ACR 2011 and Adult-onset Still’s Disease (AOSD)

There were a few posters on adult-onset Still’s disease (AOSD) to be seen. I selected one Japanese and two Korean studies.


Classification of Two Subtypes in Adult-Onset Still’s Disease

Hisae Ichida and colleagues had encoutered patients severe polyarthritis corresponding with the classification criteria of rheumatoid arthritis (RA), but most of patients with AOSD showed mild arthritis in general. They tested the hypothesis that there are two clinical subsets of AOSD. In a retrospective study they looked consecutive 73 patients with AOSD in their outpatient clinic from 1995 to 2008. Most striking results are: Ferritin <1500 and IL-18 <4000 9/11 (82% of RA-subtype) and 6/34 (18 % of NonRA-subtype) at p<0.0002. The authors propose two subsets: 1. high ferritin / IL-18 is associated with a severe systemic inflammatory disease, while 2. low ferrin / IL-18 is associated with severe arthritis (RA-subtype).

[TUE] 1965
Classification of Two Subtypes in Adult-Onset Still’s Disease.
Hisae Ichida, Yasushi Kawaguchi, Tomoko Sugiura, Takahisa Gono, Kae Takagi,
Yuko Ota, Ikuko Masuda and Hisashi Yamanaka.
Institute of Rheumatology, Tokyo Women’s Medical University, Tokyo, Japan
Conclusion: We concluded the existence of two subsets in patients with AOSD. Patients with high levels of IL-18 or ferritin were complicated with severe systemic inflammatory disorders (nonRA-subtype), and patients with low levels of them developed to severe arthritis (RA-subtype).


Free Interleukin 18 As a Predictor of Remission and Flare up in Adult-Onset Still’s Disease Patients

Kyong-Hee Jung And colleagues were interested in IL-18 as a predictor to remisssion and flare up. The found higher levels of IL-18 in the group of patients with active disease than in the group of inactive disease. “During follow up, 4 out of 14 inactive AOSD patients with higher levels of free IL-18 despite of normal ESR, CRP and ferritin had a disease flare up within 3 months.” The authors concluded that IL-18 might be a good tool to predict a flare.

[TUE] 1966
Free Interleukin 18 As a Predictor of Remission and Flare up in Adult-Onset Still’s Disease Patients.
Kyong-Hee Jung1, Joo Hyun Lee2, JinJu Kim2, Jin Sook Lee2, Won Park1, Tae-Hwan Kim2 and Dae-Hyun Yoo2.
1Center for Rheumatism, Inha University Hospital, Incheon, South Korea, 2Hanyang University Hospital for Rheumatic Diseases, Seoul, South Korea
Conclusion: Free IL-18 level was significantly high in AOSD patients despite compensation of IL-18BP. Free IL-18 could be useful in the assessment of disease activity especially in clinically inactive AOSD patients, a useful predictor of remission and flare up.


The Role of Sufficient Starting Dose of Steroids in Adult-Onset Still’s Disease

You Jae Kim looked at response to therapy in patients with adult-onset Still’s disease (AOSD). They wanted to know more about prognostic factors related with unfavorable outcomes. An insufficient starting dosage of prednisolone or its equivalent (less than 30 mg/day) was a significant predictive factor with a unfavorable disease course. The authors concludet: “Patients may require early treatment with sufficient steroids to control the disease activity and achieve quicker remission.”

[TUE] 1970
The Role of Sufficient Starting Dose of Steroids in Adult-Onset Still’s Disease.
You Jae Kim1, Bon San Koo1, Min Wook So1, Wook Jang Seo2, Ji Seon Oh3, Yong-Gil Kim1, Chang-Keun Lee1 and Bin Yoo1.
1University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea, 2Seoul Veterans Hospital, Seoul, South Korea, 3University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, South Korea
Conclusion: Analyzing the risk factors for a poor prognosis, an insufficient starting dosage of steroids, i.e. less than 30mg/day of prednisolone, was seen to be significantly related to chronic or relapsing disease course and longer steroid use. Patients may require early treatment with sufficient steroids to control the disease activity and achieve quicker remission.