Transitioning Juvenile Idiopathic Arthritis to Adult Care: Disease Reclassification, Patterns of Care, and Mental Health Insights
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".