Medication
Medication – Your Doctor’s Toolkit
As we have already seen, there is no medically acknowledged cure for Adult Onset Still’s Disease. With that said, there is a widely recognised protocol used by medical doctors to manage the symptoms of AOSD.
Generally speaking, medication is used to either suppress the body’s inflammatory response or to slow down the progression of the illness. The drugs used to treat Adult Onset Still’s Disease are fairly heavy-duty. As such, it is very important that you fully understand the medication that you have been prescribed.
NSAIDs – The Front Line in Treatment
Non-steroidal anti inflammatory medication – or NSAIDs – is the front line in managing the symptoms of Adult Onset Still’s Disease. NSAIDs are found most commonly in over-the-counter medications such as Neurofen, Advil and aspirin.
In most cases, your doctor will give you a prescription strength NSAID that will be more effective in reducing inflammation than your over-the-counter alternatives. The most commonly prescribed NSAIDs for Still’s Disease sufferers are the drugs Naprosyn, Naproxyn and Brufen.
These drugs work by restricting the body’s production of pro-inflammatory agents called eicasinoids. Although the specific way that these drugs work is a little out of the scope of this website, you will typically expect modest pain relief using NSAIDs.
These drugs can be used both as a reactionary medicine – taken after the joint inflammation appears – or as a preventative medicine taken at the same time daily.
While NSAIDs have the most tolerable side-effects of any of the medications commonly prescribed for Adult Onset Still’s Disease, it is not to say that they do not have their dangers. The most common complaint of NSAID users are gastro-intestinal problems. NSAIDs do not only target the processes that trigger inflammation, they also decrease the body’s ability to produce the protective lining of the stomach. Ulcers, gastric bleeding, nausea and diarrhoea are all side effects of NSAID use.
If you do suffer nausea or stomach upsets while using NSAIDs, your doctor may prescribe you a new class of anti-inflammatory drugs called COX-2 inhibitors. These drugs have a similar effect to other NSAIDs, but are gentler on the stomach due to their more targeted application to the body’s inflammatory agents. This class of drug is considerably more expensive than other NSAIDs.
The most important thing, however, is that you understand your medication. This includes the effects, risks and contraindications of any medication that is prescribed to you. If you are not sure, ask your doctor.
Steroids – Relief at a Price
The most effective medication that your doctor will have in their tool kit for treating Adult Onset Still’s Disease is undoubtedly corticosteroids.
These types of steroids differ from the infamous anabolic steroids that are used to increase muscle mass.
Corticosteroid (sometimes referred to as glucosteroids) mimic the function of the adrenal gland’s production of hormones that have a profound effect on the body’s inflammatory response. Synthetic corticosteroids such as prednisone and prednisolone are used for a variety of applications from asthma to migraines. They are particularly effective in the treatment of auto-immune diseases.
People that are crippled in the acute phase of Adult Onset Still’s Disease are often amazed to see their symptoms be “switched off” after only a few days of taking corticosteroids. The dramatic results come with a dark side, however.
Even short term use of corticosteroids can lead to a slew of side effects including weight gain, depression, acne, osteoporosis and an increased risk of infection. Long term use increases the risk of more serious side effects such as Cushing’s syndrome, tumours, changes in mood and personality and eye degeneration.
Corticosteroids cause physical dependency within only a few days of commencing treatment. As such, it is vitally important that you do not stop taking your dose without explicit instruction from your doctor. Even missing one dose can lead to a crash of your adrenal system… this is not an experience that you should ever want to go through!
When it is time to stop taking corticosteroids, this must be done very slowly. For example, weening off a relatively small dose of 10mg per day may take as long as a year to accomplish.
If your doctor prescribes you corticosteroids, it is very important to discuss their long term medication plan for treating your condition. During the initial onset of the illness, a maximum dose of 60mg of oral corticosteroids may be prescribed to you. With that said, steroids need to be used as sparingly as possible – and if possible – avoided as part of a long term treatment plan.
