AB0989 PATIENTS’ AND CAREGIVERS’ ASSESSMENT OF A DEDICATED OUTPATIENT SERVICE FOR INTRAARTICULAR GLUCOCORTICOID INJECTIONS IN JUVENILE IDIOPATHIC ARTHRITIS
Authors: Hanan Jadoun, Aurora Pucacco, Angela Aquilani, Andrea Uva, Fabio Basta, Rebecca Nicolai, Fabrizio De Benedetti, Silvia Magni-Manzoni
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Patients with juvenile idiopathic arthritis (JIA) may require several hospital admissions over the disease course, due to flares or persistently active arthritis, with a negative impact on the patients' and family's daily life. To provide timely intervention and support the patients' and families' quality of life, in 2018 an afternoon outpatient service for intraarticular glucocorticoid injections (IAGI) in JIA has been created at the study center. <h3>Objectives</h3> To evaluate the patients' and caregivers' assessment of the outpatient service for IAGI in JIA; to investigate demographic and clinical features of patients entering the service. <h3>Methods</h3> All consecutive JIA patients and their caregivers seen at the IAGI outpatient service from February 2018 to January 2019 completed a satisfactory questionnaire just after the IAGI procedure. The patient's part included: satisfaction on the overall service and on dedicated personnel (yes/no, why), procedure pain assessment (VAS 0-10, 0=none; 10 worst); whereas the caregiver's part: satisfaction on the overall service (yes/no, why), facilitation of family burden (yes/no, why). Demographic and clinical data of patients, including previous hospitalization for IAGI under general sedation or local anesthesia and geographical provenance, were registered during the questionnaire completion. Descriptive analysis was performed on data. Open answers were synthetized in items. <h3>Results</h3> All of the 46 JIA patients seen at the IAGI outpatient service and their caregivers completed the questionnaire. Patients were mostly females (78%) with early disease onset (median 4.8 years) and positive ANA status (61%). The majority (52%) had persistent oligo-JIA, followed by extended oligo-JIA (26%), RF-negative polyarthritis (17%), ERA and systemic JIA (2%, respectively). The median age at IAGI was 14.7 years (IQ 11.3-19.5). Forthy patients (87%) had previous hospitalization for IAGI, mostly under general sedation (64%). All patients, except a 12 year old girl (0.02%) with uncontrolled needle phobia and previous IAGI in general sedation, (99.98%) and all caregivers (100%) were satisfied with the IAGI outpatient service. In Table 1 reasons of satisfaction are detailed in items. Procedural pain was median rated 3 (IQ 2-6). Most of the families came from the city or province of the study center (76%); 17% from other provinces of the same geographical region; 7% from other regions. <h3>Conclusion</h3> The results outline the afternoon IAGI outpatient service foster the management of flares or persistently active arthritis in JIA patients, particularly at older ages, with high rate of satisfaction and lower impact on patients' and family burden compared to hospital admission and, of note, despite moderate pain rating and multiple site injections. This supports the development of Diagnostic Therapeutic Care Pathways for JIA patients, in the view of improving patients' quality of life and also towards resource optimization. <h3>References</h3> [1] Minden K. What are the costs of childhood-onset rheumatic disease?Best Pract Res Clin Rheumatol2006;20:223-40. [2] Cavazzana L, Fornili M, Filocamo G, Agostoni C, Auxilia F, Castaldi S. Hospital clinical pathways for children affected by juvenile idiopathic arthritis. Ital J Pediatr2018;44:139. <h3>Disclosure of Interests</h3> Hanan Jadoun: None declared, Aurora Pucacco: None declared, Angela Aquilani: None declared, Andrea Uva: None declared, Fabio Basta: None declared, Rebecca Nicolai: None declared, Fabrizio De Benedetti Grant/research support from: Abbvie, SOBI, Novimmune, Roche, Novartis, Sanofi, Pfizer, Silvia Magni-Manzoni Consultant for: Abbvie, Speakers bureau: Abbvie