Experience Of Colchicine Administration in Refractory Still’s Disease

Still’s disease (SD) is a rare chronic autoinflammatory disease manifested by the development of high peak fever, joint involvement (arthralgias and arthritis), and the appearance of a salmon-colored maculopapular rash. The 2024 EULAR guidelines unified the diagnostic criteria for Still’s disease including fever ≥39°C (102.2°F), recurrent erythematous rash, musculoskeletal involvement, neutrophilic leukocytosis, and elevated CRP and ferritin. If S100 or interleukin (IL)18 levels can be determined, their elevated values will point in favor of SD. Also, treatment strategy have been modified with the administration of biologics of IL-1 or IL-6 inhibitors if glucocorticoids (GCs) are ineffective, and the use of methotrexate (MTX) is considered if biologic therapy cannot be initiated.This case report focuses on the situation of timely diagnosis of SD and resistance to standard therapy with GCs (including pulse therapy) and MTX. Due to insufficient availability of biologics, based on the existing experience of colchicine prescription in SD in the scientific literature, the patient’s therapy was modified with the addition of colchicine at a dose of 1 mg orally per day, after the administration of which regression of clinical manifestations and normalization of acute-phase markers were noted.This clinical experience demonstrates the feasibility of colchicine administration as an alternative to biologics to reduce disease activity if SD is refractory to GC and MTX therapy.