#3-88E. Decoding Still's Disease: The Interplay of HO-1, IL-18, and Type I IFN (Arthritis Rheumatol, 2026)

Do you frequently face diagnostic dilemmas when evaluating patients with unexplained fevers and non-specific inflammatory symptoms? This episode explores a recent multi-omics study analyzing 372 patients with systemic autoinflammatory diseases12. The researchers discovered that elevated blood levels of heme oxygenase-1 (HO-1) and IL-18, combined with the activation of type I interferon (IFN) signaling in monocytes, strongly characterize Still's disease. The most pivotal finding is that the complex interplay among hemophagocytosis, IL-18, and type I IFN can serve as a highly specific diagnostic marker independent of general inflammatory markers like CRP. However, when critically appraising this paper, it is crucial to note that the study cohort did not include patients complicated with macrophage activation syndrome (MAS), meaning further validation is required before applying these markers for predicting severe disease progression. For practicing physicians, this research is highly relevant as it offers promising new mechanistic biomarkers that could directly facilitate the early and accurate diagnosis of Still's disease, ultimately guiding more timely and targeted therapeutic interventions.

Citation: Mueller YM, Katsikis PD, et al. A multifaceted interplay between hemophagocytosis, IL-18 and type I IFN distinguishes Still disease from other autoinflammatory diseases. Arthritis & Rheumatology. 2026. DOI: 10.1002/art.70102

Disclaimer: This audio summary is based on personal interpretation and does not guarantee the exact content of the original paper. Please refer to the original article for details.