METHOTREXATE TREATMENT IN PATIENTS WITH ADULT-ONSET STILLS-DISEASE - RETROSPECTIVE STUDY OF 13 JAPANESE CASES

Objective-To evaluate methotrexate treatment in patients with active a dult onset Still's disease (AOSD). Methods-Methotrexate was initially given as a single weekly oral dose of 5 mg and adjusted individually a fterwards in 13 patients with active AOSD. Symptoms and laboratory fin dings were investigated. Results-Signs of AOSD activity disappeared (r emission) in eight patients between 3 and 16 weeks after starting meth otrexate. In these patients, significant improvements in C reactive pr otein, erythrocyte sedimentation rate, white blood count, and serum fe rritin were observed at 8, 12, 14, and 16 weeks after starting methotr exate, respectively. In six of these eight patients, steroids or non-s teroidal anti-inflammatory drugs could be reduced or discontinued. In four patients methotrexate was not effective despite 12 or 16 weeks of treatment, and one patient discontinued treatment after 2 weeks becau se of severe nausea. Five patients suffered from adverse reactions, in cluding acute interstitial pneumonia (one patient) and liver toxicity (two patients). Five out of eight patients successfully treated with m ethotrexate were HLA-DR4 positive (four homozygotes), and all the unsu ccessfully treated patients were DR2 positive. Conclusions-Methotrexat e is useful for controlling disease activity in AOSD, not only for ref ractory patients but also for patients who have never taken steroids o r for those with steroid associated toxicity. However, serious adverse reactions can occur, as with rheumatoid arthritis. It is important to determine the critical factors, such as the immunogenetic background, that are associated with response to methotrexate treatment.