Reported Clinical Practice in Still Disease in France in 2024: A Descriptive Analysis and Comparison With Current Different National Guidelines

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Abstract
Objectives: Still disease, which includes systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still disease (AOSD), has historically had age-related treatment differences. With the advent of bDMARDs and evolving disease knowledge, management approaches have shifted. Our study aims to describe 2024 reported clinical practices for Still disease in France, and compare them with 2017 and 2024 national guidelines to identify practice gaps. Methods: This study is a French subanalysis of the European JIR-CliPS project, which evaluates reported prescribing practices for inflammatory diseases, taking into account recommendations and socio-economic factors in the participating countries. A detailed questionnaire was distributed to French physicians through professional societies and colleges. Results: Forty-seven physicians, mainly pediatric rheumatologists, internists, and rheumatologists, participated. While national guidelines influenced therapeutic decisions in most cases, only 26.7% followed them strictly, and 78.9% perceived no significant differences in the management of sJIA and AOSD. Treatment decisions were primarily guided by disease phenotype, severity, and relapse status. The use of bDMARDs as first-line treatment remained limited for several phenotypes, and glucocorticoid tapering strategies were heterogeneous, with most physicians adjusting tapering based on clinical response rather than following a standard schedule. Conclusion: This study highlights gaps between 2024 practice and current national guidelines for Still disease, particularly in first-line bDMARD use and glucocorticoid tapering. Understanding these gaps may support standardized practice and improved management of Still disease in the future.

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