E65 Assessment of Tunisian rheumatologists’ common practices towards children with rheumatic diseases
Authors: Makhlouf Yasmine , Belhaj Wiem , Miladi Saoussen , Fazaa Alia , Boussaa Hiba , Souebni Leila , Kassab Selma , Chekili Selma , Ben Abdelghani Kawther , Laatar Ahmed 
Published: August 2023

Abstract

Background
In the past few years, many advances have been made in the subspecialty of pediatric rheumatology in emerging countries. However, some gaps were identified requiring an update of rheumatologists' knowledge in this field [1].
Our study aimed to assess rheumatologists’ knowledge and common practices when managing children with rheumatic diseases.

Methods
We conducted an anonymous cross-sectional study including Tunisian rheumatologists. They were invited to answer an online questionnaire. The survey included demographic data, as well as outcomes of interest: rheumatologists’ knowledge and attitudes towards the management of patients with rheumatic diseases. We also inquired about the scores used to evaluate children with juvenile idiopathic arthritis (JIA). The level of confidence in the management of the pediatric population was assessed by the Likert scale.

Results
At the end of the survey, 51 responses were collected. The participants were rheumatology specialists (63%), university hospital assistants (21%), and residents (16%). Sixty-two percent of responders worked in the hospital. The mean number of years of practice (including years of residency) was 16.3 ± 5.9 [2–36]. Two rheumatologists reported that they managed over 10 children per month for rheumatic disorders. Four rheumatologists reported that they managed from 6 to 9 children per month for rheumatic disorders. Forty rheumatologists reported that they managed from 1 to 5 children per month for rheumatic disorders. And 5 rheumatologists reported that they do not manage any children with rheumatic disorders.
Only 10 (20%) doctors received training in pediatric rheumatology during their curriculum: online training (6), national training program (2) and international training program (2). Regarding the scores used to assess the different subtypes of JIA, 23 (45%) rheumatologists were not aware of the JADAS 10 score and 39 (76%) did not know the JSPADAS score. When inquiring about the level of confidence in the management of the pediatric population the average level of confidence was 2.49 ± 1.82 [0–5]. Only 2% were not confident at all. A pediatric specialist was requested for a second opinion upon diagnosis in 51% of difficult cases and in 12% of less challenging cases. Only 19 respondents managed the patients by themselves without referring them to other specialists. The rheumatologists' apprehension regarding the management of the pediatric population was attributed to the lack of training in pediatric rheumatology (94%), the absence of pediatric internship during the specialization curriculum (43%) and the lack of mastery of children’s examination (12%).

Conclusion
Our study highlighted that only a few Tunisian rheumatologists considered themselves confident in the management of children with rheumatic disorders. The establishment of training programs in pediatric rheumatology could enhance rheumatologists' knowledge in this field and give them more confidence in the management of this population.
[1] Zisman D, Samad A, Ardoin SP, et al. US Adult Rheumatologists' Perspectives on the Transition Process for Young Adults with Rheumatic Conditions. Arthritis Care Res (Hoboken). 2020; 72(3):432–40.
This was an anonymous cross-sectional study.
All subjects participated voluntary.