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Arya PVA, Marnet E, Rondla M, Tan JW, Unnikrishnan D, Buller G. Renal manifestations in adult-onset Still's disease: a systematic review. Rheumatol Int 2024; 44:1209-1218. [PMID: 38625385 DOI: 10.1007/s00296-024-05578-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/07/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE We aimed to review the literature on the clinical presentation, renal pathology, treatment, and outcome of renal manifestations in adult-onset Still's disease (AOSD). METHODS We used PRISMA guidelines for our systematic review and included all English-language original articles from inception till September 15, 2023, on AOSD and kidney involvement in any form. Data on patient demographics, diagnostic criteria, clinical presentation, renal pathology, treatment employed including dialysis, outcome, cause of death were collected and analyzed. RESULTS The median age at the diagnosis of renal issues was 37, with a higher prevalence among females (58.1%). Among the cases, 28 experienced renal problems after being diagnosed with AOSD, 12 had simultaneous diagnoses of renal issues and AOSD, and in 4 cases, renal problems appeared before AOSD diagnosis. Out of the 44 cases, 36 underwent renal biopsy, revealing various pathology findings including AA amyloidosis (25%), collapsing glomerulopathy (11.4%), thrombotic microangiopathy (TMA) (11.4%), IgA nephropathy (9.1%), minimal change disease (6.8%), and others. Some cases were clinically diagnosed with TMA, proximal tubular dysfunction, or macrophage activation syndrome-related acute kidney injury. Treatment approaches varied, but glucocorticoids were commonly used. Renal involvement was associated with increased mortality and morbidity, with 6 out of 44 patients passing away, 4 progressing to end-stage renal disease (ESRD), and data on 2 cases' outcomes not available. CONCLUSION Renal manifestations in AOSD are diverse but rarely studied owing to the rarity of the disease. Studies with larger data would be essential to study further on the pathogenesis and implications.
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Affiliation(s)
- P V Akhila Arya
- Yale New Haven Health/Bridgeport Hospital, 267 Grant St, Bridgeport, CT, 06610, USA.
| | - Erica Marnet
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
| | - Madhumita Rondla
- Department of Internal Medicine, Texas Tech University, El Paso, USA
| | - Jia Wei Tan
- Department of Nephrology, Stanford School of Medicine, Stanford, USA
| | | | - Gregory Buller
- Internal Medicine/Nephrology, Yale New Haven Health, Bridgeport Hospital, Bridgeport, USA
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Ananthaneni A, Shimkus G, Weis F, Adu-Dapaah E, Lakra R, Ramadas P, Hayat S. Adult-onset Still's disease with concurrent thrombotic microangiopathy: Observations from pooled analysis for an uncommon finding. Eur J Haematol 2024; 112:484-492. [PMID: 37997494 DOI: 10.1111/ejh.14142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder that is characterized by quotidian fevers, arthritis, and an evanescent rash. Occurrence of concurrent thrombotic microangiopathy (TMA) in AOSD is rare. The treatment aspects of TMA in AOSD are actively being debated. METHODS Medline search using MeSH terms and snowballing yielded a total of 29 articles with co-occurrence of AOSD and thrombotic thrombocytopenic purpura (TTP) including our own. Pooled data were synthesized for descriptive analysis. RESULTS Median age was 35 years with a majority of females (68.96%). A majority of these studies/patients were either Asian (34.48%) or Caucasian (31.03%). Concurrent TMA at the time of AOSD diagnosis was seen in 65.51% patients. Only 3/29 patients had ADAMTS13 level less than 10%, consistent with TTP and 3/29 were diagnosed with hemolytic uremic syndrome (HUS). The remainder were diagnosed clinically. Complication rate was high, and 15/29 (51.72%) patients died or had permanent neurological/renal/vision/gangrenous complications. Median and mean ferritin peak was observed to be higher (7458 and 12 349, respectively) in patients who either died/had partial remission, compared to those who had complete response (3257 and 10 899, respectively), p = .829. CONCLUSIONS A majority of patients with AOSD-associated TMA either died or had permanent complications. TMA was diagnosed alongside AOSD in 65% patients, while the rest developed TMA during the course of their disease. Blurred vision may precede TMA and could help risk-stratify high-risk AOSD patients clinically. Glycosylated ferritin remains low several weeks to months after disease remission and may be used to monitor severity of disease process. Further studies are necessary to confirm the existing vascular endothelial growth factor hypothesis in AOSD-associated TMA.
