Management of Adult-Onset Still's Disease AOSD Podcast
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- Health & Fitness
Adult-onset Still’s disease (AOSD) is a rare, polygenic autoinflammatory syndrome with a pathogenesis similar to systemic juvenile inflammatory arthritis. Join Drs. Petros Efthimiou and Olga Petryna as they discuss making the diagnosis of AOSD through interpretation of clinical and laboratory findings and careful exclusion of other diseases. The faculty review the evidence related to the variety of medications often used to treat patients with AOSD, focusing on canakinumab, the only medication approved in the United States for the disease.
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Case Studies
The diagnosis of adult-onset Still’s disease requires extensive evaluation guided by whether systemic or joint signs/symptoms predominate
Initial disease-modifying therapy with methotrexate is often inadequate to provide symptom relief
Treatment modification with targeted biologic treatment is generally required to achieve treatment goals -
Treatment Strategies & Options
Goals of treatment: control inflammation, prevent joint and organ damage, minimize treatment-related adverse events; relieve patient burden
A wide variety of non-biologic and biologic medications are used for treatment, but are supported with limited evidence
Canakinumab is the only medication approved by the US Food and Drug Administration for the treatment of patients with adult-onset Still’s disease based, in part, on the results of the phase 3 CONSIDER trial
There is no standardized approach to patient monitoring, but is closely tied to the goals of treatment -
Recognition & Diagnosis
Adult-onset Still’s disease is a diagnosis of exclusion
Yamaguchi criteria are useful to classify the disease -
Pathogenesis & Clinical Features
Adult-onset Still’s disease appears to share a similar pathogenesis and disease burden as systemic juvenile inflammatory arthritis
Viral infection appears to be a common trigger in those with a genetic predisposition, resulting in producing a pro-inflammatory state
Patients often present with Still’s triad: daily fevers, evanescent rash, and arthritis