Predictive Factors for Relapse in Still's Disease: A Retrospective Cohort Study of Clinical and Laboratory Biomarkers

This retrospective cohort study aimed to identify clinical and laboratory predictors of relapse in patients with Still's disease. A total of 94 patients diagnosed by Yamaguchi or Fautrel criteria across two rheumatology centers between 2012 and 2024 were evaluated, of whom 87 were eligible for analysis. Thirty-one patients (35%) experienced relapses during follow-up. Relapse was associated with higher baseline C-reactive protein (CRP > 100 mg/L), elevated neutrophil counts, and lower albumin levels. Composite ratios such as ferritin/albumin, CRP/albumin, and neutrophil/albumin were also significantly higher in the relapse group. Clinically, a joint-dominant disease phenotype and initial use of conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) were more common among patients who relapsed. In multivariate logistic regression, high CRP levels, joint-dominant phenotype, and csDMARD use emerged as independent predictors of relapse. These findings highlight the predictive value of widely available biomarkers and baseline clinical presentation in stratifying relapse risk in Still Disease. Early recognition of high-risk patients using these factors may guide more targeted treatment approaches, support earlier initiation of biologic therapies, and ultimately improve long-term disease outcomes.