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Affiliation(s)
- Anil Ananthaneni
- Division of Hematology & Oncology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Gaelen Shimkus
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Francesca Weis
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Eunice Adu-Dapaah
- Division of Rheumatology, Department of Internal Medicine, University of California, Los Angeles, California, USA
| | - Rachaita Lakra
- Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Poornima Ramadas
- Division of Hematology & Oncology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
| | - Samina Hayat
- Division of Rheumatology, Department of Internal Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA
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Dillemans L, Bekhuis Y, Betrains A, Yu K, van Hemelen M, Pörtner N, De Somer L, Matthys P, Breckpot J, Tousseyn T, Peetermans M, Proost P, Wouters C, Vanderschueren S. Biallelic mutations in the CFHR genes underlying atypical hemolytic uremic syndrome in a patient with catastrophic adult-onset Still's disease and recurrent macrophage activation syndrome: A case report. Clin Immunol 2023; 257:109815. [PMID: 37898413 DOI: 10.1016/j.clim.2023.109815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 10/02/2023] [Accepted: 10/24/2023] [Indexed: 10/30/2023]
Abstract
We report the fatal case of a 20-year-old woman with refractory adult-onset Still's disease (AOSD) accompanied by fulminant macrophage activation syndrome (MAS) and atypical hemolytic uremic syndrome (aHUS). Anakinra and tocilizumab temporarily controlled AOSD. In 2021, she presented to ICU with generalized tonic-clonic seizure, lymphocytic aseptic meningitis, and acute kidney injury. Despite hemodialysis and methylprednisolone, she developed another seizure, MAS, and disseminated intravascular coagulation (DIC). Following brief control, MAS flares -reflected by increased plasma CXCL9 and CXCL10- re-emerged and were controlled through dexamethasone, etoposide, cyclosporin and tofacitinib. No mutations were detected in haemophagocytic lymphohistiocytosis (HLH)-associated genes, nor in genes associated with periodic fever syndromes. Post-mortem genetic testing revealed loss-of-function biallelic deletions in complement factor H-related proteins (CFHR) genes, predisposing aHUS. This case underscores the importance of prompt genetic assessment of complement-encoding alleles, in addition to HLH-related genes, in patients with severe AOSD with recurrent MAS and features of thrombotic microangiopathy (TMA).
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Affiliation(s)
- Luna Dillemans
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium
| | - Youri Bekhuis
- Laboratory of Cardiology, Department of Cardiovascular Sciences, KU Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Belgium
| | - Albrecht Betrains
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), University Hospitals Leuven, Belgium
| | - Karen Yu
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium
| | - Maarten van Hemelen
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Belgium
| | - Noëmie Pörtner
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium
| | - Lien De Somer
- European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), University Hospitals Leuven, Belgium; Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium; Department of Pediatric Rheumatology, University Hospitals Leuven, Belgium
| | - Patrick Matthys
- Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium
| | | | - Thomas Tousseyn
- Translational Cell and Tissue Research, Department of Imaging and Pathology, KU Leuven, Belgium
| | - Marijke Peetermans
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Belgium
| | - Paul Proost
- Laboratory of Molecular Immunology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium.
