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
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