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Access to paediatric rheumatology care in juvenile idiopathic arthritis: what do we know? A systematic review

Aurélie Chausset1,2, Bruno Pereira3, Stéphane Echaubard1

  • 1Department of Pediatrics, Clermont Ferrand University Hospital, Clermont-Ferrand.

Rheumatology (Oxford, England)
|September 17, 2020
PubMed

Insights

Access to pediatric rheumatology (PR) care for juvenile idiopathic arthritis (JIA) patients can be lengthy, with median times of 3-10 months. Factors like swelling and fever shorten referral times, while enthesitis and pain prolong them.

Area of Science:

  • Pediatric Rheumatology
  • Systemic Autoimmune Diseases
  • Healthcare Access

Background:

  • Juvenile idiopathic arthritis (JIA) is a complex autoimmune condition requiring timely specialist intervention.
  • Access to pediatric rheumatology (PR) care is crucial for effective JIA management.
  • Understanding referral pathways and associated delays is essential for improving patient outcomes.

Purpose of the Study:

  • To systematically review the time to access appropriate care for JIA patients.
  • To analyze the referral pathway prior to the first PR visit.
  • To identify factors associated with delayed referrals in JIA.

Main Methods:

  • Systematic literature review of multiple electronic databases up to February 2020.
  • Inclusion of studies published after 1994, focusing on the unified term JIA.
  • Analysis of 15 selected articles, primarily from Europe.

Main Results:

  • Median time to first PR visit ranged from 3 to 10 months.
  • Systemic-onset JIA, swelling, fever, and elevated inflammatory markers (CRP/ESR) were linked to shorter referral times.
  • Enthesitis, older age at onset, and pain were associated with longer referral times, irrespective of healthcare system variations.

Conclusions:

  • This is the first systematic review summarizing research on PR access for JIA patients.
  • The JIA care pathway is complex, with delays influenced by multiple factors.
  • Standardized guidelines and fast-track referrals are needed to improve timely access globally, considering healthcare disparities.
Abstract

Keywords:
JIAaccess to carepaediatric rheumatologyreferral pathwaytime to referral

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