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A Population-Based Study

Debbie Ehrmann Feldman, PhD; Sasha Bernatsky, MD, PhD; Michal Abrahamowicz, PhD; Yves Roy, BA; Yongling Xiao, MSc; Jeannie Haggerty, PhD; Karen Leffondré, PhD; Pierre Tousignant, MD, MSc; Ciarán M. Duffy, MB, BCh, MSc

Arch Pediatr Adolesc Med. 2008;162(6):538-543.

Objectives  To describe consultation with an arthritis specialist because of suspected new-onset juvenile rheumatoid arthritis (JRA) and to determine factors associated with prompt consultation.

Design  Retrospective cohort study.

Setting  Physician reimbursement administrative data were obtained for all children aged 16 years or younger in the Province of Québec (Canada).

Participants  Suspected new-onset cases of JRA in 2000 were defined by a physician visit because of JRA, providing there had been no such claims in the preceding 3 years.

Main Exposure  First JRA diagnosis made by a non–arthritis specialist.

Main Outcome Measures  First consultation with an arthritis specialist subsequent to diagnosis by a non–arthritis specialist and time to first consultation with an arthritis specialist.

Results  Of 352 children and adolescents with suspected new-onset JRA identified by non–arthritis specialists, 159 (45.2%) were subsequently seen by an arthritis specialist. Mean (SD) time to consultation for those seen was 115.3 (213.8) days (median, 28 days). Younger children were more likely to obtain care from an arthritis specialist compared with those having JRA first diagnosed by a general practitioner.

Conclusion  Most patients with suspected new-onset JRA do not obtain prompt care from an arthritis specialist. Further research and action should focus on this issue so that outcomes may be optimized.

Author Affiliations: Faculte de Médecine; Ecole de Réadaptation, Université de Montréal (Drs Ehrmann Feldman and Leffondr é), Division of Clinical Epidemiology, McGill University Health Centre, McGill University (Drs Bernatsky, Abrahamowicz, and Tousignant and Ms Xiao), Santé Publique de Montréal (Dr Feldman), Direction de la Santé Publique de Montréal (Dr Tousignant and Mr Roy), Université de Sherbrooke (Dr Haggerty), and Montreal Children's Hospital (Dr Duffy), Montreal, Quebec, Canada.