| | - Carine Wouters
- European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), University Hospitals Leuven, Belgium; Laboratory of Immunobiology, Department of Microbiology, Immunology and Transplantation, Rega Institute, KU Leuven, Belgium
| | - Steven Vanderschueren
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Belgium; European Reference Network for Immunodeficiency, Autoinflammatory, Autoimmune and Pediatric Rheumatic disease (ERN-RITA), University Hospitals Leuven, Belgium
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4
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Kato R, Ikeuchi T, Tomita K, Yamasaki A. Adult-onset Still's disease with concurrent thrombotic thrombocytopenic purpura: case report and literature review. BMJ Case Rep 2020; 13:13/9/e235786. [PMID: 32988976 DOI: 10.1136/bcr-2020-235786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Thrombotic thrombocytopenic purpura (TTP) is rare complication resulting from adult-onset Still's disease (AOSD). We report the case of a 69-year-old Japanese man who initially presented with fever and joint pain and was diagnosed as having concurrent AOSD with TTP 1 month later. He had extremely high ferritin levels (32 696 ng/mL). He initially responded to plasma exchange but subsequently died of septic shock. AOSD accompanied by extremely high ferritin levels might be considered a sign of concurrent TTP.
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Affiliation(s)
- Ryohei Kato
- Division of Respiratory Medicine and Rheumatology, Department of Multidisclplinary Internal Medicine, Faculty of Medicine, Tottori University Hospital, Yonago, Tottori, Japan
| | - Tomoyuki Ikeuchi
- Department of Respiratory Medicine, Yonago Medical Centre, National Hospital Organisation Yonago Medical Center, Yonago, Tottori, Japan
| | - Katsuyuki Tomita
- Department of Respiratory Medicine, Yonago Medical Centre, National Hospital Organisation Yonago Medical Center, Yonago, Tottori, Japan
| | - Akira Yamasaki
- Division of Respiratory Medicine and Rheumatology, Department of Multidisclplinary Internal Medicine, Faculty of Medicine, Tottori University Hospital, Yonago, Tottori, Japan
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5
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Rafat C, Luque Y. Thrombotic microangiopathy in adult-onset Still's disease: the story is just beginning. Expert Rev Clin Immunol 2019; 15:1123-1124. [PMID: 31650884 DOI: 10.1080/1744666x.2019.1682892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Cédric Rafat
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France
| | - Yosu Luque
- Urgences Néphrologiques et Transplantation Rénale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Tenon, Paris, France.,Sorbonne Université, Inserm, Paris, France
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6
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Guilleminault L, Laurent S, Foucher A, Poubeau P, Paganin F. Pulmonary arterial hypertension in adult onset Still's disease: a case report of a severe complication. BMC Pulm Med 2016; 16:72. [PMID: 27160441 PMCID: PMC4862120 DOI: 10.1186/s12890-016-0237-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 05/01/2016] [Indexed: 12/02/2022] Open
Abstract
Background Adult onset of Still’s disease (AOSD) is a rare systemic inflammatory disease. Cardiorespiratory complications are mainly represented by pleural and pericardial disorders and are less frequent than cutaneous and articular complaints. Pulmonary arterial hypertension (PAH) occurring in AOSD is rarely described in literature. Case presentation We present the case of a young patient who developed severe PAH 2 years after diagnosis of AOSD. This is a rare and severe complication which is probably underestimated. Conclusions PAH in AOSD can be lethal, and unfortunately its occurrence is unpredictable. Echocardiographic screening of AOSD patients should be evaluated in further trials. Currently, the most suitable treatment is still unknown. Electronic supplementary material The online version of this article (doi:10.1186/s12890-016-0237-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L Guilleminault
- Service de Pneumologie, CHU Reunion/GHSR, Saint-Pierre, F-97410, France. .,Inserm, UMR 1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), plateforme CYROI, Sainte-Clotilde, F-97490, France. .,Université de La Réunion, UMR 1188, Sainte-Clotilde, F-97490, France. .,Service de Pneumologie, Groupe Hospitalier Sud Réunion, BP 350, 97448, Saint-Pierre cedex, France.
