There is a paucity of robust epidemiological data on adult-onset Still’s disease (AOSD), with very few prospectively collected data. It is a rare disease with an annual incidence that varies in different studies between 0.16 per 100,000 and 0.4 per 100,000 and is associated with a clearly increased mortality.[1]Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still's disease. J Autoimmun. 2018 Sep;93:24-36.
https://www.doi.org/10.1016/j.jaut.2018.07.018
http://www.ncbi.nlm.nih.gov/pubmed/30077425?tool=bestpractice.com
[2]Vordenbäumen S, Feist E, Rech J, et al. Diagnosis and treatment of adult-onset Still's disease: a concise summary of the German society of rheumatology S2 guideline. Z Rheumatol. 2023 Feb;82(suppl 2):81-92.
https://www.doi.org/10.1007/s00393-022-01294-2
http://www.ncbi.nlm.nih.gov/pubmed/36520170?tool=bestpractice.com
[4]Macovei LA, Burlui A, Bratoiu I, et al. Adult-onset Still's disease-a complex disease, a challenging treatment. Int J Mol Sci. 2022 Oct 24;23(21):12810.
https://www.doi.org/10.3390/ijms232112810
http://www.ncbi.nlm.nih.gov/pubmed/36361602?tool=bestpractice.com
The estimated point prevalence was reported by one review at 0.73-6.77 per 100,000 and by another at between 1 and 34 cases per million.[1]Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still's disease. J Autoimmun. 2018 Sep;93:24-36.
https://www.doi.org/10.1016/j.jaut.2018.07.018
http://www.ncbi.nlm.nih.gov/pubmed/30077425?tool=bestpractice.com
[5]Efthimiou P, Kontzias A, Hur P, et al. Adult-onset Still's disease in focus: clinical manifestations, diagnosis, treatment, and unmet needs in the era of targeted therapies. Semin Arthritis Rheum. 2021 Aug;51(4):858-74.
https://www.doi.org/10.1016/j.semarthrit.2021.06.004
http://www.ncbi.nlm.nih.gov/pubmed/34175791?tool=bestpractice.com
Incidence and prevalence are higher in recent studies compared with older studies, likely because of increased awareness.[5]Efthimiou P, Kontzias A, Hur P, et al. Adult-onset Still's disease in focus: clinical manifestations, diagnosis, treatment, and unmet needs in the era of targeted therapies. Semin Arthritis Rheum. 2021 Aug;51(4):858-74.
https://www.doi.org/10.1016/j.semarthrit.2021.06.004
http://www.ncbi.nlm.nih.gov/pubmed/34175791?tool=bestpractice.com
Most cases occur in young adults, with a bimodal pattern showing two peaks of onset at aged 16-25 years and 36-46 years.[1]Giacomelli R, Ruscitti P, Shoenfeld Y. A comprehensive review on adult onset Still's disease. J Autoimmun. 2018 Sep;93:24-36.
https://www.doi.org/10.1016/j.jaut.2018.07.018
http://www.ncbi.nlm.nih.gov/pubmed/30077425?tool=bestpractice.com
[4]Macovei LA, Burlui A, Bratoiu I, et al. Adult-onset Still's disease-a complex disease, a challenging treatment. Int J Mol Sci. 2022 Oct 24;23(21):12810.
https://www.doi.org/10.3390/ijms232112810
http://www.ncbi.nlm.nih.gov/pubmed/36361602?tool=bestpractice.com
[5]Efthimiou P, Kontzias A, Hur P, et al. Adult-onset Still's disease in focus: clinical manifestations, diagnosis, treatment, and unmet needs in the era of targeted therapies. Semin Arthritis Rheum. 2021 Aug;51(4):858-74.
https://www.doi.org/10.1016/j.semarthrit.2021.06.004
http://www.ncbi.nlm.nih.gov/pubmed/34175791?tool=bestpractice.com
However, there is growing evidence of a further peak at aged 60-65 years, although delayed diagnosis may be a contributory factor.[5]Efthimiou P, Kontzias A, Hur P, et al. Adult-onset Still's disease in focus: clinical manifestations, diagnosis, treatment, and unmet needs in the era of targeted therapies. Semin Arthritis Rheum. 2021 Aug;51(4):858-74.
