Access to Pediatric Rheumatology Care — A Major Challenge to Improving Outcome in Juvenile Idiopathic Arthritis: Table 1.

Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases1,2 and is one of the most common chronic rheumatic diseases in children. Improving the outcome for children with JIA remains an important goal, with current management of severe JIA involving increasingly aggressive immunosuppressive agents1. Undoubtedly, improving outcome in JIA depends on the availability of effective treatments, but if a child presents late in their disease course or receives inappropriate treatment or does not have access to treatment at all, then outcome is likely to be suboptimal. There is an increasing body of evidence (Table 1)3 that many children with JIA have a prolonged interval from disease onset to pediatric rheumatology care, and despite there being no published data from developing countries, anecdotal observations suggest that poor access to optimal care is likely to be a global issue. View this table: Table 1. Studies reporting interval from onset of symptoms to pediatric rheumatology care. Adapted from Foster, et al, Rheumatology 2010;49:401–33. The longterm impact of delay is unknown, but a longer interval from disease onset to definitive treatment is likely to adversely affect clinical outcomes4,5,6. In one study7, many children with delay (defined as > 10 weeks from symptom onset to first pediatric rheumatology assessment) had prolonged untreated active disease, many presented with multiple restricted joints, none had been referred for eye screening (to detect chronic anterior uveitis), and the median interval from onset of symptoms to starting methotrexate was 10 months. Such delay is likely to have a profound effect on the potential for functional disability and psychosocial impact as a result of poorly controlled symptoms and the family living with an uncertain diagnosis. The article by Shiff, et al 8 in this issue of The Journal describes … Address correspondence to Prof. Foster. E-mail: h.e.foster{at}ncl.ac.uk