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

Mod Rheumatol. 2012 Feb;22(1):137-41. doi: 10.1007/s10165-011-0477-9. Epub 2011 Jun 14.


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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Drug Synergism
  • Drug Therapy, Combination
  • Etanercept
  • Female
  • Humans
  • Immunoglobulin G / therapeutic use*
  • Macrophage Activation Syndrome / drug therapy*
  • Macrophage Activation Syndrome / immunology
  • Macrophage Activation Syndrome / pathology
  • Methotrexate / therapeutic use*
  • Receptors, Tumor Necrosis Factor / therapeutic use*
  • Remission Induction
  • Still's Disease, Adult-Onset / drug therapy*
  • Still's Disease, Adult-Onset / immunology
  • Still's Disease, Adult-Onset / pathology


  • Immunoglobulin G
  • Receptors, Tumor Necrosis Factor
  • Etanercept
  • Methotrexate