Referral pathways to pediatric rheumatology care in juvenile idiopathic arthritis: a multicenter study in France and Switzerland

Timely access to pediatric rheumatology (PR) care is critical for improving outcomes in juvenile idiopathic arthritis (JIA), yet, referral delays remain frequent. We aimed to examine the trajectories leading to PR care across two national healthcare settings. We conducted a multicenter study to characterize referral pathways to PR care among children with incident non-systemic JIA from the JIRcohort in France and Switzerland. We examined the sequence, number, and type of healthcare providers (HCPs) consulted before the first PR visit and assessed predictors of prolonged delays. Multiple correspondence analysis was used to explore patterns in referral trajectories. Among 227 patients, the median time from symptom onset to the first PR visit was 2.5 months [1.5; 6.3] in France and 3.0 months [1.2; 7.6] in Switzerland ( p = 0.99). Referral pathways differed between the two settings, particularly in the number and type of HCPs involved, with fewer HCPs and more frequent pediatrician involvement in Switzerland. Multiple correspondence analysis identified four distinct referral pathway profiles combining clinical and referral characteristics, with differences in HCP involvement, clinical presentation, and referral time. A diagnosis of enthesitis-related arthritis and a higher number of HCPs involved were significantly associated with a longer time before the first PR visit (HR: 0.45, 95% CI: 0.29 to 0.71, and HR: 0.74, 95% CI: 0.63 to 0.87) in multivariable analysis. Conversely, contact with an emergency care practitioner was associated with a shorter time before the first PR visit (HR: 1.81, 95% CI: 1.31 to 2.49). Despite similar overall referral times, referral pathways differed in the number and type of HCPs involved before PR assessment. These findings suggest that summary delay measures alone may not fully capture differences in pathways to PR care.