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Marino A, Baldassarre P, Ferrigno C, Biuso A, Minutoli M, Baldo F, Costi S, Gattinara MV, Caporali RF, Chighizola CB. Pre-Rheumatology Referral Consultation and Investigation Pattern in Children with Joint Complaints: Focus on Juvenile Idiopathic Arthritis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:600. [PMID: 38790595 PMCID: PMC11120367 DOI: 10.3390/children11050600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 05/09/2024] [Accepted: 05/13/2024] [Indexed: 05/26/2024]
Abstract
The diagnosis of juvenile idiopathic arthritis (JIA) is often entrusted to the pediatric rheumatologist specialist. Timely referral to a specialized center is crucial. This study aims to assess the consultation and investigation patterns of patients with joint complaints before rheumatology referral. This longitudinal cohort study included patients with joint complaints who were referred to the Pediatric Rheumatology Unit. The cohort included 301 patients (58% female), 50 of them (17%) diagnosed with JIA. Compared to patients with orthopedic conditions or functional diseases, JIA patients had seen more specialists (p < 0.01) and received a quicker diagnosis (p < 0.01). Patients with early JIA diagnosis (within 3 months from symptoms onset) were younger (8.46 vs. 11.5 years old; p = 0.04), more frequently female (78% vs. 47%, p = 0.03), and with higher erythrocyte sedimentation rate (ESR) values (37 vs. 9 mm/h; p = 0.02) than those diagnosed later. Patients with a late diagnosis of JIA had a significantly longer median time between the first healthcare visit and the PR referral (25 vs. 101 days; p < 0.01). The main contributor to diagnostic delay in JIA was the time required for PR referral after the first healthcare consult. Younger age, female sex, and higher ESR values were associated with earlier diagnosis of JIA.
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Affiliation(s)
- Achille Marino
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Paola Baldassarre
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Cristina Ferrigno
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Andrea Biuso
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Martina Minutoli
- Department of Biomedical and Clinical Sciences, Buzzi Children’s Hospital, University of Milan, 20122 Milan, Italy; (P.B.); (C.F.); (A.B.); (M.M.)
| | - Francesco Baldo
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Stefania Costi
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Maurizio Virgilio Gattinara
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
| | - Roberto Felice Caporali
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
- Department of Rheumatology and Medical Sciences, ASST G. Pini-CTO, 20122 Milan, Italy
| | - Cecilia Beatrice Chighizola
- Unit of Pediatric Rheumatology, ASST G. Pini-CTO, 20122 Milan, Italy; (F.B.); (S.C.); (M.V.G.); (R.F.C.); (C.B.C.)
- Department of Clinical Sciences and Community Health, Research Center for Pediatric and Adult Rheumatic Diseases (RECAP.RD), University of Milan, 20122 Milan, Italy
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Chausset A, Lambert C, Belot A, Merlin E, Cannizzaro E, Kone-Paut I, Ballot C, Devauchelle V, Poignant S, Carlomagno R, Lohse A, Barbier C, Despert V, Carbasse A, Sparsa L, Adank E, Vanoni F, Reumaux H, Pillet P, Kaiser D, Hofer M, Freychet C, Schott AM. Individual and environmental determinants associated with longer times to access pediatric rheumatology centers for patients with juvenile idiopathic arthritis, a JIR cohort study. Pediatr Rheumatol Online J 2023; 21:24. [PMID: 36918902 PMCID: PMC10015663 DOI: 10.1186/s12969-023-00809-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Despite guidelines, poor access to appropriate care for juvenile idiopathic arthritis (JIA) patients remains a global issue. Prompt referral to a pediatric rheumatology (PR) center and effective care is known to be critical for changing the natural history of the disease and improving long-term prognosis. This project assesses socio-economic factors of delayed referral to a pediatric rheumatologist (PRst) for JIA patients in France and Switzerland within the Juvenile Inflammatory Rheumatism (JIR) Cohort. METHODS All patients diagnosed with JIA, presenting at one center of the JIRcohort in France or Switzerland with additional data on referral pathway were included. Patient characteristics at first visit to the PR center, dates of visits to healthcare providers during referral, and parent characteristics were extracted from the JIRcohort database. RESULTS Two hundred fifty children were included. The overall median time to first PR assessment was 2.4 months [1.3; 6.9] and ranged widely across the JIA subtypes, from 1.4 months [0.6; 3.8] for children with systemic juvenile idiopathic arthritis (sJIA) to 5.3 months [2.0; 19.1] for children with enthesitis-related arthritis (ERA). A diagnosis of ERA and an appointment with an orthopedist during the referral pathway were significantly associated with a longer time before the first PR visit (hazard ratio HR 0.50 [95% CI: 0.29; 0.84]) and HR 0.68 [95% CI: 0.49; 0.93], respectively) in multivariable analysis. Having a mother with a post-graduate educational attainment level was tendentially associated with a shorter time before the first PR visit, (HR 1.32 [95% CI: 0.99; 1.78]). CONCLUSIONS Time to first PRst visit was most often short compared to other studies and close to the British recommendations. However, this time remained too long for many patients. We observed no social inequities in access to a PRst, but we show the need to improve effective pathway and access to a PR center for JIA patients.
