Outcomes of Transition in Pediatric Rheumatology: Healthcare Utilization and Disease Activity in Juvenile Idiopathic Arthritis Patients Seen at the Young Adults with Rheumatic Disease Clinic in British Columbia

Objectives Approximately 50% of patients with juvenile idiopathic arthritis (JIA) require adult rheumatology care.[1] In British Columbia, the Young Adults with Rheumatic Diseases (YARD) clinic provides multidisciplinary care to young adults transitioning from pediatric to adult care. We aimed to describe the disease activity and healthcare utilization of JIA patients seen at BC Children’s Hospital who transitioned to the YARD clinic.

Methods We conducted a retrospective chart review of JIA patients transitioning from pediatric care to the YARD clinic between 2013 and 2023. Inclusion criteria: patients >17 years with ≥ 1 pediatric visit 12 months prior to YARD transfer, ≥1 YARD visit, and 1 12-month YARD follow-up (FU). Descriptive statistics assessed demographics, disease activity, medications and healthcare utilization (ED = emergency department, HA = hospital admission) 1 year pre- and post-transition. For study purposes, “transition” equates to the first YARD visit.

Results 68 patients (n=47, 69% female) met inclusion criteria: enthesitis-related arthritis (21/68), oligoarticular extended (6/68), oligoarticular persistent (9/68), polyarticular RF-negative (7/68), polyarticular RF-positive (7/68), psoriatic (8/68), systemic (4/68), unclassified (4/68), and rheumatoid arthritis (2/68). The YARD clinic received 122 JIA patient referrals. Median transition age was 18 years. 13.24% of patients had pre-existing uveitis. Median time from last pediatric visit to first YARD visit was 4.45 months (2.96-6.06). Patients attended an average of 3.54 FU visits 12 months pre-transition and 2.76 visits 12 months post-transition. Median missed rheumatology visits: 0 (0-1) pre- and 0 (0-1) post-transition (Table 1). Median PGA scores were 2 (IQR 0-2, n=64) pre-transition and 0 (0-2, n=53) post-transition. ED visits occurred in 4/68 patients pre- and 3/53 post- transition (Table 1). HA occurred in 3/68 and 1/53 patients pre- and post-transition. Post-transition, 15 patients were discharged <12 months due to repeated missed appointments (3/15), distance/transportation challenges (3/15), refusal of care (2/15), relocation for work/education (2/15), and unspecified reasons (5/15). 7/15 patients were transferred to adult rheumatologists and 5/15 to family physicians.

Conclusion JIA patients transitioning to the YARD clinic maintained stable rates of ED use and HA in the first year, suggesting minimal acute complications. Missed visit rates remained similar, and clinical disease activity improved. Early discharge was moderately high, primarily due to geographic challenges and patient preferences. These results show that youth with JIA can maintain healthcare engagement and stable outcomes in this model, supporting its efficacy. Further research assessing long-term healthcare utilization and disease control following transfer to adult care is needed.

References [1.] Chhabra A. Rheumatology (Oxford) 2020;59:3727-30.