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OP0021 Young Persons with JIA in Transition of Care Show Higher Drop-Out Rates; Results From a Longitudinal Observational Study
  1. P. Van Pelt1,2,
  2. A. Kruize3,
  3. R. Dolhain4,
  4. J. Bijlsma3,
  5. N. Wulffraat1
  1. 1Pediatric Rheumatology and Immunology, University Medical Center, Utrecht
  2. 2Rheumatology and Pediatric Rheumatology, Erasmus MC University, Rotterdam
  3. 3Rheumatology and Immunology, University Medical Center, Utrecht
  4. 4Rheumatology, Erasmus MC University, Rotterdam, Netherlands

Abstract

Background Young persons under care for JIA are transferred from a child-oriented to an adult-focused service. Experts opinion suggests that this critical period is associated with increased disease-activity and drop-out. However, clinical studies supporting this hypothesis are lacking

Objectives To determine whether the process of transition is associated with increased disease-activity and a higher drop-out rate and to identify factors associated with disease activity and drop-out during transition

Methods After consent, 176 consecutive patients with all subtypes of JIA aged 10-24years, were included in an observational follow-up study of 3 years. Patients were divided into 3 age-classes, according to treatment location; pediatric rheumatology (age-class 1, 10-13yrs); patients in process of transition (age-class 2, 14-17yrs) and patients treated at adult rheumatology (age-class 3, 18-24yrs). Drop-out is defined as non-attending the clinic during the entire third year of the study period. Non-parametric tests are used to determine differences between age-classes

Results Age-classes did not differ regarding base-line variables of subtype (p=0.14), gender (p=0.42), uveitis (p=0.27), ANA-(p=0.38), RF- (p=0.12) or HLA B27-positivity (p=0.09) and current or past DMARD-use. Age and disease-duration were different as expected (table). Median disease-activity was not different between age-classes both at baseline and after three years (table). Drop-out rate in the entire study group was 20%. Drop-out was significantly higher in patients under transition compared with age-class 1 and 3 (table; p<0.01). Patients who dropped out had significantly lower disease-activity at baseline (JADAS 27, median 1.7, IQR 5.2 vs 4.3, IQR 6.5; p=0,01; and DAS 28 (median 1.5, IQR 1.4 vs 2.3, IQR 1.3; p<0.00), but did not differ regarding subtype (p=0.21), uveitis (p=0.34), ANA- (p=0.58) RF- (p=0.24) and HLA-B27 (p=1.0)

Conclusions In contrast to what is currently thought, the process of transition 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

References

  1. Bridging the gap in rheumatology. McDonagh JE, Southwood TR, Ryder CA. Ann Rheum Dis. 2000 Feb;59(2):86-93.

Acknowledgements This study was supported by a grant of the Dutch Arthritis Foundation

Disclosure of Interest None declared

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