https://www.doi.org/10.1016/j.semarthrit.2021.06.004
http://www.ncbi.nlm.nih.gov/pubmed/34175791?tool=bestpractice.com
[7]Sfriso P, Priori R, Valesini G, et al. Adult-onset Still's disease: an Italian multicentre retrospective observational study of manifestations and treatments in 245 patients. Clin Rheumatol. 2016 Jul;35(7):1683-9.
https://www.doi.org/10.1007/s10067-016-3308-8
http://www.ncbi.nlm.nih.gov/pubmed/27207567?tool=bestpractice.com
[8]Bogdan M, Nitsch-Osuch A, Samel-Kowalik P, et al. Adult-onset Still's disease in Poland - a nationwide population-based study. Ann Agric Environ Med. 2021 Jun 14;28(2):250-4.
https://www.doi.org/10.26444/aaem/132451
http://www.ncbi.nlm.nih.gov/pubmed/34184506?tool=bestpractice.com
[9]Magadur-Joly G, Billaud E, Barrier JH, et al. Epidemiology of adult Still's disease: estimate of the incidence by a retrospective study in west France. Ann Rheum Dis. 1995 Jul;54(7):587-90.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1009940/7
http://www.ncbi.nlm.nih.gov/pubmed/7668903?tool=bestpractice.com
[10]Evensen KJ, Nossent HC. Epidemiology and outcome of adult-onset Still's disease in Northern Norway. Scand J Rheumatol. 2006 Jan-Feb;35(1):48-51.
https://www.doi.org/10.1080/03009740510026616
http://www.ncbi.nlm.nih.gov/pubmed/16467042?tool=bestpractice.com
Most studies have noted a female predominance, with women accounting for 60% to 80% of cases, although a minority have reported an equal distribution between men and women.[7]Sfriso P, Priori R, Valesini G, et al. Adult-onset Still's disease: an Italian multicentre retrospective observational study of manifestations and treatments in 245 patients. Clin Rheumatol. 2016 Jul;35(7):1683-9.
https://www.doi.org/10.1007/s10067-016-3308-8
http://www.ncbi.nlm.nih.gov/pubmed/27207567?tool=bestpractice.com
[8]Bogdan M, Nitsch-Osuch A, Samel-Kowalik P, et al. Adult-onset Still's disease in Poland - a nationwide population-based study. Ann Agric Environ Med. 2021 Jun 14;28(2):250-4.
https://www.doi.org/10.26444/aaem/132451
http://www.ncbi.nlm.nih.gov/pubmed/34184506?tool=bestpractice.com
[10]Evensen KJ, Nossent HC. Epidemiology and outcome of adult-onset Still's disease in Northern Norway. Scand J Rheumatol. 2006 Jan-Feb;35(1):48-51.
https://www.doi.org/10.1080/03009740510026616
http://www.ncbi.nlm.nih.gov/pubmed/16467042?tool=bestpractice.com
[11]Lenert A, Oh G, Ombrello MJ, et al. Clinical characteristics and comorbidities in adult-onset Still's disease using a large US administrative claims database. Rheumatology (Oxford). 2020 Jul 1;59(7):1725-33.
https://www.doi.org/10.1093/rheumatology/kez622
http://www.ncbi.nlm.nih.gov/pubmed/31965185?tool=bestpractice.com
[12]Mehta BY, Ibrahim S, Briggs W, et al. Racial/ethnic variations in morbidity and mortality in adult onset Still's disease: an analysis of national dataset. Semin Arthritis Rheum. 2019 Dec;49(3):469-73.
https://www.doi.org/10.1016/j.semarthrit.2019.04.004
http://www.ncbi.nlm.nih.gov/pubmed/31109638?tool=bestpractice.com
In one of the largest nationwide studies of AOSD epidemiology in the US, analysis of 5-year retrospective data between 2009 and 2013 revealed an inpatient mortality of 2.6%.[12]Mehta BY, Ibrahim S, Briggs W, et al. Racial/ethnic variations in morbidity and mortality in adult onset Still's disease: an analysis of national dataset. Semin Arthritis Rheum. 2019 Dec;49(3):469-73.
https://www.doi.org/10.1016/j.semarthrit.2019.04.004
http://www.ncbi.nlm.nih.gov/pubmed/31109638?tool=bestpractice.com