E62 Paediatric rheumatology cases at department of physical medicine/rheumatology Victoria hospital over nine years
Authors: Koussougbo Ouma Devi , Munnee Kamini Boodhoo , Karooa Anupa Roshni Ramjutun 
Published: August 2023

Abstract

Introduction
Victoria Hospital is a centrally located public hospital in Mauritius with a catchment area attaining around 500 000 people. Paediatric rheumatic cases refer to rheumatic diseases occurring in children below the age of 16. Till date there is no official data on the number of paediatric rheumatic cases seen at Victoria hospital.

Objective
To study paediatric rheumatic cases seen and followed up over a period of nine years at Victoria Hospital Mauritius.

Methods
This is a retrospective study conducted in the department of Physical Medicine/Rheumatology. Data was extracted from files of patients below age of 16 following treatment over the last 9 years (December 2013 till December 2022). Basic information on age, gender, family situation, were noted. Clinical information on diagnosis, treatment and outcomes were also noted. Data was processed using IBM SPSS.

Results
A total of 18 children are being followed by our department since the last 9 years and they had been seen by 3 different rheumatologists.
13 patients (72.2%) were referred internally either through Paediatrics or Unsorted Outpatient units, and 5 patients (27.7%) were referred from private hospitals. The ratio of male to female was 1:5.
The mean age of onset of symptoms was 9.7 ± 4.75 years, mean age at which a diagnosis was made was 10.7 ± 4.50 years, and the mean age at which patients were referred to our department was 11.1 ± 4.45 years. The mean diagnostic delay is one year. Four cases are adults now.
9 cases (50%) are being followed for Juvenile Idiopathic Arthritis (JIA) of which 7 (38.9%) had polyarticular JIA (pJIA) and 2 (11.1%) had systemic JIA (sJIA). Paediatric Systemic Lupus
Erythematosus accounted for 5 cases (27.8%), 1(5.6%) had Juvenile Dermatomyositis , 1 (5.6%) had Juvenile Fibromyalgia, 1(5.6%) had Psoriatic Arthritis and 1 (5.6%) had Rheumatic Fever.
36.8% of children have single parents and 44.4% of parents did manual jobs. Social status of parents statistically correlate with disease conditions (P &lt; 0.001).
Nine (50%) patients were on methotrexate, 8 (44.4%) of JIA were treated with biological DMARDs
(bDMARDs), 4 of them achieved remission and has stopped bDMARDs and 4 of them are on maintenance dose for remission. Tocilizumab was the mostly used bDMARDs 5 (62.5%), followed by rituximab 2 (25%); other bDMARDs used were infliximab 1 (12.5%) and adalimumab 1 (12.5%).
Uveitis was seen in one of the patients with JIA and is being managed with infliximab. Two patients (one systemic JIA and one SLE) have hip joint involvement. The SLE case has developed osteonecrosis of hip joints.
patients (55.5%) are in remission at present, 4 (22.2%) in partial remission, 3 (16.7%) still having repeated flares and one has physical impairment.

Discussion
This is the first published set of data on Paediatric Rheumatology cases at Victoria Hospital. A diagnostic delay of around one year is noted. 34.5% of children live with single parents and hence might not have received the care and support as required. Furthermore, the cases seen could only be part of the tip of the iceberg as patients are often lost in between paediatric and rheumatology units. Paediatric Lupus patients remain challenging to manage.

Conclusion
This is the first report of published data on paediatrics rheumatic disease from Victoria Hospital in Mauritius. We need more collaborative data from other centres to work out the prevalence and incidence of paediatric rheumatic diseases in our country. Efforts must be made to shorten diagnostic delay and referral time.