Biologic treatments for adult-onset Still's disease

Rheumatology (Oxford). 2014 Jan;53(1):32-8. doi: 10.1093/rheumatology/ket250. Epub 2013 Jul 17.


Adult-onset Still's disease (AOSD) is a systemic inflammatory disorder that is a diagnosis of exclusion. It is characterized by high spiking fevers, arthritis or arthralgia, and an evanescent salmon-coloured rash. Many other systemic manifestations and laboratory test abnormalities may occur. Biologic drugs, TNF-α inhibitors, and IL-1 and IL-6 blockers have been used for the treatment of patients with AOSD refractory to conventional treatment or those with life-threatening manifestations aiming for better disease control. Data on biologic treatments in AOSD are limited and consist mainly of case reports, small case series and retrospective studies. Using biologic agents (anti-TNF-α, anti-IL-1 and anti-IL-6) with traditional immunosuppressive drugs resulted in significant improvement of disease outcomes. IL-1 and IL-6 inhibitors seem to be more efficient than TNF-α inhibitors.

Keywords: TNF-α inhibitor; abatacept; adult-onset Still’s; anakinra; canakinumab; rituximab; tocilizumab.

Publication types

  • Review

MeSH terms

  • Humans
  • Immunologic Factors / therapeutic use*
  • Still's Disease, Adult-Onset / metabolism
  • Still's Disease, Adult-Onset / therapy*
  • Treatment Outcome
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors


  • Immunologic Factors
  • Tumor Necrosis Factor-alpha