High Cost and Limited Access to Biologics
§ Annual treatment costs for Still's disease often range from USD 20,000 to over USD 100,000, making affordability a major barrier for patients in lower-income regions. Access to biologics is further constrained by pricing, regulatory hurdles, and weak healthcare infrastructure in some regions, while lengthy and regionally inconsistent reimbursement processes delay uptake.
§ The small number of approved therapies creates treatment gaps and poor disease management for some patient groups, and adults in particular struggle to access innovative or experimental therapies, often relying on off-label drug use.
Diagnostic Delays and Complexity
§ Still's disease is primarily a diagnosis of exclusion, with ambiguous presentation and no reliable serologic markers, so diagnosis is frequently delayed or incorrect. Because symptoms overlap with other autoimmune and infectious conditions and awareness is low among both paediatric and adult general medicine, referrals and treatment are slow, raising the risk of complications.
§ Compounding this, the disease's rarity makes clinical trial recruitment difficult and lengthens drug development timelines. Delayed diagnosis also increases the risk of life-threatening complications such as macrophage activation syndrome (MAS), which affects roughly 10–15% of patients and carries high mortality.
