Adult-onset Still disease biologic therapy — SCE Rheumatology MCQ

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HardPregnancy in Rheumatic Disease, Rare ConditionsAdult-onset Still disease biologic therapySCE Rheumatology

A 39-year-old woman with adult-onset Still disease has persistent quotidian fevers, arthritis and ferritin 12,000 microgram/L despite high-dose glucocorticoids and methotrexate. Infection and malignancy have been excluded. Liver tests are stable. What is the most appropriate biologic?

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Correct answer: A — Anakinra

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

Anakinra is best because IL-1 blockade with anakinra is an appropriate biologic strategy for refractory systemic Still disease. A is less suitable because rituximab is not a standard Still disease biologic; B is less suitable because adalimumab is less targeted for systemic Still disease than IL-1/IL-6 blockade; C is less suitable because denosumab treats osteoporosis; E is less suitable because belimumab treats SLE. Clinical pearl: Still disease biology is strongly IL-1 and IL-6 driven, especially in systemic phenotypes.

Reference: EULAR Still disease recommendations; BNF