Inhibiting inflammatory cytokines in adult onset Still’s disease. Current trends and new therapeutic perspectives

ABSTRACT Introduction: Multiple lines of evidence suggest the clinical usefulness of inhibiting inflammatory cytokines in patients affected by adult onset Still’s disease (AOSD), a rare inflammatory disease. The lack of response to the first therapeutic strategy with glucocorticoids and synthetic disease-modifying anti-rheumatic drugs (DMARDs) identifies ‘refractory patients’, to be subsequently treated with biologic DMARDs. Areas covered: In this article, evidence has been reviewed about the clinical usefulness of biologic DMARDs, targeting inflammatory cytokines, in AOSD, analyzing current trends and suggesting future therapeutic perspectives. Expert opinion: Therapeutic management of AOSD is directed at targeting inflammatory signs and symptoms, preventing life-threating complications, and minimizing the adverse effects of immunosuppressive therapies. In this context, over the last decade, the clinical usefulness of inhibiting inflammatory cytokines has shown in AOSD with multiple benefits, since a large percentage of patients attain a clinical response. The inhibition of inflammatory cytokines could also be helpful in managing life-threating complications of AOSD. Going forward, this field of research is rapidly growing, and in the next future, the results about ongoing randomized controlled trials and the development of clinical tools readily transferable in clinical practice, would improve the management of AOSD providing more targeted treatment and improving the outcomes of these patients.