TY - JOUR T1 - Transfer from Pediatric to Adult Care Is Hardly Child’s Play JF - The Journal of Rheumatology JO - J Rheumatol SP - 3 LP - 5 DO - 10.3899/jrheum.200323 VL - 48 IS - 1 AU - Amanda Steiman AU - Zahi Touma Y1 - 2021/01/01 UR - http://www.jrheum.org/content/48/1/3.abstract N2 - In this issue of The Journal, Chang and colleagues describe patterns of rheumatologic/nephrologic care and changes in healthcare use and medication adherence among patients with childhood-onset systemic lupus erythematosus (SLE) during their transfer from pediatric to adult care1. The most salient of their findings was a 26% rate of loss to follow-up, defined as more than 12 months between last pediatric visit and first adult visit, or end of enrollment. Consequently, and not surprisingly, ambulatory visits declined (although interestingly, there was no signal for increased acute care use). Medication adherence was poor across groups, regardless of whether the transfer was deemed a “success.”Taken together, Chang, et al’s findings reinforce the overarching themes of the literature on pediatric transition to adult care, not to mention the anecdotal — but remarkably consistently held — impressions of physicians who practice in this space: that the period of transition from pediatric to adult care is littered with landmines, quilted with quagmires. Some find their way to adult care and succeed; many others, however, fail dramatically and with dire consequences. Other groups have reported that only 50% of pediatric rheumatology patients transition successfully to adult care2,3. Surely, we could forge a less perilous path.And while patients with childhood-onset SLE, like those in the Chang study, reflect a particularly vulnerable group, with complex and potentially fatal multisystemic disease, the challenges associated with transfer from pediatric to adult care transcend diagnosis or specialty. Themes are consistent among chronic diseases of onset in childhood that persist into adulthood regardless of whether the young patient has SLE, juvenile idiopathic arthritis (JIA), diabetes, or sickle cell disease4,5,6.The unique challenges associated with care of these patients are … Address correspondence to Dr. A. Steiman, Sinai Health System, Medicine, 60 Murray St., Suite 2-223, Toronto, ON M5T 3L9, Canada. Email: amanda.steiman{at}sinaihealthsystem.ca. ER -