How do you approach management of Adult Onset Still's disease in a patient with ongoing fatigue and inflammatory joint pain despite methotrexate, colchicine, canakinumab and tocilizumab?  

There are several considerations for ongoing inflammatory symptoms despite trials of canakinumab and tocilizumab in a patient with presumed AOSD: If the patient has ongoing CRP elevation, a trial of anakinra might be considered if not previously used. The required daily dosing is not as convenien...

Do they actually have arthritis or just joint pain? What do their labs show? I have had AOSD and sJIA patients whose arthritis needs TNF or MTX but their systemic sx still needs IL-1 mediation. But for this patient, I think the important thing to consider is whether this is actually arthritis or som...

I would confirm the diagnosis of AOSD. In the absence of objective findings, fatigue and joint pain are not specific to AOSD or any other rheumatic disease. The diagnosis of AOSD is often given to people with joint pain and elevated inflammatory markers, or to people with fever and joint pain. Howe...