Corticosteroids may seem like miracle drugs, but above all else, they need to be respected.
DMARDs – Preventing Long Term Damage
Disease modifying anti-rheumatic drugs (DMARDs) are a group of drugs that slow down the progression of Adult Onset Still’s Disease and other rheumatic illnesses, particularly joint damage. There are over a dozen drugs that fit into the DMARD category, but we’ll take a look at the some of the most commonly prescribed DMARDs used in the treatment of Adult Onset Still’s Disease in more detail.
Sulfasalazyne
Going by the brand names of Azulfidine and Salazopyrin, Sulfasalazyne is a sulphur based medication that is often used as the DMARD of choice by rheumatologists due to its relatively minor side effects. Sulfasalzyne seems to work by reducing inflammatory mediators in the body.
Due to the fact that this drug increases the body’s toxicity, nausea is the most common side effect with Sulfasalazyne use. The drug can also cause headaches, mouth sores and diarrhoea. These side effects are normally controlled by adjusting the dosage. In rare cases, Sulfasalazyne can cause fever and an intense itching rash. These symptoms disappear once the medication is stopped.
Methotrexate (MTX)
Methotrexate is the next most commonly prescribed DMARD in the treatment of Adult Onset Still’s Disease.
Methotrexate is a slow acting, but effective medication that is taken only once a week by the patient. While Methotrexate does not have major side effects (although nausea is not uncommon), it is important that it is not used in conjunction with sulfa-antibiotics, and alcohol should be avoided while on Methotrexate.
This short video by Dr. Andy Thompson at www.rheuminfo.com further introduces Methotrexate as a DMARD:
Anti-Malarial Medication
Anti malarial drugs such as chloroquine and hydroxychloroquine are also used in the treatment of rheumatic conditions. While they have a mild immunosuppressant function on their own, they are often used to increase the effectiveness of Methotrexate.
The biggest benefit of combining chloroquine (most commonly prescribed under the brand name Plaquenil) with other DMARDs is that they are steroid sparing – allowing you to reduce the dosage of the more powerful – but more dangerous – corticosteroids.
The typical side effects of Plaquenil and other chloroquine brands are dizziness, headaches and rashes. In rare cases, damage to the eye can lead to loss of vision. As such, your doctor will ask you to undergo regular eye checks to ensure that there is no macular degeneration present.
TNF- Inhibitors
There are a set of new drugs on the DMARD scene that are proving to be very effective in the fight against Adult Onset Still’s Disease, known as Tumor Necrosis Factor alpha (TNF alpha) Inhibitors.
These drugs are very effective in significantly reducing the body’s inflammatory response to Still’s Disease.
TNF Inhibitors are currently available in the US under the brand names of Humira, Remicade and Enbrel and are administered by a weekly injection. These drugs are very expensive; in fact, typical retail prices of these drugs are around $18,000 per year.
Before prescribing you a TNF inhibitor, your doctor will conduct a series of blood tests to make sure that you do not carry Lupus, Tuberculosis or other infections.
Minocycline
Another type of therapy that is gaining momentum, but still remains controversial is Minocycline therapy. Minocycline is an antibiotic that is used commonly for acne and mild skin infections, however it also exhibits some immunosuppressant properties by inhibiting the cell death that leads to inflammation.
Rheumatologists are in debate of the virtues of Minocycline treatment, and to date no serious controlled experiments have been conducted. Should this treatment be accepted into the mainstream medical protocol of treating Adult Onset Still’s Disease, it could prove beneficial for patients to avoid the dangerous side effects of taking corticosteroids and the more heavy-duty DMARDs.
Although medication is an important and usually necessary part of your Adult Onset Still’s Disease management plan, it should not be your only consideration.
The next part of this website looks at alternative therapies that have been scientifically proven to assist in the management of illnesses like Adult Onset Still’s Disease. [...next]
What is the long term prognosis of Still’s Disease?
How is Still’s Disease diagnosed?
What are the best supplements to take?
What alternative therapies are beneficial?
