How Is Adult-Onset Still’s Disease Treated?

In people with adult-onset Still’s disease (AOSD), the immune system does not work the way it should. Instead, their immune system proteins cause too much inflammation. Over time, this can damage their healthy cells. Most of the damage from AOSD occurs in the joints, like the knees or wrists.^1-3

Inflammation can also lead to other AOSD symptoms and complications. Symptoms may include fevers, rashes, and swollen lymph nodes. Complications may include macrophage activation syndrome (MAS). MAS is a possibly life-threatening condition in which the body’s immune system is overwhelmingly active.^1-4

Early treatment can help reduce long-term damage from AOSD. If you have AOSD, your doctor will monitor you for MAS and other complications. They will then adjust treatment as needed.^1-4

Treatment planning

The goal of AOSD treatment is to turn down the overactive immune system and reduce symptoms. This can be done with numerous medicines, including those that directly target the specific proteins (called cytokines) that are causing the inflammation. Examples of these are proteins called IL-1 and IL-6. Other drugs may target general inflammation in the body or help reduce pain.^1,2,4

Choosing the best treatment for you will depend on many factors. Some of these factors are:^1-3

• How severe your symptoms are
• What symptoms are most bothersome to you
• How often symptoms return

Some people may only need to be treated once for a short period of time. Others will need treatment for years. This may mean taking drugs even when active symptoms are not present to help prevent future flare-ups.^1-3

Treatment may require trial and error for some people. Treatment plans also often change over time. Your doctor will work with you to figure out the best options for you.^1-3

Nonsteroidal anti-inflammatory drugs (NSAIDs)

NSAIDs are drugs that block certain inflammation-causing chemicals in the body. This can help reduce pain and fevers. They are sold over the counter or in stronger doses by prescription. Aspirin and ibuprofen are 2 types of NSAIDS.^1,5

NSAIDs are useful for treating mild AOSD. They do not have as many side effects as steroids. However, NSAIDs should not be taken at high doses for long periods of time. If your AOSD is not controlled by NSAIDs, your doctor might recommend corticosteroids or other treatment options.^1,4

Corticosteroids (steroids)

Like NSAIDs, steroid drugs have general anti-inflammatory effects on the body. They mimic a naturally occurring hormone that plays a role in controlling inflammation. Steroids can help turn down the immune system and reduce symptoms quickly. Examples of steroids are prednisone and prednisolone.^1,4

However, steroids can cause many side effects. These include weight gain, mood changes, muscle problems, and bone thinning. They can also increase your risk for developing diabetes, high blood pressure, and vision problems.^1,6

Your doctor will try to limit your exposure to steroids as much as possible. But they can be useful in treating flare-ups of symptoms or more severe cases of AOSD.^1,6

Disease-modifying antirheumatic drugs (DMARDs)

DMARDs also help reduce inflammation. They often target specific processes in the body rather than the immune system as a whole. The side effects can vary for each DMARD, and some are harder on the body than others. DMARDs are used to treat people who have severe or hard-to-treat AOSD.^1,2,4,7

Biologic drugs

Most DMARDs are synthetic, which means they are made from chemicals in a lab. However, biologic drugs are DMARDs made from living cells. Biologics can target very specific processes in the body. They often have fewer side effects than steroids or traditional DMARDs.^1,2,4

Some biologics target specific cytokines that are causing damage, including IL-1 and IL-6. Examples of biologics are anakinra and canakinumab. Biologics can be effective in controlling AOSD, but they are usually not the first-line treatment. Like DMARDs, they are used in more severe cases or when other drugs have not worked.^1,2,4

Before taking DMARDs or biologics, you may need to undergo testing. Because these drugs decrease the immune system, some inactive (latent) infections can reappear if you have previously been exposed. These include certain hepatitis viruses and tuberculosis (TB).¹

Other blood tests also may be helpful to track how your body is responding to treatment and to monitor for any complications, such as MAS. These include tests that look at your:^1,7

• Blood cell counts
• Levels of different cytokines or other immune system proteins
• Liver function

Diet, exercise, and other lifestyle changes

In addition to medicine, there are other ways to help manage the symptoms of AOSD. They can reduce strain on joints, improve pain, and ease fatigue. Examples of helpful lifestyle changes include:^3,4,8

• Eating a balanced diet
• Exercising regularly
• Maintaining a healthy weight

Staying active and eating well can help keep your body in the best shape possible to battle AOSD or other issues.^3,4,8

Emotional support

Having a potentially long-term, painful condition like AOSD can take a toll on your mental and emotional health. Talking to a counselor, therapist, or other mental health professional can help you cope with these feelings as they arise.⁴

It may also be helpful to join a support group. Your doctor can point you in the direction of an in-person group if there is one near you. There are likely online support groups as well.⁴