| | - S Laurent
- Service de Pneumologie, CHU Reunion/GHSR, Saint-Pierre, F-97410, France
| | - A Foucher
- Service de maladies infectieuses, CHU Reunion/GHSR, Saint-Pierre, F-97410, France
| | - P Poubeau
- Service de maladies infectieuses, CHU Reunion/GHSR, Saint-Pierre, F-97410, France
| | - F Paganin
- Service de Pneumologie, CHU Reunion/GHSR, Saint-Pierre, F-97410, France.,Université de La Réunion, UMR 1188, Sainte-Clotilde, F-97490, France
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7
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Gerfaud-Valentin M, Jamilloux Y, Iwaz J, Sève P. Adult-onset Still's disease. Autoimmun Rev 2014; 13:708-22. [PMID: 24657513 DOI: 10.1016/j.autrev.2014.01.058] [Citation(s) in RCA: 358] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 01/02/2014] [Indexed: 12/17/2022]
Abstract
First described in 1971, adult-onset Still's disease (AOSD) is a rare multisystemic disorder considered as a complex (multigenic) autoinflammatory syndrome. A genetic background would confer susceptibility to the development of autoinflammatory reactions to environmental triggers. Macrophage and neutrophil activation is a hallmark of AOSD which can lead to a reactive hemophagocytic lymphohistiocytosis. As in the latter disease, the cytotoxic function of natural killer cells is decreased in patients with active AOSD. IL-18 and IL-1β, two proinflammatory cytokines processed through the inflammasome machinery, are key factors in the pathogenesis of AOSD; they cause IL-6 and Th1 cytokine secretion as well as NK cell dysregulation leading to macrophage activation. The clinico-biological picture of AOSD usually includes high spiking fever with joint symptoms, evanescent skin rash, sore throat, striking neutrophilic leukocytosis, hyperferritinemia with collapsed glycosylated ferritin (<20%), and abnormal liver function tests. According to the clinical presentation of the disease at diagnosis, two AOSD phenotypes may be distinguished: i) a highly symptomatic, systemic and feverish one, which would evolve into a systemic (mono- or polycyclic) pattern; ii) a more indolent one with arthritis in the foreground and poor systemic symptomatology, which would evolve into a chronic articular pattern. Steroid- and methotrexate-refractory AOSD cases benefit now from recent insights into autoinflammatory disorders: anakinra seems to be an efficient, well tolerated, steroid-sparing treatment in systemic patterns; tocilizumab seems efficient in AOSD with active arthritis and systemic symptoms while TNFα-blockers could be interesting in chronic polyarticular refractory AOSD.
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Affiliation(s)
- Mathieu Gerfaud-Valentin
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, Service de médecine interne, F-69004 Lyon, France; Université Lyon I, F-69100 Villeurbanne, France; Université de Lyon, F-69000 Lyon, France
| | - Yvan Jamilloux
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, Service de médecine interne, F-69004 Lyon, France; Inserm U1111, Centre International de Recherche en Infectiologie, F-69365 Lyon, France; Département de Biochimie, Université de Lausanne, 1006 Epalinges, Switzerland
| | - Jean Iwaz
- Université Lyon I, F-69100 Villeurbanne, France; Université de Lyon, F-69000 Lyon, France; Hospices Civils de Lyon, Service de Biostatistique, F-69000 Lyon, France; CNRS UMR 5558, Laboratoire de Biométrie et Biologie Evolutive, Equipe Biostatistique Santé, F-69310 Pierre-Bénite, France
| | - Pascal Sève
- Hospices Civils de Lyon, Hôpital Universitaire de la Croix-Rousse, Service de médecine interne, F-69004 Lyon, France; Université Lyon I, F-69100 Villeurbanne, France; Université de Lyon, F-69000 Lyon, France.
