JIA Rheumatologist Wait Times Within Benchmarks, Canadian Study Finds

JIA Rheumatologist Wait Times Within Benchmarks, Canadian Study Finds

Children with juvenile idiopathic arthritis (JIA) generally saw rheumatologists within the recommended wait times, a Canadian single-center study found.

Older patients waited longer, highlighting the need for better monitoring of this important measure of quality care in JIA, the researchers said.

The study, “Patient factors associated with waiting time to pediatric rheumatologist consultation for patients with juvenile idiopathic arthritis,” was published in the journal Pediatric Rheumatology.

Timely diagnosis and treatment of JIA are essential for better outcomes. In Canada, wait time to pediatric rheumatology consultation for JIA patients is a nationally endorsed quality measure.

Benchmark times from referral to first rheumatology visit are seven days for systemic JIA (sJIA), and four weeks for other JIA categories.

Researchers at the University of Calgary’s Cumming School of Medicine assessed wait times at a pediatric rheumatology center, seeking to identify factors associated with longer wait times.

They collected data on 164 eligible patients enrolled in a pharmacogenetic study in Alberta between 2002 and 2018, including dates of referral and first rheumatology visits.

Of the total, 116 patients (71%) were female, and median age at diagnosis was 8. The most common disease subtype was oligoarticular JIA (75 patients, or 46%), with rheumatoid factor (RF)-negative polyarticular JIA found in 48 patients (29%), and sJIA in six (4%).

The median distance between a patient’s home and the clinic was 22.8 km (about 14 miles).

Median wait time was 22 days between referral and pediatric rheumatologist visit, with no differences across JIA subtypes.

Most sJIA cases (67%) met the benchmark of seven days, with a median wait time of 1.5 days. Other JIA types also had high rates of benchmark adherence, namely RF-positive JIA (71%) and oligoarticular JIA (69%). In turn, fewer patients with psoriatic JIA (38%) and enthesitis-related arthritis (45%) met the four-week benchmark.

“Overall, 62% of JIA cases were seen within the established WT [wait time] benchmarks,” the researchers wrote.

Longer wait times were significantly associated with older age, but not other variables such as sex, pain, or inflammation. This was also observed in a previous French study, which identified joint pain and the presence of enthesitis as other factors contributing to longer wait times, while inflammatory markers and joint swelling and limping were linked to shorter times.

“It is possible that younger patients with oligoarthritis present more frequently with knee arthritis and limping, which is readily identified,” the researchers said. “Older children may also be less likely to bring non-painful swollen joints to the attention of family and healthcare providers.”

The study’s limitations included the small numbers of patients in some JIA categories, lack of information about symptom onset, and lack of ethnic diversity (72% of patients were Caucasian), which collectively may have affected data significance and extrapolation to other communities.

“While the median WTs for patients with JIA in this study met the national benchmarks, 38% of patients still experienced longer WTs for appointments indicating additional work needs to be done to improve access to pediatric rheumatology care,” the scientists said.

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