#4-65E. Unmasking Chronicity: IL-18 as a Prognostic Biomarker in Still Disease (Arthritis Rheumatol, 2026)

Predicting which patients with Still disease will develop a refractory, chronic-persistent course remains a significant clinical challenge in rheumatology. This retrospective study evaluated 66 biologic-naive patients treated with first-line interleukin-1 inhibitors to determine the prognostic utility of longitudinal circulating IL-18 levels. The most pivotal finding demonstrates that an elevated IL-18 level greater than 15,000 pg/mL at three months post-treatment initiation powerfully predicts a chronic-persistent disease trajectory, independent of whether the patient shows clinical disease activity. While this provides a compelling early marker for disease severity, the results must be critically appraised; the study's retrospective, single-center design and relatively small cohort size of 66 patients necessitate cautious interpretation and further multicenter validation to rule out potential selection bias. For clinicians, these insights are highly actionable, suggesting that dynamic monitoring of IL-18 could crucially aid in early risk stratification, empowering physicians to proactively escalate or adjust therapies for high-risk patients at the three-month mark, even if their systemic symptoms currently appear controlled.

Citation: Trevisan M, De Benedetti F, et al. Interleukin-18 Levels Are Associated With Disease Course in Patients With Still Disease Treated With Interleukin-1 Inhibitors. Arthritis & Rheumatology. 2026. DOI: 10.1002/art.70024

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