Background/Purpose: Many patients are overwhelmed with the diagnosis of chronic childhood arthritis and require long-term treatments. Our objective was to develop a new, child and family centered, multi-disciplinary model of care for newly diagnosed children with Juvenile Idiopathic Arthritis (JIA), in order to provide early access to our multidisciplinary team and achieve better clinical outcomes and patient satisfaction.

Methods: A multidisciplinary Early Arthritis Clinic (EAC) program that included an OT, PT, SW, RN, Pharmacist and MD was developed. Children with a confirmed new diagnosis of arthritis were referred through pediatric rheumatologists to the EAC. Patients were seen by each sub-specialty during their visit with a provided pre-set schedule. The team met pre- and post-appointments to develop a comprehensive management plan. The primary focuses of this clinic were to ensure patient and family understanding of disease process, medications, and access to required resources, to ensure patient safety and well-being. Once patients were stable they were transferred back to their primary rheumatologist for ongoing care. Patient characteristics, treatments, time from diagnosis to first EAC visit, and time to re-transfer to general rheumatology clinic were captured. Each visit the following quality measurements were collected: Visual analog scale for pain 0-10 (VAS), juvenile arthritis disease activity score (JADAS), childhood health assessment questionnaire (CHAQ), patient and physician global assessment of disease activity.

Results: The cohort included 49 patients with 61% females and a median age of seven. The majority of patients had a rheumatoid factor negative polyarticular (38.8%) and persistent oligoarticular (36.7%) JIA subtype. The median time from diagnosis to first EAC visit was 68 days and a median time of 315 days was spent in EAC. In the first year of disease 59 % were treated with DMARDs and 27% with biologics. The median JADAS 71 at disease onset was 12 (Q25/75 7.4/17.5); decreased at 6 months to 3.7 (Q25/75 0.2/7.7 and at 12 months to 2.2 (Q25/75 0.4/6.2). The median pain VAS at baseline was 3.5 (Q25/75 2/6.3); decreased at 6 months to 0.6 (Q25/75 0/3) and at 12 months was 1.2 (Q25/75 0/2.4). The median CHAQ at baseline was 0.5 (Q25/75 0.125/1.0) and decreased at 12 months 0.125 (Q25/75 0/0.625). Patients felt well supported and liked that they had all their appointments in one day. Medication errors and compliance were more quickly identified and addressed. Extra communication time between health care providers about patient management was reduced through pre and post team meetings which led to increased efficiency.

Conclusion: Our multidisciplinary approach was found to be very beneficial for newly diagnosed children with chronic childhood arthritis. This approach removed the burden from families and better supported them through access to available services in a streamlined way. Our unified messaging also increased trust and compliance, which led to better health outcomes, safety and well-being for our patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/advanced-multidisciplinary-care-a-new-approach-to-childhood-arthritis/