Abstract
BackgroundEarly diagnosis and treatment of Juvenile Idiopathic Arthritis (JIA) is essential to optimize outcomes. Wait times (WTs) to consultation with a pediatric rheumatologist consultation is a Canadian quality measure, with benchmarks set at 7 days for systemic JIA (sJIA) and 4 weeks for other JIA categories. In this study we assess WTs for JIA at a single academic center and describe factors associated with longer WTs.MethodsThis was a retrospective cohort study of 164 patients enrolled in a pharmacogenetic study in Alberta between 2002 and 2018. Limited chart reviews were conducted to evaluate dates of referral and first rheumatology visit to calculate WTs for receipt of pediatric rheumatology care. Cox proportional hazard models identified factors associated with WTs considering variables at the first pediatric rheumatology visit including: JIA category, age, sex, distance to the pediatric rheumatology clinic, number of active joints, pain and C-reactive protein.ResultsThe median age at diagnosis was 8.0 years (interquartile range, IQR 3.5, 12.0) and 46% of patients had oligoarticular JIA. Only 18 patients (11%) were from rural locations. The median WT for all patients met the national benchmark (22 days, IQR, 9, 44) with no statistically significant difference between WTs among JIA categories (p = 0.055). Importantly, the majority of sJIA cases met the 7-day benchmark (67%) with a median WT of 1.5 days. Older age was associated with longer WT (HR 0.94, 95% CI 0.89, 0.98, p = 0.005).ConclusionMedian benchmarks were met, however delays in older patients highlight the need for monitoring WTs.
Highlights
Diagnosis and treatment of Juvenile Idiopathic Arthritis (JIA) is essential to optimize outcomes
Factors evaluated for their association with Wait time (WT) included JIA category, age, sex, distance from residence to the pediatric rheumatology clinic, number of active joints, pain and Creactive protein (CRP) at the first pediatric rheumatology clinic visit
Longer waits for older JIA patients were observed in a French study, as were joint pain and the presence of enthesitis, while abnormal inflammatory markers and joint swelling or limp were associated with shorter WTs [10]
Summary
Diagnosis and treatment of Juvenile Idiopathic Arthritis (JIA) is essential to optimize outcomes. Wait times (WTs) to consultation with a pediatric rheumatologist consultation is a Canadian quality measure, with benchmarks set at 7 days for systemic JIA (sJIA) and 4 weeks for other JIA categories. In this study we assess WTs for JIA at a single academic center and describe factors associated with longer WTs. Juvenile idiopathic arthritis (JIA) is a chronic inflammatory condition affecting approximately 0.11% of females and 0.07% of males younger than 16 years of age in Canada [1, 2]. Wait time (WT) to pediatric rheumatology care for patients with JIA is a nationally endorsed quality measure in Canada, with benchmark times from referral to pediatric rheumatology care of 7 days for systemic JIA (sJIA), and 4 weeks for other JIA categories [4, 5]. The purpose of this study was to measure and evaluate patient factors associated with WTs at a single academic pediatric rheumatology center
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