Adolescence is a life phase with tremendous biological changes and social-role transitions. This unique developmental stage is characterized by pubertal maturation, individuation from parents and peer group identification. In this sensitive period both normative and maladaptive patterns of adult health are established. Sexual health, tobacco use, substance misuse, mental health, obesity, and injuries become major health categories. Adolescents have particular patterns of rheumatic diseases. Adolescents are not only medically, but also developmentally and psychologically distinct from children and from adults. Knowledge of adolescent health and normal adolescent development is pivotal for clinicians to provide developmentally appropriate care for adolescents with rheumatic diseases.
The period of transition from adolescence to adulthood presents particular challenges for young people with rheumatic diseases (as for those with other chronic diseases). These patients have not only to cope with their illness, but also with common tasks of adolescence. Young people with a chronic illness may face barriers in achieving autonomy and independence or finding a vocation. Also, they are “doubly disadvantaged” by the higher attributable risk from risk taking behavior (e.g., smoking, substance use) in the context of the underlying chronic disease or its treatment. Therefore, they need support, information and advice on their disease, but also on generic and sexual health, educational/vocational and psychosocial issues.
Since rheumatic diseases continue in approximately half of all patients into adulthood, transitional care is an important consideration for adolescents. It is essential to provide the young people with educational resources to help them develop skills they need to manage their care and develop routes of communication to facilitate the transfer from paediatric to adult care provider. Key elements of transitional care include among others a written transition policy, a preparation period, an education programme for patient and parent addressing medical, psychosocial and educational/vocational aspects of care, and a network of relevant local agencies and health care provider (1). The latter should have expertise in rheumatic diseases and special problems of those young people whose illness began in childhood. A close collaboration between health care providers will bridge the gap between pediatric and adult rheumatology. Due to the holistic nature of transition, care requires a multidisciplinary and multiagency approach.
McDonagh JE. Young people first, juvenile idiopathic arthritis second: transitional care in rheumatology. Arthritis Rheum 2008;59:1162-70.
Disclosure of Interest None Declared
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