Efficacy of tight control strategy in the treatment of adult-onset Still disease

Mahdavi, Aida Malek; Khalili, Afshin; Alihosseini, Samin; Jaberinezhad, Mehran; Esalatmanesh, Kamal; Hajialilo, Mehrzad; Seyedmardani, Seyedmostafa; Khabbazi, Alireza

doi:10.1007/s10067-021-05758-9

Cited by 2 publications

(5 citation statements)

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“…Our results resonate with a recent report that the presence of skin rash was associated with the monocyclic course of AOSD [ 30 ]. Besides, Mahdavi et al showed that a tight-control therapeutic strategy might contribute to a high rate of disease remission [ 31 ]. Viewing that there was no significant difference in the medication use or treatment strategies between the SDP-implemented and non-SDP-implemented groups, the increased remission rates in the SDP-implemented group would be related, at least partly, to the high proportion of “early diagnosis” in those patients.…”

Section: Discussionmentioning

confidence: 99%

“…The retrospective nature of our study did not allow for obtaining all the needed information from the enrolled patients. The lack of statistical significance in the multivariate regression analysis of SDP implementation for predicting disease remission could be due to the small sample size, a limitation inherent in the study of this rare disease [ 31 ]. Besides, the selection of discriminative markers and the cutoff levels of serum ferritin and IL-18 in our SDP design should be further validated, and the beneficial effect of SDP implementation shown in our study awaits further external validation.…”

Section: Discussionmentioning

confidence: 99%

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A Streamlined Diagnostic Process Improved the Outcomes of Patients with Adult-Onset Still’s Disease: A Single-Center Retrospective Observational Study

et al. 2022

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Introduction The diagnosis of adult-onset Still’s disease (AOSD) is often delayed due to its clinical heterogeneity and lack of pathognomic features. Hence, there is an unmet need for an efficient diagnostic process. The major aim of this study was to compare the differences in disease outcomes between two groups of AOSD patients with and without implementation of the streamlined diagnostic process (SDP). Methods Of 172 febrile patients with skin rash and/or arthralgia, 112 individuals had AOSD. The tentative diagnosis of AOSD or non-AOSD was made with or without the SDP implementation. The selection criteria for AOSD outcomes analysis were as follows: (1) age at study entry older than 20 years, (2) fulfillment of the Yamaguchi criteria for AOSD diagnosis, and (3) a follow-up period longer than 6 months after initiation of therapy. Three outcome parameters were evaluated, including diagnosis lag period, the proportion of “early diagnosis,” and the proportion of achieving disease remission after a 6-month therapy. Results The SDP was implemented for expediting AOSD diagnosis in 41 (36%) enrolled patients (SDP-implemented group). The diagnosis lag period was significantly shorter in the SDP-implemented group (median 2.0 weeks, interquartile range [IQR] 1.0–2.5 weeks) than in the non-SDP-implemented group (4.0 weeks, IQR 2.0–6.0 weeks, p < 0.001). A significantly higher proportion of “early diagnosis” was also found in the SDP-implemented group (75.6%) compared with the non-SDP-implemented group (33.8%, p < 0.001). We revealed a significantly higher proportion of achieving remission in the SDP-implemented group (85.4%) compared with the non-SDP-implemented group (67.6%, p < 0.05). Logistic regression analysis revealed SDP implementation as a potential predictor of achieving disease remission. Conclusions Implementing an SDP for expediting diagnosis could improve outcomes for AOSD patients. This diagnostic process increased the early diagnosis rate and led to a higher disease remission rate. However, the beneficial effects of SDP implementation need further external validation.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Streamlined Diagnostic Process Improved the Outcomes of Patients with Adult-Onset Still’s Disease: A Single-Center Retrospective Observational Study

et al. 2022

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“…The outcome of AOSD was assessed by acquiring remission on treatment, remission off treatment, time to remission, rate of flare and remission in the last visit. Remission on treatment was defined as the lack of systemic and articular disease activity, and prednisolone dose ≤5 mg/day for at least 6 months 15 . Use of other medications, including nonsteroidal anti‐inflammatory drugs (NSAIDs) and conventional and biological disease‐modifying antirheumatic drugs (DMARDs), was permitted.…”

Section: Methodsmentioning

confidence: 99%

“…Remission on treatment was defined as the lack of systemic and articular disease activity, and prednisolone dose ≤5 mg/day for at least 6 months. 15 Use of other medications, including nonsteroidal anti-inflammatory drugs (NSAIDs) and conventional and biological diseasemodifying antirheumatic drugs (DMARDs), was permitted. Remission off treatment was defined as the lack of systemic and articular disease activity for ≥6 months as well as the discontinuation of all medications, including prednisolone, NSAIDs and conventional and biological DMARDs.…”

Section: Data Collectionmentioning

confidence: 99%

“…Remission off treatment was defined as the lack of systemic and articular disease activity for ≥6 months as well as the discontinuation of all medications, including prednisolone, NSAIDs and conventional and biological DMARDs. 15 The smoking status of participants was defined by direct or phone interviews. Individuals who had smoked daily for at least 6 months were defined as smokers.…”

Section: Data Collectionmentioning

confidence: 99%

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Cigarette smoking and risk of adult‐onset Still disease: a propensity score matching analysis

Rahmanpour

Mahdavi

Mahmoudi

et al. 2023

Internal Medicine Journal

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BackgroundEnvironmental factors play an important role in the pathogenesis of rheumatic diseases. Smoking is thought to be a risk factor for autoimmune rheumatic diseases.AimsThe purpose of the present study was to assess the association between smoking and adult‐onset Still disease (AOSD) and the effect of smoking on outcomes of this disease.MethodsIn this case‐control study, patients with AOSD who met the Yamaguchi criteria, were older than 16 years at the disease onset and were in follow‐up for at least 12 months were consecutively enrolled in the study. The outcome of AOSD was assessed by acquiring remission on treatment, remission off treatment, time to remission and rate of flare. The smoking status of participants was defined by direct or phone interviews. Individuals who had smoked daily for at least 6 months were defined as a smoker. We performed propensity score matching analyses by using four parameters, including age, sex, educational status and marital status.ResultsPropensity score matching resulted in 72 patients with AOSD and 216 matched controls. The number of ever smokers in the AOSD and control groups were 11 (15.3%) and 25 (11.6%) respectively. There was no significant increase in the risk of AOSD in multivariate analysis after adjustment for age, sex, marital status and educational level. There were no significant differences in the outcomes of AOSD between ever and never smokers.ConclusionsSmoking probably is not a risk factor for AOSD and did not affect the response to treatment.

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Efficacy of tight control strategy in the treatment of adult-onset Still disease

Cited by 2 publications

References 13 publications

A Streamlined Diagnostic Process Improved the Outcomes of Patients with Adult-Onset Still’s Disease: A Single-Center Retrospective Observational Study

A Streamlined Diagnostic Process Improved the Outcomes of Patients with Adult-Onset Still’s Disease: A Single-Center Retrospective Observational Study

Cigarette smoking and risk of adult‐onset Still disease: a propensity score matching analysis

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