{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T17:23:31Z","timestamp":1787505811718,"version":"build-2736575974"},"reference-count":24,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Still\u2019s 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\u2013STAT) 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.<\/jats:p>","DOI":"10.3389\/fmed.2025.1591431","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T05:30:48Z","timestamp":1753680648000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Successful management of Still\u2019s disease with severe liver injury through the administration of baricitinib: a case report"],"prefix":"10.3389","volume":"12","author":[{"given":"Dabin","family":"Tang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yubao","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanying","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingjing","family":"Xie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jianyong","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1748","DOI":"10.1136\/ard-2024-225853","article-title":"Systemic juvenile idiopathic arthritis and adult-onset Still's disease are the same disease: evidence from systematic reviews and Meta-analyses informing the 2023 EULAR\/PReS recommendations for the diagnosis and management of Still's disease","volume":"83","author":"De Matteis","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1136\/ard-2024-225851","article-title":"EULAR\/PReS recommendations for the diagnosis and Management of Still's disease, comprising systemic juvenile idiopathic arthritis and adult-onset Still's disease","volume":"83","author":"Fautrel","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"116","DOI":"10.1038\/s41584-023-01065-6","article-title":"Recent advances and evolving concepts in Still's disease","volume":"20","author":"Ruscitti","year":"2024","journal-title":"Nat Rev Rheumatol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1038\/s41584-018-0081-x","article-title":"Mechanisms, biomarkers and targets for adult-onset Still's disease","volume":"14","author":"Feist","year":"2018","journal-title":"Nat Rev Rheumatol"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1038\/ncprheum0681","article-title":"Primer: inflammasomes and interleukin-1 beta in inflammatory disorders","volume":"4","author":"Church","year":"2008","journal-title":"Nat Clin Pract Rheumatol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1002\/art.38398","article-title":"Efficacy of tocilizumab in conventional treatment-refractory adult-onset Still's disease: multicenter retrospective open-label study of thirty-four patients","volume":"66","author":"Ortiz-Sanju\u00e1n","year":"2014","journal-title":"Arthritis Rheumatol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"776","DOI":"10.1093\/rheumatology\/keq397","article-title":"Markedly increased IL-18 liver expression in adult-onset Still's disease-related hepatitis","volume":"50","author":"Priori","year":"2011","journal-title":"Rheumatology (Oxford)"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"iii55","DOI":"10.1136\/ard.60.90003.iii55","article-title":"Successful treatment of a small cohort of patients with adult onset of Still's disease with infliximab: first experiences","volume":"60","author":"Kraetsch","year":"2001","journal-title":"Ann Rheum Dis"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"6804","DOI":"10.1038\/s41467-022-34560-7","article-title":"Ferritin triggers neutrophil extracellular trap-mediated cytokine storm through MSR 1 contributing to adult-onset Still's disease pathogenesis","volume":"13","author":"Jia","year":"2022","journal-title":"Nat Commun"},{"key":"ref10","first-page":"S765","article-title":"Safety and efficacy of Il-1 trap in resistant adult onset Still\u2019s disease: 24 month follow-up of open label treatment and biomarkers of response","volume":"62","author":"Henderson","year":"2010","journal-title":"Arthritis Rheum"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1243","DOI":"10.1056\/NEJMoa1507247","article-title":"Baricitinib in patients with refractory rheumatoid arthritis","volume":"374","author":"Genovese","year":"2016","journal-title":"N Engl J Med"},{"key":"ref12","first-page":"424","article-title":"Preliminary criteria for classification of adult Still\u2019s disease","volume":"19","author":"Yamaguchi","year":"1992","journal-title":"J Rheumatol"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1016\/0014-5793(93)80403-h","article-title":"Differential inhibition by cyclosporins of primary-active ATP-dependent transporters in the hepatocyte canalicular membrane","volume":"333","author":"Bohme","year":"1993","journal-title":"FEBS Lett"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"284","DOI":"10.1097\/RHU.0b013e3181b57199","article-title":"Liver abnormalities in adult onset Still's disease: a retrospective study of 77 Chinese patients","volume":"15","author":"Zhu","year":"2009","journal-title":"J Clin Rheumatol"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1056\/NEJMra1816149","article-title":"Drug-induced liver injury-types and phenotypes","volume":"381","author":"Hoofnagle","year":"2019","journal-title":"N Engl J Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"820724","DOI":"10.3389\/fphar.2022.820724","article-title":"Role of corticosteroids in drug-induced liver injury. A systematic review","volume":"13","author":"Bjornsson","year":"2022","journal-title":"Front Pharmacol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1177\/2050640619840147","article-title":"Liver injury after methylprednisolone pulses: a disputable cause of hepatotoxicity. A case series and literature review. United European","volume":"7","author":"Zoubek","year":"2019","journal-title":"Gastroenterol J"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1007\/s12328-022-01661-1","article-title":"A case of drug-induced acute liver failure caused by corticosteroids","volume":"15","author":"Kajiwara","year":"2022","journal-title":"Clin J Gastroenterol"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1209","DOI":"10.1001\/archderm.1989.01670210047006","article-title":"Detection of hepatotoxicity associated with methotrexate therapy for psoriasis","volume":"125","author":"O'Connor","year":"1989","journal-title":"Arch Dermatol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1218","DOI":"10.1001\/archderm.1989.01670210056007","article-title":"The role of liver biopsies in psoriatic patients receiving long-term methotrexate treatment. Improvement in liver abnormalities after cessation of treatment","volume":"125","author":"Newman","year":"1989","journal-title":"Arch Dermatol"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1507","DOI":"10.1016\/0016-5085(93)90363-h","article-title":"Inhibition by cyclosporin a of adenosine triphosphate-dependent transport from the hepatocyte into bile","volume":"104","author":"Kadmon","year":"1993","journal-title":"Gastroenterology"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1731","DOI":"10.1136\/ard-2024-225854","article-title":"Efficacy and safety of therapies for still\u2019s disease and macrophage activation syndrome (Mas): a systematic review informing the eular\/pres guidelines for the management of still\u2019s disease","volume":"83","author":"Bindoli","year":"2024","journal-title":"Ann Rheum Dis"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1093\/rheumatology\/key414","article-title":"Treatment of refractory adult onset Still's disease with combination Anakinra and Baricitinib therapy","volume":"58","author":"Ladhari","year":"2019","journal-title":"Rheumatology (Oxford)"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1594","DOI":"10.1093\/rheumatology\/keac440","article-title":"Jak inhibitors in difficult-to-treat adult-onset Still's disease and systemic-onset juvenile idiopathic arthritis","volume":"62","author":"Gillard","year":"2023","journal-title":"Rheumatology (Oxford)"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1591431\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T05:30:49Z","timestamp":1753680649000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1591431\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,28]]},"references-count":24,"alternative-id":["10.3389\/fmed.2025.1591431"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1591431","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,28]]},"article-number":"1591431"}}