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Affiliation(s)
- Aurélie Chausset
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France.
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France.
- Pédiatrie, CHU Estaing, 1 Place Lucie & Raymond Aubrac, Clermont-Fd cedex1, 63003, France.
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Belot
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
| | - Etienne Merlin
- CRECHE Unit, INSERM CIC 1405, Department of Pediatrics, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Elvira Cannizzaro
- Department of Rheumatology, University Children's Hospital, University of Zurich, Zurich, Switzerland
| | - Isabelle Kone-Paut
- Department of Pediatrics & Pediatric Rheumatology, Centre de référence maladies auto-inflammatoires rares et amylose inflammatoire (CEREMAIA), Bicêtre University, Paris Sud Hospital, Le Kremlin-Bicêtre, France
| | - Claire Ballot
- Pediatric Hematology, Jean-Minjoz Hospital, Besançon, France
| | - Valérie Devauchelle
- Rheumatology Department, CHU Brest and Brest University, INSERM UMR 1227, Brest, France
| | | | - Raffaella Carlomagno
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Anne Lohse
- Department of Rheumatology, Nord Franche-Comté Hospital, Belfort, France
| | | | | | - Aurélia Carbasse
- Department of Pediatrics, Hôpital Arnaud de Villeneuve, CHRU Montpellier, Montpellier, France
| | | | - Eva Adank
- Department of Pediatrics, Kantonsspital Graubünden, Chur, Switzerland
| | - Federica Vanoni
- Institute of Pediatrics of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - Héloise Reumaux
- Pediatric Rheumatology, Lille University Hospital, Lille, France
| | - Pascal Pillet
- Department of Pediatrics, Hôpital des Enfants, CHRU Bordeaux, Bordeaux, France
| | - Daniela Kaiser
- Department of Pediatrics, Centre Hospitalier Cantonal Luzern, Lucerne, Switzerland
| | - Michael Hofer
- Pediatric Immuno-Rheumatology of Western Switzerland, Department Women-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
- University Hospital, Geneva, Switzerland
| | - Caroline Freychet
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
- Pediatric Nephrology, Rheumatology, Dermatology, HFME, Hospices Civils de Lyon, National Referee Centre RAISE & INSERM U1111, Lyon University, Lyon, France
- Pediatrics, CHU Saint-Etienne, Saint-Etienne, France
| | - Anne-Marie Schott
- Research on Healthcare Performance (RESHAPE), INSERM U1290, Claude Bernard University Lyon 1, Lyon, France
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Regusci A, Lava SAG, Milani GP, Bianchetti MG, Simonetti GD, Vanoni F. Tubulointerstitial nephritis and uveitis syndrome: a systematic review. Nephrol Dial Transplant 2022; 37:876-886. [PMID: 33561271 DOI: 10.1093/ndt/gfab030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Tubulointerstitial nephritis and uveitis (TINU) syndrome is defined as the occurrence of tubulointerstitial nephritis (TIN) and uveitis in the absence of other systemic diseases. The most comprehensive review on this condition was published in 2001. METHODS We conducted a systematic review of the literature for cases of TINU syndrome. MEDLINE and Embase databases were screened. Full-length articles or letters reporting cases with both TIN and uveitis were selected. We investigated differences between males and females and paediatric and adult cases. Multivariate analysis was performed to identify potential risk factors for chronic kidney disease (CKD) development. RESULTS A total of 233 articles reporting 592 TINU cases were retained for the analysis. The median age of the included subjects was 17 years (interquartile range 13-46) with a female predominance (65%). Uveitis most frequently (52%) followed renal disease and was mostly anterior (65%) and bilateral (88%). Children tended to have more ocular relapses, while they were slightly less likely than adults to suffer from acute kidney injury and to develop CKD. Adult age as well as posterior or panuveitis were associated with an increased risk of developing CKD. CONCLUSIONS TINU affects both children and adults, with some differences between these two categories. Adult age and the presence of a posterior uveitis or panuveitis appear to be associated with the development of CKD.
