S. Concha, MD, P.S. Morales, MD, E. Talesnik, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, Pontificia Universidad Católica de Chile.
A. Borzutzky, MD, Department of Pediatric Infectious Diseases and Immunology, School of Medicine, and Millennium Institute on Immunology and Immunotherapy, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Rheumatol. 2021 Nov;48(11):1725-1731. doi: 10.3899/jrheum.210011. Epub 2021 May 1.
To evaluate the clinical and demographic characteristics of patients with juvenile idiopathic arthritis (JIA) in Chile and compare treatments and outcomes before and after the introduction in 2010 of the Explicit Health Guarantees (GES) for JIA, a national universal access program for diagnosis and treatment of this condition.
The clinical records of 280 patients with JIA followed at a private tertiary academic health network between 2007 and 2018 were reviewed.
Seventy percent of patients with JIA were female, mean age at diagnosis was 8.5 ± 4.8 years and mean follow-up was 4.0 ± 3.7 years. After GES implementation (post-GES), time to evaluation by pediatric rheumatologist and diagnostic delay were significantly reduced (15.0 ± 4.5 vs 9.0 ± 4.2 months, = 0.004). In addition, use of magnetic resonance imaging significantly increased post-GES ( < 0.001). In terms of JIA treatments, before GES implementation, no patients received biologics. Of the 67 patients diagnosed before 2010 with continued follow-up at our center, 34% began biologic treatment after GES implementation. Of 196 patients diagnosed post-GES, 46% were treated with biologics. JIA remission rates were significantly higher in patients diagnosed post-GES compared to pre-GES (43% vs 29%, = 0.02). Post-GES, we observed a significant decrease in uveitis complications among JIA patients (45% vs 13%, = 0.04).
The implementation of a national government-mandated universal access program for guaranteed JIA diagnosis and treatment led to earlier access to a pediatric rheumatologist and JIA diagnosis, increased rates of treatment with biologic drugs, higher rates of clinical remission, and lower rates of uveitis complications in Chilean children with JIA.
评估智利幼年特发性关节炎（JIA）患者的临床和人口统计学特征，并比较在 2010 年明确的 JIA 健康保障（GES）实施前后的治疗方法和结果，这是一项针对该疾病诊断和治疗的国家全民准入计划。
回顾了 2007 年至 2018 年期间在一家私立三级学术医疗网络就诊的 280 例 JIA 患者的临床记录。
70%的 JIA 患者为女性，平均诊断年龄为 8.5 ± 4.8 岁，平均随访时间为 4.0 ± 3.7 年。在 GES 实施后（GES 后），儿科风湿病医生的评估时间和诊断延迟明显缩短（15.0 ± 4.5 比 9.0 ± 4.2 个月， = 0.004）。此外，GES 后磁共振成像的使用率显著增加（ < 0.001）。在 JIA 治疗方面，在 GES 实施之前，没有患者接受生物制剂治疗。在我们中心继续接受随访的 67 例在 2010 年之前诊断的患者中，34%在 GES 实施后开始接受生物制剂治疗。在 196 例 GES 后诊断的患者中，46%接受了生物制剂治疗。与 GES 前相比，GES 后诊断的 JIA 患者的缓解率显著更高（43%比 29%， = 0.02）。GES 后，我们观察到 JIA 患者葡萄膜炎并发症的显著减少（45%比 13%， = 0.04）。
在智利，实施国家政府授权的 JIA 诊断和治疗全民准入计划，导致儿童更早获得儿科风湿病医生的诊治，增加了生物药物治疗的比例，提高了临床缓解率，并降低了 JIA 患儿葡萄膜炎并发症的发生率。
