Clinical Correlates of a Successful Transition in Pediatric Rheumatology

Objective This study aimed to identify key prognostic factors for a successful transition from pediatric to adult rheumatology care.

Methods A retrospective analysis was conducted of patients enrolled in the transition program at the Hamburg Centre for Pediatric and Adolescent Rheumatology between December 2014 and December 2023. Only patients who received disease-modifying antirheumatic drugs (DMARDs) during their disease course were offered to participate in the transition program. The first 2 visits (T1 and T2) were conducted in the presence of both adult and pediatric specialists in the pediatric rheumatology clinic, followed by a third visit (T3) at the adult rheumatology clinic. Successful transitions were defined as attendance at T3. Patients who decided to leave the program were excluded. Variables analyzed included demographics, diagnosis, treatment, joint count, and Childhood Health Assessment Questionnaire (CHAQ) scores.

Results Out of 547 included patients, 359 (65.6%) completed the transition successfully. Completion was highest in patients with uveitis (96%, with the lowest risk to discontinue the transition process [RDTP] of 0.16), biologic DMARD therapy (RDTP 0.42), and combination DMARD treatment (RDTP 0.27). Higher joint counts, increased disease activity, and elevated CHAQ scores were associated with a successful transition to adult care.

Conclusion Higher disease activity, ongoing DMARD treatment, and specific diagnoses such as uveitis are associated with better transition outcomes. Patients with no active treatment may require additional support.