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Affiliation(s)
- Alessia Regusci
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Sebastiano A G Lava
- Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Gregorio P Milani
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Mario G Bianchetti
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Giacomo D Simonetti
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, University of Southern Switzerland, Lugano, Switzerland
| | - Federica Vanoni
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
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Abstract
Health and health care disparities in pediatric rheumatology are prevalent among socially disadvantaged and marginalized populations based on race/ethnicity, socioeconomic position, and geographic region. These groups are more likely to experience greater disease severity, morbidity, mortality, decreased quality of life, and poor mental health outcomes, which are in part due to persistent structural and institutional barriers, including decreased access to quality health care. Most of the research on health and health care disparities in pediatric rheumatology focuses on juvenile idiopathic arthritis and childhood-onset systemic lupus erythematosus; there are significant gaps in the literature assessing disparities associated with other pediatric rheumatic diseases. Understanding the underlying causes of health care disparities will ultimately inform the development and implementation of innovative policies and interventions on a federal, local, and individual level.
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Affiliation(s)
- Alisha M Akinsete
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA. https://twitter.com/@akinsetemd
| | - Jennifer M P Woo
- Epidemiology Branch, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA. https://twitter.com/@jmpwoo
| | - Tamar B Rubinstein
- Division of Pediatric Rheumatology, Department of Pediatrics, Children's Hospital at Montefiore/Albert Einstein College of Medicine, 3415 Bainbridge Avenue, Bronx, NY 10467, USA.
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Pediatric Rheumatic Disease in Lower to Middle-Income Countries: Impact of Global Disparities, Ancestral Diversity, and the Path Forward. Rheum Dis Clin North Am 2021; 48:199-215. [PMID: 34798947 DOI: 10.1016/j.rdc.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Pediatric rheumatology subspecialists treat chronic autoimmune diseases with onset in childhood. Prompt diagnosis and ongoing management of these conditions are imperative to prevent damage from ongoing inflammation. Here, we aim to describe the current landscape of pediatric rheumatic disease in lower to middle-income countries (LMICs) and explore current barriers to understanding global disease burden. We then examine innovative strategies to promote a more equitable future for children and young people living with rheumatic diseases worldwide.
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Lee JJY, Laxer RM, Feldman BM, Barber CEH, Batthish M, Berard R, Tucker LB, Levy DM. Variations in Pediatric Rheumatology Workforce and Care Processes Across Canada. J Rheumatol 2021; 49:197-204. [PMID: 34334367 DOI: 10.3899/jrheum.201611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine Canadian pediatric rheumatology workforce and care processes. METHODS Pediatric rheumatologists and allied health professionals (AHPs) participated. A designee from each academic centre provided workforce information including number of providers, total and breakdown of full-time equivalents (FTE), and triage processes. We calculated the clinical care FTE (cFTE) available per 75,000 (recommended benchmark) and 300,000 (adjusted) children using 2019 census data. The national workforce deficit was calculated as the difference between current and expected cFTEs. Remaining respondents were asked about ambulatory practices. RESULTS The response rate of survey A (workforce information) and survey B (ambulatory practice information) was 100% and 54%, respectively. The majority of rheumatologists (91%) practiced in academic centres. The median number of rheumatologists per centre was 3 (IQR:3) and median cFTE was 1.8 (IQR:1.5). The median cFTE per 75,000 was 0.2 (IQR:0.3) with a national deficit of 80 cFTEs. With the adjusted benchmark, there was no national deficit but a regional maldistribution of rheumatologists. All centres engaged in multidisciplinary practices with a median of 4 different AHPs, although the median FTE for AHPs was ≤1. Most centres (87%) utilized a centralized triage process. Of 9 (60%) centres that used an electronic triage process, 6 were able to calculate wait times. Most clinicians integrated quality improvement practices, such as pre-visit planning (68%), post-visit planning (68%), and periodic health outcome monitoring (36-59%). CONCLUSION This study confirms a national deficit at the current recommended benchmark. Most rheumatologists work in multidisciplinary teams, but AHP support may be inadequate.