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8
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Masuyama A, Kobayashi H, Kobayashi Y, Yokoe I, Sugimura Y, Maniwa K, Sato H, Ishida T, Hatanaka Y. A case of adult-onset Still’s disease complicated by thrombotic thrombocytopenic purpura with retinal microangiopathy and rapidly fatal cerebral edema. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0650-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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9
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Sayarlioglu M, Sayarlioglu H, Ozkaya M, Balakan O, Ucar MA. Thrombotic thrombocytopenic purpura–hemolytic uremic syndrome and adult onset Still’s disease: case report and review of the literature. Mod Rheumatol 2014. [DOI: 10.3109/s10165-008-0061-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Mehmet Sayarlioglu
- Department of Internal Medicine, Division of Rheumatology, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Hayriye Sayarlioglu
- Department of Internal Medicine, Division of Nephrology, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Mesut Ozkaya
- Department of Internal Medicine, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Ozan Balakan
- Department of Internal Medicine, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
| | - Mehmet Ali Ucar
- Department of Internal Medicine, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey
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10
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A case of adult-onset Still's disease complicated by thrombotic thrombocytopenic purpura with retinal microangiopathy and rapidly fatal cerebral edema. Mod Rheumatol 2012; 23:379-85. [PMID: 22623015 DOI: 10.1007/s10165-012-0650-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 03/29/2012] [Indexed: 10/28/2022]
Abstract
We present a patient who had adult-onset Still's disease (AOSD) complicated by thrombotic thrombocytopenic purpura (TTP) that resulted in retinal microangiopathy and rapidly fatal cerebral edema. The patient was a 37-year-old male who developed fever, eruption, arthritis and hepatic dysfunction, that, based on close examination, was diagnosed as AOSD. Despite treatment with corticosteroids, the patient developed acute visual field defect, neurological deterioration including convulsions and impaired consciousness, as well as acute renal failure that ultimately resulted in death. Pathological examination of autopsy specimens revealed multiple fibrin thrombi disseminated in small vessels of the brain and kidney, which was consistent with TTP, along with marked cerebral edema. Although TTP has rarely been reported in association with AOSD, awareness of the possible coexistence of these two diseases is important for diagnosis and treatment.
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11
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Khamashta MA, Ramos-Casals M. Complex Situations in Patients with Adult-Onset Still’s Disease. Autoimmune Dis 2011. [PMCID: PMC7122824 DOI: 10.1007/978-0-85729-358-9_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology, characterized by quotidian or double quotidian fever, a peri-febrile cutaneous eruption, polyarthritis, and multiorgan involvement. AOSD is a challenging disease with protean disease manifestations and rare, albeit potentially life-threatening, complications. In such cases, prompt diagnosis and treatment may prove life-saving. The purpose of this chapter is to review the diagnosis and management of challenging clinical situations in AOSD patients that are associated with significant morbidity and mortality and to provide the readers with information that could aid their decision-making process.
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Affiliation(s)
- Munther A. Khamashta
- Rayne Institute, Lupus Research Unit, St. Thomas' Hospital, London, SE1 7EH United Kingdom
| | - Manuel Ramos-Casals
- Barcelona, Surgey, Hospital Clinic, Calle Villarroel, 170, Barcelona, 08036 Spain
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12
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El Karoui K, Karras A, Lebrun G, Charles P, Arlet JB, Jacquot C, Orssaud C, Nochy D, Pouchot J. Thrombotic microangiopathy and purtscher-like retinopathy associated with adult-onset Still's disease: a role for glomerular vascular endothelial growth factor? ACTA ACUST UNITED AC 2010; 61:1609-13. [PMID: 19877102 DOI: 10.1002/art.24826] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Khalil El Karoui
- Faculté de Médecine Paris Descartes, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
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13
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Thrombotic microangiopathy in adult-onset Still's disease: case report and review of the literature. Wien Klin Wochenschr 2009; 121:583-8. [DOI: 10.1007/s00508-009-1217-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Accepted: 05/20/2009] [Indexed: 10/20/2022]
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14
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Akritidis N, Papadopoulos A, Pappas G. Long‐term follow‐up of patients with adult‐onset Still's disease. Scand J Rheumatol 2009; 35:395-7. [PMID: 17062441 DOI: 10.1080/03009740600709816] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the long-term outcome of patients with adult-onset Still's disease (AOSD). METHODS Eleven patients with AOSD who were regularly followed-up during the past 13 years, even after discontinuation of treatment, were evaluated for the long-term prognosis of the disease and its possible complications. RESULTS No exacerbation of the symptoms was noted during therapy. Only two of the 11 patients exhibited relapse of the systemic disease after discontinuation of treatment. Both patients had previously been on corticosteroids and responded well to reinitiation of therapy. Progressive deforming arthritis was not noted in any patient. Hepatic failure, central nervous system involvement, renal involvement or systematic amyloidosis did not complicate the course of any of the patients. CONCLUSIONS Long-term prognosis of AOSD may be benign in a significant subset of patients. Further studies should clarify characteristics of the subset of patients for whom disease-modifying therapy is warranted.
