Exploring Best Practices for Diagnosis & Management of Adult-Onset Still's Disease

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

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

Adult-onset Still’s disease is a diagnosis of exclusion Yamaguchi criteria are useful to classify the disease

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