Anti-inflammatory drugs for adult-onset Still disease

For mild symptoms (eg mild arthralgias, myalgias, arthritis, or fever), a nonsteroidal anti-inflammatory drug (NSAID) may be used for its anti-inflammatory, analgesic and antipyretic effects. All of the NSAIDs listed below are equally effective, and drug choice should be based on patient factors (eg comorbidities); see Choosing an NSAID for advice on drug choice. If an NSAID is indicated for mild symptoms in adult-onset Still disease, use:

1celecoxib 100 to 200 mg orally, daily in 1 or 2 divided doses, until symptoms subside celecoxib celecoxib celecoxib

OR

1etoricoxib 30 to 60 mg orally, daily until symptoms subside etoricoxib etoricoxib etoricoxib

OR

1ibuprofen immediate-release 200 to 400 mg orally, 3 or 4 times daily until symptoms subside ibuprofen ibuprofen ibuprofen

OR

1indometacin 25 to 50 mg orally, 2 to 4 times daily until symptoms subside indometacin indometacin indometacin

OR

1ketoprofen modified-release 200 mg orally, daily until symptoms subside ketoprofen ketoprofen ketoprofen

OR

1meloxicam 7.5 to 15 mg orally, daily until symptoms subside meloxicam meloxicam meloxicam

OR

1naproxen immediate-release 250 to 500 mg orally, twice daily until symptoms subside naproxen naproxen naproxen

OR

1naproxen modified-release 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen

OR

1piroxicam 10 to 20 mg orally, daily until symptoms subside piroxicam piroxicam piroxicam

OR

2diclofenac 25 to 50 mg orally, 2 or 3 times daily until symptoms subside. diclofenac diclofenac diclofenac

The potential benefits of an NSAID should be weighed against its potential harms, particularly in people at high risk of harms (see Principles of NSAID use for musculoskeletal pain for more information).

Response to an NSAID is often inadequate, and a systemic corticosteroid may be required instead; response to systemic corticosteroids is usually rapid. People are usually only prescribed oral corticosteroids when the diagnosis of adult-onset Still disease has been confirmed by a specialist. Do not combine oral corticosteroids with NSAIDs because of the potential for gastrointestinal adverse effects.

Note: Do not combine oral corticosteroids with NSAIDs because of the potential for gastrointestinal adverse effects.

If oral corticosteroids are required to treat symptoms of adult-onset Still disease that are not relieved by an NSAID, under specialist supervision, use:

prednisolone (or prednisone) 10 to 25 mg orally, daily. prednis ol one prednis(ol)one prednis(ol)one

See Principles of immunomodulatory drug use for information on adverse effects associated with long-term corticosteroid use (such as bone density loss) and advice on how to minimise and monitor for such complications.

Once symptoms are controlled, slowly reduce the dosage of oral corticosteroid while carefully monitoring disease activity. Some people may require long-term oral corticosteroid therapy; however, the course of adult-onset Still disease is highly variable. People who require ongoing, or high doses of, oral corticosteroids to maintain disease remission should be referred back to a specialist for review, because treatment with another immunomodulatory drug may be required.