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Affiliation(s)
- Jennifer J Y Lee
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Ronald M Laxer
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Brian M Feldman
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Claire E H Barber
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Michelle Batthish
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Roberta Berard
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
| | - Lori B Tucker
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; The Cumming School of Medicine, University of Calgary, Alberta, Canada; McMaster Children's Hospital, Hamilton, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada; Western University, London, Ontario, Canada; British Columbia Children's Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, Canada. Sources of Support: Jennifer JY Lee is funded by the SickKids Clinician Scientist Training Program Study funding is provided by the Canadian Rheumatology Association. Address correspondence to: Deborah M. Levy, MD, MSc, FRCPC The Hospital for Sick Children (SickKids) 555 University Avenue Toronto, Ontario, Canada M5G 1X8.
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Abstract
PURPOSE OF THE REVIEW To highlight the current challenges in diagnosis and clinical care of pediatric rheumatic disease and barriers to research and education of pediatric rheumatologists worldwide. RECENT FINDINGS Recent studies and reports demonstrate a paucity of studies on epidemiology, outcomes, and management guidelines from many regions of the world. There have been noteworthy efforts to bridge the gap in under resourced areas. An analysis of the global burden of rheumatic disease has demonstrated that while understudied, musculoskeletal diseases are prevalent and increasingly contribute to loss of years of healthy life. In juvenile idiopathic arthritis, two milestone publications in global pediatric rheumatology have recently been published. An international study evaluated the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis and demonstrated global diversity in both clinical manifestations and outcomes. Notably, the first guidelines for managing pediatric rheumatic disease in a less resourced setting have been published for juvenile idiopathic arthritis. This document offers the first publication targeted to address challenges faced by pediatric rheumatology caregivers in low-resourced settings. These documents serve as exemplars for international collaboration in pediatric rheumatology and can be used as models for other pediatric rheumatic disease research. Other efforts are making progress in various arenas towards increasing access to care, education, and training in pediatric rheumatology. SUMMARY The global burden of rheumatic disease in the pediatric population is poorly understood but unrecognized disease greatly impacts the overall morbidity and mortality in this population. More studies in lesser resourced regions are needed to prioritize access to pediatric rheumatology care and prioritize a further increase in research capacity and education moving forward.
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Chausset A, Pereira B, Echaubard S, Merlin E, Freychet C. Access to paediatric rheumatology care in juvenile idiopathic arthritis: what do we know? A systematic review. Rheumatology (Oxford) 2021; 59:3633-3644. [PMID: 32940701 DOI: 10.1093/rheumatology/keaa438] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/28/2020] [Accepted: 06/21/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE This review examines time to access appropriate care for JIA patients and analyses the referral pathway before the first paediatric rheumatology (PR) visit. We also describe factors associated with a longer referral. METHODS We performed a systematic literature review, screening electronic databases (PubMed, Web of Science, EMBASE, Cochrane library and Open Grey database) up to February 2020. Articles written before 1994 (i.e. before the introduction of the unifying term JIA) were excluded. RESULTS From 595 nonduplicate citations found, 15 articles were finally included in the review. Most of the studies took place in Europe. The median time to first PR visit ranged from 3 to 10 months, with some disparities between referral pathway and patient characteristics. Patients with systemic-onset JIA had the shortest time to referral. Some clinical and biological factors such as swelling, fever, and elevated CRP and/or ESR were associated with a shorter time to first PR visit. Conversely, enthesitis, older age at symptom onset or pain were associated with a longer time. Whatever the country or world region, and despite disparities in healthcare system organization and healthcare practitioner availabilities, times to access PR were not wide-ranging. CONCLUSION This is the first systematic review to summarize research on access to PR for JIA patients. The pathway of care for JIA patients remains complex, and reasons for delayed referral depend on several factors. Standardized clinical guidelines and fast-track pathways to facilitate prompt referral to specialized teams have to allow for worldwide disparities in healthcare provision.
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Affiliation(s)
- Aurélie Chausset
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand.,CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand
| | - Bruno Pereira
- Department of Biostatistics, Clermont Ferrand University Hospital, Clermont-Ferrand
| | - Stéphane Echaubard
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand
| | - Etienne Merlin
- Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand.,CRECHE Unit, INSERM, CIC 1405, Clermont Auvergne University, Clermont-Ferrand
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