Still's disease: bridging the gap between guidelines and clinical practice

The recently published EULAR/PReS recommendations on Still's disease provide a comprehensive framework for disease classification and management, yet certain aspects warrant further refinement. Defining systemic juvenile idiopathic arthritis (sJIA) as Still's disease underscores the need for updated classification criteria. The routine use of transthoracic echocardiography or thoracic ultrasonography at diagnosis could help detect serosal involvement, aiding in the early identification of interstitial lung disease and cardiac complications. Refining cytopenia definitions by incorporating declining trend of platelet counts despite being within normal ranges may facilitate earlier detection of macrophage activation syndrome (MAS). Additionally, specifying therapeutic target trough levels for cyclosporine A (CsA) in international guidelines would enhance treatment precision. Integrating these insights could improve diagnostic accuracy, facilitate timely interventions, and optimize patient outcomes in Still's disease.