Corticosteroid sparing effect of low dose methotrexate treatment in adult Still's disease

Objective. Adult Still's disease (ASD) is a rare chronic polyarthritis, usu ally treated with corticosteroid therapy. Because some patients become depe ndent on high dose prednisone or are refractory to that treatment, and beca use adverse events are frequent with corticosteroid, we evaluated the effic acy of low dose methotrexate (MTX) as a second-line drug. Methods. We retrospectively studied 26 patients with ASD treated with low d ose MTX because their disease was either resistant to or dependent on corti costeroids. Results, The group included 13 women and 13 men, with a mean age of 32.6 ye ars at onset of ASD. Mean disease duration at the beginning of MTX treatmen t was 59.9 mo (range 7 to 444). Evaluation took place at the maximum follow up, which averaged 48.9 mo (range 8 to 136). The mean dose of MTX was 11.5 +/- 3.6 mg/week (range 7.5 to 17.5). Twenty-three patients responded to MTX ; 18 had complete remission. No difference was seen between patients with o r without extraarticular manifestations. Leukocyte and neutrophil counts an d erythrocyte sedimentation rate were significantly reduced (p = 0.0001). D aily prednisone intake decreased by 69% (21.5 mg) (p = 0.0001), Eleven pati ents were able to stop taking corticosteroids. One patient with AA amyloido sis renal failure died of neutropenia: this was the only serious adverse ev ent. Conclusion. MTX is an effective second-line treatment of ASD that does not respond to prednisone. It allows significant reduction of corticosteroid do ses, which is beneficial to these patients, who have frequent and numerous corticosteroid related adverse events.