Transitioning Juvenile Idiopathic Arthritis to Adult Care: Disease Reclassification, Patterns of Care, and Mental Health Insights
Notice bibliographique
Résumé
Objectives Although the management of juvenile idiopathic arthritis (JIA) is well-established in the pediatric context, management in adulthood and long-term outcomes, including mental health concerns, are less understood, limited in part by reclassification to adult diagnoses, such as rheumatoid arthritis (RA) and ankylosing spondylitis (AS). Current management of adults with JIA is largely extrapolated from pediatric strategies; it is unclear if this is best practice. This study’s objective is to discern patterns of care and natural history of JIA after patients enter Adult Rheumatology care. Methods Patients with JIA followed by Adult Rheumatology at a large Edmonton site were identified through the electronic medical record. Patients were excluded if they were under age 17 or their diagnosis was reclassified prior to age 18. A retrospective chart review was completed to collect information including the transition into Adult Rheumatology care, current disease status and classification, DMARD use, uveitis frequency and monitoring, and mental health interventions. Results 181 patients were identified (135 female). Most patients (74.3%) were referred from Pediatric Rheumatology while 5.4% were referred from elsewhere but were previously followed by Pediatric Rheumatology; 20% did not have transfer-of-care details available. 74% were in remission or low disease activity state, of whom 17.9% were in drug-free remission when transitioned to adult care. 41.9% were reclassified under a new diagnosis in adulthood: RA (26.2%), psoriatic arthritis (5.8%), AS (7.6%), and IBD-associated inflammatory arthritis (2.3%). 40.6% had documented uveitis screening in adulthood; 79.3% with prior childhood uveitis had ongoing ophthalmologic surveillance. All patients diagnosed with uveitis in adulthood had uveitis in childhood; 41.1% of children with uveitis experienced recurrence in adulthood. As children, 28.2% sought mental health services. Further, 35.4% were treated for mental illness in adulthood, while 4.4% received inpatient psychiatric treatment as a child or adult. Conclusion Our study identified a cohort of patients with JIA followed by Adult Rheumatology; nearly half were reclassified to an alternate Adult Rheumatology diagnosis, which may contribute to the challenges of managing and monitoring long-term outcomes of patients with JIA. Purposeful ongoing uveitis surveillance in adulthood was fair (79%) and captured all patients who experienced uveitis in adulthood, highlighting its importance in this particular group. The high prevalence of mental illness treatment within this cohort suggests that patients with JIA may benefit from monitoring for mental health issues. Best Abstract by a Medical Student Award
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».