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Trends in paediatric rheumatology referral times and disease activity indices over a ten-year period among children with juvenile idiopathic arthritis: results from the childhood arthritis prospective study

  • 1, 2,
  • 3,
  • 2,
  • 4,
  • 5,
  • 6,
  • 7,
  • 8,
  • 2 and
  • 2
Pediatric Rheumatology201412 (Suppl 1) :P13

https://doi.org/10.1186/1546-0096-12-S1-P13

  • Published:

Keywords

  • Juvenile Idiopathic Arthritis
  • Symptom Onset
  • Inflammatory Arthritis
  • Definitive Treatment
  • Disease Activity Index

Introduction

The medical management of children and adolescents with juvenile idiopathic arthritis (JIA) has advanced significantly over the past ten years. The UK BSPAR Standards of Care (2009) stipulate that children with JIA should see a paediatric rheumatology team (PRh) within ten weeks of symptom onset and within four weeks of referral. It is not known how often these standards are met or whether they have impacted on outcomes.

Objectives

To describe trends in referral times, baseline disease severity, treatment times and one-year outcomes over a ten-year period among children with new-onset JIA.

Methods

The Childhood Arthritis Prospective Study is a prospective inception cohort of children with new-onset inflammatory arthritis recruiting from seven UK PRh centres. This analysis included all children recruited between 2001 and 2011 with at least one year of follow-up. The cohort was divided into four groups by year of diagnosis and baseline referral times, disease pattern, disease activity indices, time to first definitive treatment and proportion achieving minimal disease activity (MDA) (Magni-Manzoni, 2008) were determined for each group. Values across the four groups were compared using linear and logistic regression, adjusting for PRh centre and disease pattern.

Results

Table 1.

Table 1

 

2001-2004

2005-2006

2007-2008

2009-2011

P value

N (1066)

285

265

306

210

--

Time between symptom onset and 1st PRh, weeks

22.7 (11.9, 40.1)

23.5 (12.1, 52.7)

24.7 (12, 58.2)

23.1 (13.2, 50.1)

0.28

% seen within 10 weeks

20.5%

21%

20%

19%

0.66

Time from referral to 1st PRh appointment, weeks

3.4 (1.2, 7.9)

4 (1.4, 7.3)

4.7 (1.4, 8)

4.3 (1.6, 8.7)

0.61

% seen within 4 weeks

58%

55%

49%

50%

0.02

AJC

2 (1, 4)

2 (1, 6)

2 (1, 5)

2 (1, 5)

0.82

JADAS

10.8 (7, 16.2)

12.1 (7.2, 20.2)

9.3 (4.4, 18.4)

10.4 (4, 10.6)

0.60

CHAQ

0.8 (0.1, 1.5)

0.9 (0.3, 1.5)

0.6 (0.1, 1.4)

0.6 (0.1, 1.3)

0.045

Oligoarticular pattern: Time (days) from 1st PRh to 1st IA steroid, median (IQR)

25.5 (9,65)

25 (7, 49)

19 (8, 48)

19 (9, 48)

0.04

% in MDA at 1 year

62

66

66

67

0.87

Time (days) from 1st PRh to 1st methotrexate, median (IQR)

27 (1, 79)

17 (1, 43)

5 (0, 17)

11 (0, 84)

0.03

% in MDA at 1 year

39

56

50

59

0.07

Time (days) from 1st PRh to 1st methotrexate, median (IQR)

37 (14, 78)

14 (9, 25)

15 (6, 24)

15 (13, 26)

0.07

% in MDA at 1 year

64

50

75

57

0.85

Conclusion

Approximately half of children with new-onset JIA were not seen within four weeks of referral, with only 20% within ten weeks of symptom onset. The reasons for the former may be related to PRh service pressures, with the latter relating to both public and physician education. Although it is encouraging to see more rapid introduction of treatment, further research is necessary to understand why approximately one-third of children have active disease at one year. Delay in access to definitive treatments may impact on outcomes.

Disclosure of interest

None declared.

Authors’ Affiliations

(1)
Paediatric Rheumatology, Great North Children's Hospital, Newcastle upon Tyne, UK
(2)
Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
(3)
Rheumatology, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
(4)
Paediatric Rheumatology, Alder Hey Children's Hospital, Liverpool, UK
(5)
Paediatric Rheumatology, Royal Manchester Children's Hospital, Manchester, UK
(6)
Paediatric Rheumatology, University of Glasgow, Glasgow, UK
(7)
Rheumatology, University College London, UK
(8)
Rheumatology Unit, UCL Institute of Child Health, London, UK

Copyright

© Mcerlane et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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