Still’s disease is a rare auto inflammatory disease which can affect adults (adult onset Still’s disease) or children (systemic idiopathic juvenile arthritis). The symptoms of Still’s disease can develop quickly or over time and include a daily fever which usually peaks in the late afternoon/early evening, joint pain and swelling and a pink rash. The cause of Still’s disease is unknown although it is thought that abnormalities in a particular part of the immune system causes episodes of inflammation to occur in the body. Still’s disease is usually treated first with non-steroidal anti-inflammatory drugs (NSAIDs) or steroids, however in some people, these drugs will fail to control and treat the disease. In these cases, different drugs are needed to treat the disease.
Anakinra is a drug which blocks a particular inflammatory protein which causes inflammation and is thought to play a role in the activity of Still’s disease. Anakinra is administered by injection under the skin (subcutaneously) and can be used in new onset patients or those with continued disease activity. As of February 2018, anakinra has been licenced for the treatment of adults, adolescents, children and infants aged 8 months and older patients with Still’s disease who have not responded to treatment with NSAIDs or steroids, and therefore require further treatment to control their disease.
Tizanidine as an intranasal spray is being developed as a new treatment option for patients with acute low back pain. It works by blocking pain sensations that are sent to the brain, temporarily relaxing muscle tone. Tizanidine is already available in the tablet form as a short-acting muscle relaxer used to relieve the stiffness and restriction of muscles due to injuries or diseases of the spinal cord. If licensed, tizanidine prepared for intranasal administration will offer an alternative to the oral administration for patients with acute low back pain when short term dosing and a fast effect is desired.