# Advancing Precision Medicine in Adult-Onset Still’s Disease: Insights into Biomarkers, Therapies, and COVID-19 Impacts

## TL;DR

This paper reviews biomarkers and therapies for adult-onset Still’s disease, a rare inflammatory condition, and discusses challenges in diagnosis and treatment, especially during the COVID-19 pandemic.

## Contribution

The paper introduces novel biomarkers like gasdermin D and emerging therapies such as IL-18 binding protein for precision medicine in AOSD.

## Key findings

- Biologic therapies achieve remission in 80–90% of systemic AOSD cases.
- SARS-CoV-2 infection and vaccination can trigger AOSD flares, requiring adaptive management.
- Gasdermin D is proposed as a novel biomarker for AOSD.

## Abstract

Adult-onset Still’s disease (AOSD) is a rare autoinflammatory disorder characterized by spiking fevers, arthralgia, and a transient salmon-pink rash, with an incidence of 0.16–0.4 per 100,000. AOSD shares overlapping clinical and immunological features with systemic juvenile idiopathic arthritis (sJIA), supporting a disease continuum and shared treatment approaches. The COVID-19 pandemic has impacted AOSD care, with SARS-CoV-2 infection and vaccination occasionally triggering disease flares, necessitating adaptive management strategies. Driven by innate immune dysregulation and overproduction of proinflammatory cytokines (IL-1, IL-6, IL-18), AOSD presents in systemic and articular phenotypes, with severe complications like macrophage activation syndrome (MAS), fulminant hepatitis, and parenchymal lung disease. Diagnosis, based on Yamaguchi or Fautrel criteria and biomarkers (ferritin, IL-18), is challenging due to nonspecific symptoms. Biologic therapies (anakinra, canakinumab, tocilizumab) achieve remission in 80–90% of systemic cases. This review synthesises diagnostic challenges, novel biomarkers (e.g., gasdermin D), and emerging therapies (e.g., IL-18 binding protein), emphasising precision medicine and future research needs.