Background The transition of patients with childhood-onset rheumatic diseases from pediatric to adult rheumatology care providers requires a gradual and effective approachment given the chronic and complex nature of these disorders. The transition units play an important role to facilitate this step. Several models have been proposed to manage this process in a multidisciplinary way, but there is no consensus on which is the best model.
Objectives To describe the epidemiological and clinical characteristics of patients treated in a transition care unit for pediatric-onset rheumatic diseases in a Spanish tertiary center.
Methods We performed a descriptive and retrospective study of patients seen in the transition unit of our center between January 2011 and December 2014. All patients with age range 16–24 years (target population of the unit) were included. Demographics, diagnosis and treatment data were collected through review of their medical records. The consultation of the transition unit is carried out once a week and has a continuous model in which the pediatric rheumatologist is the same responsible of the transition consultation and coordinates the multidisciplinary team, attending patients of our own center as well as other patients referred to the unit.
Results During the period studied a total of 109 patients were attended, the majority of them women (62.4%) with a mean age at beginning of follow-up by the unit of 17 years. The origin of the patients was the pediatric rheumatology consultation of our center in 47%, primary care 13%, the department of Pediatrics of our center 4%, departments of pediatric rheumatology of other centers 4%, other non-pediatric rheumatologists 8% and pediatric orthopedics 5%. The patients came from the area assigned to the hospital in 54%, other areas 32% and other regions in 14%. The most frequent diagnoses were juvenile idiopathic arthritis (JIA) in 32.7%, juvenile systemic lupus erythematosus 13.1%, juvenile dermatomyositis 2.8%, juvenile systemic sclerosis 2.8%, primary Raynaud's phenomenon 5%, Behcet's disease 2.8%, Scheuermann's disease 2.8% and mechanical low back pain 2.8%. The management of the patients required participation of other medical specialties in 53%. At the end period studied 62% of patients were still in follow-up, 22% were discharged, 15% lost follow-up and 1% died. With regard to treatment 43% of patients received DMARDs (methotrexate, sulfasalazine, hydroxychloroquine), 13.7% immunosuppressants (azathioprine, cyclosporine, mycophenolate mofetil, cyclophosphamide) and 21% biologic drugs (anti-TNF 14, tocilizumab 4, rituximab 3, anakinra 3, belimumab 1).
Conclusions The diseases most frequently treated in the transition unit of our center were JIA and systemic autoimmune diseases and more than half of the cases require a multidisciplinary management with involvement of other departments. A high percentage of patients were still active at the end of follow-up by the unity and required treatment with DMARDs and biologic drugs. Due to the characteristics of the population treated at our center, the current operating model of the unit allows the continuity of proper management of these patients.
Castrejόn I. Transitional care programs for patients with rheumatic diseases: review of the literature. Reumatol Clin. 2012.
Disclosure of Interest None declared