TY - JOUR
T1 - Management of adult-onset Still's disease
T2 - evidence- and consensus-based recommendations by experts
AU - Leavis, Helen L
AU - van Daele, Paul L A
AU - Mulders-Manders, Catharina
AU - Michels, Renée
AU - Rutgers, Abraham
AU - Legger, Elizabeth
AU - Bijl, Marc
AU - Hak, Elisabeth A
AU - Lam-Tse, Wai-Kwan
AU - Bonte-Mineur, Femke
AU - Fretter, Peter
AU - Simon, Anna
AU - van Paassen, Pieter
AU - van der Goes, Marlies
AU - Flendrie, Marcel
AU - Vercoutere, Ward
AU - van Lieshout, Antoine W T
AU - Leek, Arjen
AU - Vastert, Sebastiaan J
AU - Tas, Sander W
N1 - © The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.
PY - 2024/6
Y1 - 2024/6
N2 - BACKGROUND: Adult-onset Still's disease (AOSD) is a rare condition characterized by fevers, rash, and arthralgia/arthritis. Most doctors treating AOSD in the Netherlands treat <5 patients per year. Currently, there is no internationally accepted treatment guideline for AOSD.OBJECTIVES: To conduct a Delphi panel aimed at reaching consensus about diagnostic and treatment strategies for patients with AOSD and to use the outcomes as a basis for a treatment algorithm.METHODS: The Delphi panel brought together 18 AOSD experts: rheumatologists, internists and paediatricians. The Delphi process consisted of 3 rounds. In the first two rounds, online list of questions and statements were completed. In the third round, final statements were discussed during a virtual meeting and a final vote took place. Consensus threshold was set at 80%. Two targeted literature searches were performed identifying the level of evidence of the consensus-based statements.RESULTS: Consensus was reached on 29 statements, including statements related to diagnosis and diagnostic tests, definition of response and remission, the therapy, the use of methotrexate, and tapering of treatment. The panel consented on reduction of the use of glucocorticoids to avoid side-effect, and preferred the use of biologics over conventional treatment. The role of interleukin-1 and interleukin-6 blocking agents was considered important in the treatment of AOSD.CONCLUSIONS: In this Delphi panel, a high level of consensus was achieved on recommendations for diagnosis and therapy of AOSD that can serve as a basis for a treatment guideline.
AB - BACKGROUND: Adult-onset Still's disease (AOSD) is a rare condition characterized by fevers, rash, and arthralgia/arthritis. Most doctors treating AOSD in the Netherlands treat <5 patients per year. Currently, there is no internationally accepted treatment guideline for AOSD.OBJECTIVES: To conduct a Delphi panel aimed at reaching consensus about diagnostic and treatment strategies for patients with AOSD and to use the outcomes as a basis for a treatment algorithm.METHODS: The Delphi panel brought together 18 AOSD experts: rheumatologists, internists and paediatricians. The Delphi process consisted of 3 rounds. In the first two rounds, online list of questions and statements were completed. In the third round, final statements were discussed during a virtual meeting and a final vote took place. Consensus threshold was set at 80%. Two targeted literature searches were performed identifying the level of evidence of the consensus-based statements.RESULTS: Consensus was reached on 29 statements, including statements related to diagnosis and diagnostic tests, definition of response and remission, the therapy, the use of methotrexate, and tapering of treatment. The panel consented on reduction of the use of glucocorticoids to avoid side-effect, and preferred the use of biologics over conventional treatment. The role of interleukin-1 and interleukin-6 blocking agents was considered important in the treatment of AOSD.CONCLUSIONS: In this Delphi panel, a high level of consensus was achieved on recommendations for diagnosis and therapy of AOSD that can serve as a basis for a treatment guideline.
U2 - 10.1093/rheumatology/kead461
DO - 10.1093/rheumatology/kead461
M3 - Article
C2 - 37669122
SN - 1462-0324
VL - 63
SP - 1656
EP - 1663
JO - Rheumatology
JF - Rheumatology
IS - 6
ER -