TY - JOUR
T1 - Disease activity and dropout in young persons with juvenile idiopathic arthritis in transition of care
T2 - A longitudinal observational study
AU - van Pelt, Philomine A.
AU - Dolhain, Radboud J.E.M.
AU - Kruize, Aike A.
AU - Ammerlaan, Judy W.
AU - Hazes, Johanna W.
AU - Bijlsma, Johannes W.J.
AU - Wulffraat, Nico M.
N1 - Funding Information:
Funding: this study was financially supported by the Dutch Arthritis Association. Competing interests: none declared.
Publisher Copyright:
© Clinical and Experimental Rheumatology 2018.
PY - 2018/1/1
Y1 - 2018/1/1
N2 - OBJECTIVES: Reaching a certain age, juvenile idiopathic arthritis (JIA) patients in paediatric care are transferred to adult care. An increased disease activity after transfer and increased dropout has been suggested, however, evidence is scarce. Our aim is to determine whether the process of transition is associated with increased disease-activity and dropout, and to identify associated factors.METHODS: During a 3-year prospective transition cohort study, paediatric patients (14-17yrs) were transferred to adult care. Paediatric (10-13yrs) and adult JIA patients (18-27yrs) were used as control groups. Demographic and disease-related items were obtained yearly. Non-parametric tests were used to compare differences between the groups and mixed models to evaluate disease activity over time, measured by JADAS27 and DAS28. Dropout was defined as not attending the clinic for 2 consecutive visits.RESULTS: Groups did not differ regarding baseline variables of subtype, gender, uveitis, ANA-, RF- or HLA B27-positivity and current or past DMARD use. Median disease activity was not different between groups during follow-up. Transfer was not associated with disease activity. Dropout rate was 12%, and was significantly higher in patients under transition (22%) compared with paediatric (3%) and adult care (10%). Patients who dropped out had significantly lower disease activity at baseline and were using less MTX, but did not differ regarding subtype, ANA, RF and HLA-B27.CONCLUSIONS: The process of transition in JIA is not associated with an increase in disease activity, however, this period carries a risk for drop out especially in patients with low disease activity.
AB - OBJECTIVES: Reaching a certain age, juvenile idiopathic arthritis (JIA) patients in paediatric care are transferred to adult care. An increased disease activity after transfer and increased dropout has been suggested, however, evidence is scarce. Our aim is to determine whether the process of transition is associated with increased disease-activity and dropout, and to identify associated factors.METHODS: During a 3-year prospective transition cohort study, paediatric patients (14-17yrs) were transferred to adult care. Paediatric (10-13yrs) and adult JIA patients (18-27yrs) were used as control groups. Demographic and disease-related items were obtained yearly. Non-parametric tests were used to compare differences between the groups and mixed models to evaluate disease activity over time, measured by JADAS27 and DAS28. Dropout was defined as not attending the clinic for 2 consecutive visits.RESULTS: Groups did not differ regarding baseline variables of subtype, gender, uveitis, ANA-, RF- or HLA B27-positivity and current or past DMARD use. Median disease activity was not different between groups during follow-up. Transfer was not associated with disease activity. Dropout rate was 12%, and was significantly higher in patients under transition (22%) compared with paediatric (3%) and adult care (10%). Patients who dropped out had significantly lower disease activity at baseline and were using less MTX, but did not differ regarding subtype, ANA, RF and HLA-B27.CONCLUSIONS: The process of transition in JIA is not associated with an increase in disease activity, however, this period carries a risk for drop out especially in patients with low disease activity.
KW - Adolescents
KW - Disease activity
KW - DMARD
KW - Dropout
KW - Juvenile idiopathic arthritis
KW - Transition
KW - Prospective Studies
KW - Humans
KW - Transition to Adult Care
KW - Male
KW - Patient Dropouts
KW - Case-Control Studies
KW - Young Adult
KW - Arthritis, Juvenile/diagnosis
KW - Time Factors
KW - Adult
KW - Female
KW - Methotrexate/therapeutic use
KW - Severity of Illness Index
KW - Risk Factors
KW - No-Show Patients
KW - Adolescent
KW - Antirheumatic Agents/adverse effects
KW - Appointments and Schedules
KW - Longitudinal Studies
UR - https://www.scopus.com/pages/publications/85042145277
M3 - Article
C2 - 29461957
AN - SCOPUS:85042145277
SN - 0392-856X
VL - 36
SP - 163
EP - 168
JO - Clinical and Experimental Rheumatology
JF - Clinical and Experimental Rheumatology
IS - 1
ER -