Caroline Freychet1, Céline Lambert2, Bruno Pereira2, Jean L Stephan3, Stéphane Echaubard4, Etienne Merlin4, Aurélie Chausset4. 1. Health services and performance research (HESPER) laboratory, Claude-Bernard university, 8, avenue Rockefeller, 69003 Lyon, France; Service de pédiatrie, CHU de St-Étienne, 42000 St-Étienne, France. Electronic address: caroline.freychet@yahoo.fr. 2. Délégation de la recherche clinique et de l'innovation, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France. 3. Service de pédiatrie, CHU de St-Étienne, 42000 St-Étienne, France. 4. Inserm CIC 1405, service de pédiatrie, CHU Estaing, 63003 Clermont-Ferrand, France.
Abstract
OBJECTIVE: A better understanding about the referral pathway of patients suffering from juvenile idiopathic arthritis (JIA) is required The aim of this study was to describe and analyze time from onset of symptoms to first pediatric rheumatology (PR) visit and the referral pathway of children with incident JIA in two French competence centers. METHODS: From October 2009 to October 2017, new JIA patients were registered in the "Auvergne-Loire cohort on JIA". We collected referral pathway, symptom onset, biological and clinical data at first assessment in PR department. RESULTS: In all, 111 children were included. Median time to first PR visit was 3.3 months [interquartile range (IQR) 1.3, 10.7] with a significant difference between JIA subtypes. After exclusion of systemic JIA, older age at onset of symptoms, and presence of enthesitis or joint pain were significantly associated with a longer time to first PR visit, while joint swelling or limping, abnormal ESR or CRP were associated with a shorter time. The median number of health care practitioners met was 3 [IQR 3, 4]. Orthopedists referred children to a PR center in 64% of cases, pediatricians in 50%, emergency care practitioners in 27% and general practitioners in 25%. Although non-systemic JIAs are not an emergency, 45% were referred to the emergency room. CONCLUSION: Time to first PR visit is rather short compared to other countries but remains too long. Pediatric rheumatologists should offer primary care providers basic training on JIA and fast direct access to PR departments if JIA is suspected.
OBJECTIVE: A better understanding about the referral pathway of patients suffering from juvenile idiopathic arthritis (JIA) is required The aim of this study was to describe and analyze time from onset of symptoms to first pediatric rheumatology (PR) visit and the referral pathway of children with incident JIA in two French competence centers. METHODS: From October 2009 to October 2017, new JIA patients were registered in the "Auvergne-Loire cohort on JIA". We collected referral pathway, symptom onset, biological and clinical data at first assessment in PR department. RESULTS: In all, 111 children were included. Median time to first PR visit was 3.3 months [interquartile range (IQR) 1.3, 10.7] with a significant difference between JIA subtypes. After exclusion of systemic JIA, older age at onset of symptoms, and presence of enthesitis or joint pain were significantly associated with a longer time to first PR visit, while joint swelling or limping, abnormal ESR or CRP were associated with a shorter time. The median number of health care practitioners met was 3 [IQR 3, 4]. Orthopedists referred children to a PR center in 64% of cases, pediatricians in 50%, emergency care practitioners in 27% and general practitioners in 25%. Although non-systemic JIAs are not an emergency, 45% were referred to the emergency room. CONCLUSION: Time to first PR visit is rather short compared to other countries but remains too long. Pediatric rheumatologists should offer primary care providers basic training on JIA and fast direct access to PR departments if JIA is suspected.
Authors: Rodrigo Cánovas; Joanna Cobb; Marta Brozynska; John Bowes; Yun R Li; Samantha Louise Smith; Hakon Hakonarson; Wendy Thomson; Justine A Ellis; Gad Abraham; Jane E Munro; Michael Inouye Journal: Ann Rheum Dis Date: 2020-09-04 Impact factor: 19.103