Medical pathways of children with juvenile idiopathic arthritis before referral to pediatric rheumatology centers - 15/11/19
, Céline Lambert c, Bruno Pereira c, Jean L. Stephan b, Stéphane Echaubard d, Etienne Merlin d, Aurélie Chausset dBienvenue sur EM-consulte, la référence des professionnels de santé.
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| Iconographies | 3 |
| Vidéos | 0 |
| Autres | 0 |
Highlights |
• | Juvenile idiopathic arthritis (JIA) is the commonest form of chronic arthritis in children. Referral to a pediatric rheumatologist is frequently delayed, adversely affecting long-term outcome. |
• | This work confirms that compared to other countries, time to first pediatric rheumatology visit in France is fairly short, but still too long. |
• | Systemic JIA patients who have the worse short-term prognosis have the shortest time to referral whereas ERA patients have the longest one. |
• | This study highlights the central place of emergency care departments and charts under-referral by primary health care providers to pediatric rheumatologists. |
• | Pediatric rheumatologists should offer primary care providers basic training on JIA and fast direct access to pediatric rheumatology departments if JIA is suspected. |
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.
Le texte complet de cet article est disponible en PDF.Keywords : Juvenile idiopathic arthritis, Pediatric rheumatology, Referral pathway, Access to care
Plan
Vol 86 - N° 6
P. 739-745 - novembre 2019 Retour au numéro
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