The importance of transition from pediatric to adult rheumatology care in juvenile idiopathic arthritis

ABSTRACT

Introduction: Juvenile idiopathic arthritis (JIA) is the most common rheumatic inflammatory condition in childhood. The long-term morbidity, mortality, and quality of life have improved with the earlier use of disease-modifying drugs (DMARDs) and the availability of biology disease-modifying drugs (bDMARDs). Despite the improvement of treatment, around 50% of the patients reach adulthood with articular and/or extra articular disease activity. A careful planned transition from pediatric to adult care is necessary to reduce the loss of follow-up that is associated with stopping medications, flares, and disability due to untreated arthritis or uveitis.

Areas covered: This narrative review provides an overview of the importance of transition in JIA Articles were selected from Pubmed searches.

Expert opinion: JIA patients, family, and healthcare workers have to be trained to provide an effective transition plan, based on local and national policies. Important aspects such as expectations, maturation, disease characteristics, disease activity, adherence, disability, and psychological aspects among others have to be considered and addressed during the transition phase to improve self-esteem, self-assurance, and quality of life.

KEYWORDS:

• Transition of care
• juvenile idiopathic arthritis
• long-term outcome
• young adult clinic
• Flare
• SLE
• risk factors

Article highlights

• JIA is a chronic disease and the transition from pediatric to adult care should be carefully planned.

• Checklists and transition-readiness tools enhance and qualify the transition of care of young adults.

• Multiprofessional team members addressing physical, mental, and vocational aspects improve the transition process.

• Maturation, independence, disease activity, and medication should be taken into account when planning an effective transition.

• Patients, family members, and healthcare professionals should be actively part and support the transition plan.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by grants from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) – Financial Code 001; Fundação Apoio À Pesquisa Estado São Paulo-Brasil (FAPESP - 2019/06632-5), National Council for Scientific and Technological Development CNPq 306723/2019-0).