Research ArticleArticle
Obstacles in Early Diagnosis of Children With Juvenile Idiopathic Arthritis: A Nationwide Israeli Retrospective Study
Yochai Frenkel, Irit Kraushar, Mohamad Hamad Saied, Ruby Haviv, Yosef Uziel, Merav Heshin-Bekenstein, Eduard Ling, Gil Amarilyo, Liora Harel, Irit Tirosh, Shiri Spielman, Yackov Berkun and Yonatan Butbul Aviel
The Journal of Rheumatology December 2022, jrheum.220359; DOI: https://doi.org/10.3899/jrheum.220359
Yochai Frenkel
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Irit Kraushar
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Mohamad Hamad Saied
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Ruby Haviv
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Yosef Uziel
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Merav Heshin-Bekenstein
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Eduard Ling
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Gil Amarilyo
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Liora Harel
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Irit Tirosh
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Shiri Spielman
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Yackov Berkun
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Yonatan Butbul Aviel
Funding for conducting the study was received from AbbVie. Y. Frenkel, MD, Department of Pediatrics A, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa. I. Kraushar, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, Haifa. M.H. Saied, MD, The Ruth and Bruce Rappaport Faculty of Medicine, Technion – Israel Institute of Technology, and Department of Pediatrics, Carmel Medical Center and Clalit Health Services, Haifa. R. Haviv, MD, Y. Uziel, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Meir Medical Center, Kfar Saba, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. M. Heshin-Bekenstein, MD, Tel Aviv University, Sackler School of Medicine, and Pediatric Rheumatology Service, Dana-Dwek Children's Hospital, Tel Aviv Medical Center, Tel Aviv. E. Ling, MD, Department of Pediatrics, Pediatric Rheumatology Unit, Soroka University Medical Center, and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva. G. Amarilyo, MD, L. Harel, MD, Tel Aviv University, Sackler School of Medicine, Tel Aviv, and Pediatric Rheumatology Unit, Schneider Children's Medical Center, Petah Tikva. I. Tirosh, MD, S. Spielman, MD, Pediatric Rheumatology Service and Pediatric Department, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, and Tel Aviv University, Sackler School of Medicine, Tel Aviv. Y. Berkun, MD, Department of Pediatrics, Hadassah-Hebrew University Medical Center, Mount Scopus, and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem. Y. Butbul Aviel, MD, Department of Pediatrics B, and Pediatric Rheumatology Service, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Haifa, Israel. The authors declare no conflicts of interest relevant to this article. Address correspondence to Dr. Y. Butbul Aviel, Ruth Rappaport Children's Hospital, Rambam Health Care Campus, Efron Street 1, Bat-Galim, Haifa 31096, Israel. Email: yonatanbutbul@gmail.com. Accepted for publication November 18, 2022.
Abstract
Objective Characterization of the stages that patients with juvenile idiopathic arthritis (JIA) pass until they are diagnosed, and analysis of the different causes that lead to a delay in JIA diagnosis in Israel.
Methods This is a retrospective cohort study conducted in 8 pediatric rheumatology centers in Israel. All patients diagnosed with JIA between October 2017 and October 2019 were included in the study. Demographic, clinical, and data regarding the referring physicians were collected from hospital and community medical charts.
Results Of 207 patients included in the study, 201 cases were analyzed, 71.1% of the population were female. Patients, on average, were evaluated during the diagnostic process by 3.1 different physicians. In most cases, they initially met with a pediatrician in the community setting (61.2%), and later, most commonly referred to a rheumatologist by the community pediatrician (27.9%). The median time until diagnosis was 56.0 days (range: 1.0-2451.0 days). Patients diagnosed with polyarticular and spondyloarthritis/enthesitis-related arthritis (SpA/ERA) JIA subtypes had the longest period until diagnosis (median: 115.5 and 112.0 days, respectively). Younger age correlated with a quicker diagnosis, and females were diagnosed earlier compared to males. Fever at presentation significantly shortened the time to diagnosis (P < 0.01), whereas involvement of the small joints/sacroiliac joints significantly lengthened the time (P < 0.05).
Conclusion This is the first nationwide multicenter study that analyzes obstacles in the diagnosis of JIA in Israel. Raising awareness about JIA, especially for patients with SpA/ERA, is crucial in order to avoid delays in diagnosis and treatment.
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In this issue
The Journal of Rheumatology
Vol. 50, Issue 3
1 Mar 2023
Obstacles in Early Diagnosis of Children With Juvenile Idiopathic Arthritis: A Nationwide Israeli Retrospective Study
Yochai Frenkel, Irit Kraushar, Mohamad Hamad Saied, Ruby Haviv, Yosef Uziel, Merav Heshin-Bekenstein, Eduard Ling, Gil Amarilyo, Liora Harel, Irit Tirosh, Shiri Spielman, Yackov Berkun, Yonatan Butbul Aviel
The Journal of Rheumatology Dec 2022, jrheum.220359; DOI: 10.3899/jrheum.220359
Obstacles in Early Diagnosis of Children With Juvenile Idiopathic Arthritis: A Nationwide Israeli Retrospective Study
Yochai Frenkel, Irit Kraushar, Mohamad Hamad Saied, Ruby Haviv, Yosef Uziel, Merav Heshin-Bekenstein, Eduard Ling, Gil Amarilyo, Liora Harel, Irit Tirosh, Shiri Spielman, Yackov Berkun, Yonatan Butbul Aviel
The Journal of Rheumatology Dec 2022, jrheum.220359; DOI: 10.3899/jrheum.220359