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Affiliation(s)
- N Akritidis
- Department of Internal Medicine, General Hospital G. Hatzikosta of Ioannina, Greece.
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15
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Thonhofer R, Soleiman A, Kriessmayr M, Thonhofer U, Wipfler E, Gaugg M, Eder S, Erlacher L. Decrease of proteinuria in a patient with adult‐onset Still's disease and glomerulonephritis after anti‐TNFα therapy. Scand J Rheumatol 2009; 35:485-8. [PMID: 17343260 DOI: 10.1080/03009740600844688] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We report the case of a 41-year-old man diagnosed with Still's disease. Multiple disease-modifying anti-rheumatic drug (DMARD) therapies failed to induce disease remission or to prevent progressive joint destruction. The man presented with active arthritis and classical Still's rash accompanied by fever. Anti-tumour necrosis factor-alpha (TNFalpha) therapy was planned but during the medical check-up prior to the biological therapy, renal insufficiency with marked proteinuria (PU) was discovered. With PU of 912 mg/24 h a renal biopsy was performed and a histopathological evaluation revealed the diagnosis of a residual mesangio-proliferative immunocomplex-based glomerulonephritis (GN). After excluding contraindications, infliximab therapy was initiated and a good response of the arthritis was documented after 6 weeks. A significant decrease in PU (279 mg/24 h) was noted after the third infliximab infusion. Because of an allergic reaction during the fifth dose, the infliximab was discontinued. During the time frame without anti-TNFalpha therapy, active joint disease reoccurred and the proteinuria increased significantly. Because of the active disease entanercept therapy was initiated. The arthritis diminished and the PU was reduced markedly within 4 weeks. In the follow-up period of 12 months a good response to therapy was sustained. As described by other investigators, the joint disease showed a rapid and sustained response to anti-TNFalpha therapy. The decrease in proteinuria during biological therapy was notable. It was concluded that the significant decrease in PU in this patient was achieved by eliminating the inflammatory activity of the underlying kidney disease.
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Affiliation(s)
- R Thonhofer
- Department of Internal Medicine, State Hospital Muerzzuschlag, Austria.
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16
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Sayarlioglu M, Sayarlioglu H, Ozkaya M, Balakan O, Ucar MA. Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome and adult onset Still's disease: case report and review of the literature. Mod Rheumatol 2008; 18:403-6. [PMID: 18427722 DOI: 10.1007/s10165-008-0061-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2007] [Accepted: 02/20/2008] [Indexed: 10/22/2022]
Abstract
Thrombotic thrombocytopenic purpura-hemolytic uremic syndrome (TTP/HUS) is a multisystem disorder characterized by consumptive thrombocytopenia, microangiopathic hemolytic anemia, neurologic symptoms, renal function abnormalities, and fever. Coexistence of TTP/HUS and adult onset Still's disease (ASD) is extremely rare. We report the case of a 46-year-old woman who presented with fever, arthritis, myalgias, petechia on skin and confusion five years after the onset of ASD. Thrombocytopenia, renal failure, marked elevation lactate dehydrogenase, and red cell fragmentation on peripheral blood smear were observed. We made a diagnosis of TTP/HUS associated with ASD, according to physical examination and characteristic laboratory data. She recovered from the TTP/HUS following daily sessions of therapeutic plasma exchange with fresh frozen plasma replacement and glucocorticoid therapy. Awareness of the possible development of TTP/HUS in ASD is important for early diagnosis and treatment.
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Affiliation(s)
- Mehmet Sayarlioglu
- Department of Internal Medicine, Division of Rheumatology, Sutcu Imam University Medical Faculty, Kahramanmaras, Turkey.
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