Background: Adult Still’s disease (ASD) is a systemic autoinflammatory disease, in which danger-associated molecular patterns (DAMPs)-mediated inflammasome activation seems to be involved in the disease pathogenesis. Cold inducible RNA-binding protein (CIRP) belongs to a family of cold-shock proteins that respond to cellular stress and has been identified as a DAMP that triggers the inflammatory response. The aim of this study is to investigate the clinical significance of serum CIRP levels in ASD.Methods: Serum samples were obtained from 42 patients with active ASD or 50 patients with rheumatoid arthritis (RA) and 15 healthy control patients (HCs). Serum levels of CIRP and IL-18 were determined using enzyme-linked immunosorbent assay and compared with 42 patients with ASD or 50 patients with RA and 15 HCs. Results were also analyzed according to the clinical features of ASD.Results: Serum CIRP levels were significantly higher in patients with ASD compared with patients with RA (median: 9.6 ng/mL, IQR [5.7–14.4] versus 3.2 ng/mL, IQR [1.9–3.8]; p < 0.001) and with HCs (2.8 ng/mL, [IQR; 1.4–4.9], p < 0.001). There was a significant positive correlation between serum CIRP levels and ASD disease activity score (Pouchet’s score r=0.45, p=0.003) as well as between ASD-specific biomarkers ferritin and IL-18. However, there was no significant difference in the serum CIRP levels among ASD patients with three different disease phenotypes. Intracellular CIRP expression on CD14+ monocytes was elevated in patients with ASD compared with those in patients in RA.Conclusion: These results suggest that CIRP may play a significant role in the pathophysiology of ASD and could be a potential biomarker for monitoring the disease activity of ASD.