THU0546 RETROSPECTIVE STUDY ON ANKLE INVOLVEMENT IN CHILDREN WITH JUVENILE IDIOPATHIC ARTHRITIS (JIA) WITH A FOCUS ON HOW TREATMENT IS LINKED TO OUTCOMES
Authors: Katie Munro, Kate Mcnally, Brian Chieng, Nicole Pike, Liam Vandewalle, Orla Macpherson, Colin Purdie, Janet Gardner-Medwin
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Ankle and midfoot joints have poorer long-term outcomes in JIA compared to other joints. Esbjornsson et al found that children with ankle involvement in the first year of disease have higher CHAQ scores and are less likely to have achieved remission by eight years [1]. Adherence to treatment has been shown to improve short term outcomes in children with JIA but there is a lack of studies which look at the long-term outcome of children who experience barriers to treatment [2]. <h3>Objectives:</h3> The aim of this study was to identify risk factors for severe ankle involvement in children with JIA. This abstract focuses on barriers to treatment; one of the main identified risk factors for adverse ankle outcomes. <h3>Methods:</h3> This was a retrospective study which looked at JIA patients who had been treated at the Children's Hospital in Glasgow and had tibiotalar, subtalar or midfoot involvement (TT, ST and MF respectively). 680 patients with JIA were identified from clinic lists from 2002 until 2018, inclusive. The clinic lists from 2008-2010 were inaccessible meaning that anyone who was seen exclusively within those two years has not been identified. Children with systemic arthritis were excluded. Of the 680 who were identified to have JIA; 123 have been found to have TT, ST or MF involvement. Of these; 104 were included in this study and the results of 19 patients were not avaliable for analysis. For each of the 104 patients with ankle involvement their notes were reviewed and information about their JIA disease course was noted; specifically looking at any ankle involvement or potential risk factors for a adverse outcome. Poor ankle outcomes was defined as ankle arthritis having a significant impact on the child's quality of life, persistently limited joint movemet for more than 12 months or damage on imaging. <h3>Results:</h3> Barriers to treatment was defined as anything which prevented a child from getting their medication as prescribed. Figure 1 shows the outcomes of children who had barriers to treatment compared to the children who did not. The difference between the two groups is stark with 67% of children who faced barriers to treatment having poor ankle outcomes compared to only 25% in the group which did not experience barriers to treatment. Furthermore, children with poor ankle outcomes are almost three times more likely to need surgery if they have experienced barriers to treatment compared to those who have not. This shows that children who experience barriers to treatment are more likely to have severe long-term damage to their ankle resulting in pain and limited functionality. Five children declined any treatment at one point in their care against the advice of their healthcare team and of these five; four (80%) had severe ankle involvement with one requiring surgery and another's ankle auto-fused. <h3>Conclusion:</h3> Experiencing barriers to treatment has been shown to increase the risk of poor ankle outcomes. Identified barriers to treatment ranged from concerns about adherence to needle phobias in addition to side effects and medication being with-held or taken incorrectly. This study demonstrates the need for further work to explore how these barriers can be effectively minimised. <h3>References:</h3> [1] Esbjörnsson A-C, Aalto K, Broström EW, et al. Ankle arthritis predicts polyarticular disease course and unfavourable outcome in children with juvenile idiopathic arthritis. Clin Exp Rheumatol;33:751–7. [2] Feldman DE, De Civita M, Dobkin PL, et al. Effects of adherence to treatment on short-term outcomes in children with juvenile idiopathic arthritis. Arthritis Care Res2007;57:905–12. doi:10.1002/art.22907 <h3>Disclosure of Interests:</h3> None declared