AB1016 OUTCOME OF TRANSITION OF CARE IN YOUNG ADULTS WITH JUVENILE ONSET CHRONIC RHEUMATIC DISEASES
Authors: Patrícia Martins, Sofia C. Barreira, Ana Teresa Melo, Raquel Campanilho-Marques, Joao Eurico Fonseca, Filipa Oliveira-Ramos
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> The transition process of adolescent care from a paediatric to an adult medical environment may affect the compliance with the management plan. Paediatric care is family oriented and relies on significant parental involvement in decision making. On the contrary, adult care is patient-specific and requires autonomy and independent skills. <h3>Objectives</h3> The aim of this study was to evaluate the transition of care at our centre, namely the adherence to clinical appointments, modification of disease activity and patient satisfaction. <h3>Methods</h3> All consecutive patients with juvenile onset of rheumatic chronic diseases followed in a young adult clinic were included. Disease activity was evaluated at the last appointment in the paediatric unit and up to 2 years after transition of care, according to validated scores for each rheumatic disease. Dropout was defined as not attending the clinic for 2 consecutive visits. Global assessment of patient satisfaction with the clinical appointments before and after transition of care was evaluated in a scale of 0 to 10. Variables were analysed as means, medians and frequencies as appropriate. Univariate analysis was performed with student t-test and Qui-square. <h3>Results</h3> 126 patients were included. Of these, 77 (61.1%) had juvenile idiopathic arthritis (JIA, see table I for list of diagnosis), 78 (61%) were female with a mean age of 23.1±3.2 years and a mean disease duration of 12.7±5.3 years. During the transition of care, 92 patients were treated with conventional disease modifying antirheumatic drugs (73%) and 35 with biologic therapy (27.8%). 69 patients (54.7%) missed at least one clinical appointment with a dropout rate of 9%. This was associated with longer disease duration (15.9 vs 12.3 years, p=0.024). 11 patients (8.7%) had worsened clinical activity: 5 patients with polyarticular JIA with arthritis flare (∆DAS28 2.14 ± 0.83); 4 patients with oligoarticular JIA with new onset uveitis and 2 patients with juvenile systemic lupus erythematosus with a SLEDAI increase from 5 to 16 points. 4 patients abandoned DMARDs. Regarding patient satisfaction questionnaire, paediatric rheumatology appointments had a median evaluation of 9 (7-10), adult rheumatology appointments of 8 (5-10) and the transition process had an evaluation of 8 (5-10). The majority of patients reported the longer appointment waiting time as the major negative aspect after transition. <h3>Conclusion</h3> In our centre the transition of care had a small percentage of dropping out from the clinic, which was associated with longer disease duration, a slight worsening of disease activity and a 10% decrease in patient satisfaction. <h3>References</h3> [1] Foster H, et al. EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases. Annals of the Rheumatic Diseases 2018; 77 960-960 Published Online First: 10 May 2018. <h3>Disclosure of Interests</h3> None declared