AUTHOR=Tang Dabin , Jiang Yubao , Zhang Yanying , Xie Jingjing , Zhang Jianyong 

TITLE=Successful management of Still’s disease with severe liver injury through the administration of baricitinib: a case report

JOURNAL=Frontiers in Medicine

VOLUME=Volume 12 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2025.1591431

DOI=10.3389/fmed.2025.1591431

ISSN=2296-858X

ABSTRACT=Still’s disease (SD) is a rare systemic autoinflammatory disorder of unknown etiology, clinically characterized by a triad of high-spiking fevers, an evanescent salmon-colored rash, and arthritis. The disease exhibits considerable heterogeneity, ranging from mild manifestations to severe, life-threatening complications such as macrophage activation syndrome (MAS). Management strategies are tailored according to disease severity, with glucocorticoids remaining the mainstay of treatment for moderate to severe cases. However, a subset of patients becomes glucocorticoid-dependent or refractory, necessitating the use of steroid-sparing immunosuppressive agents. Recent advancements in biologic therapies have significantly improved disease outcomes and are increasingly adopted as first-line therapies. The Janus kinase-signal transducer and activator of transcription (JAK–STAT) signaling pathway, known to be activated in various autoimmune and inflammatory conditions, has emerged as a promising therapeutic target. Herein, we present a case of SD complicated by severe liver injury, which was successfully managed with baricitinib following the failure of conventional synthetic disease-modifying antirheumatic drugs.