Relas Heikki, Luosujärvi Riitta, Kosola Silja
a Department of Rheumatology , Helsinki University Hospital and University of Helsinki , Helsinki , Finland.
b Children's Hospital, Helsinki University Hospital and University of Helsinki , Helsinki , Finland.
Mod Rheumatol. 2018 Sep;28(5):832-837. doi: 10.1080/14397595.2017.1416890. Epub 2018 Jan 8.
Across diagnosis groups, successful transition of adolescent and young adults from children's hospitals to adult care is often associated with decreased treatment adherence and treatment results. The aim of this study was to characterize disease activity and anti-rheumatic medications following transfer of care of juvenile idiopathic arthritis (JIA) patients to the adult clinic.
All consecutive JIA patients aged 16-20 years who visited the specific transition clinic in the rheumatology outpatient clinic of Helsinki University Hospital between November 2012 and May 2013 and between April 2015 and April 2016 were evaluated.
A total of 214 patients were identified, and 23 appeared in both cohorts. Females had higher disease activity scores (DAS) than males (DAS28-CRP 1.9 ± 0.7 versus 1.6 ± 0.3, p = .019; and DAS44-CRP 1.0 ± 0.7 versus 0.7 ± 0.5, p = .005; respectively) in the latter cohort. Disease-modifying antirheumatic drugs (DMARDs) were prescribed to 86% of patients, and 48% were on biological DMARDs (bDMARDs), whereas 14% had no specific treatments.
Disease activity and clinic attendance remained stable during the transition period. The proportion of transition phase JIA patients on bDMARDs was high and disease activity was low. Reasons for lower disease activity in males in the latter cohort require further investigation.
在各个诊断组中,青少年和青年从儿童医院顺利过渡到成人护理往往与治疗依从性降低和治疗效果不佳有关。本研究的目的是描述幼年特发性关节炎(JIA)患者转诊至成人诊所后的疾病活动情况和抗风湿药物使用情况。
对2012年11月至2013年5月以及2015年4月至2016年4月期间在赫尔辛基大学医院风湿病门诊特定过渡诊所就诊的所有16 - 20岁连续JIA患者进行评估。
共识别出214例患者,其中23例在两个队列中均出现。在后一个队列中,女性的疾病活动评分(DAS)高于男性(DAS28 - CRP分别为1.9±0.7对1.6±0.3,p = 0.019;DAS44 - CRP分别为1.0±0.7对0.7±0.5,p = 0.005)。86%的患者使用了改善病情抗风湿药物(DMARDs),48%的患者使用生物DMARDs(bDMARDs),而14%的患者未接受特定治疗。
在过渡期间,疾病活动和门诊就诊情况保持稳定。过渡阶段使用bDMARDs的JIA患者比例较高,且疾病活动度较低。后一个队列中男性疾病活动度较低的原因需要进一步研究。