Consultation With an Arthritis Specialist for Children With Suspected Juvenile Rheumatoid Arthritis

OBJECTIVES: To describe consultation with an arthritis specialist because of suspected new-onset juvenile rheumatoid arthritis (JRA) and to determine factors associated with prompt consultation. DESIGN: Retrospective cohort study. SETTING: Physician reimbursement administrative data were obtained for all children aged 16 years or younger in the Province of Québec (Canada). PARTICIPANTS: Suspected new-onset cases of JRA in 2000 were defined by a physician visit because of JRA, providing there had been no such claims in the preceding 3 years. MAIN EXPOSURE: First JRA diagnosis made by a non-arthritis specialist. MAIN OUTCOME MEASURES: First consultation with an arthritis specialist subsequent to diagnosis by a non-arthritis specialist and time to first consultation with an arthritis specialist. RESULTS: Of 352 children and adolescents with suspected new-onset JRA identified by non-arthritis specialists, 159 (45.2%) were subsequently seen by an arthritis specialist. Mean (SD) time to consultation for those seen was 115.3 (213.8) days (median, 28 days). Younger children were more likely to obtain care from an arthritis specialist compared with those having JRA first diagnosed by a general practitioner. CONCLUSION: Most patients with suspected new-onset JRA do not obtain prompt care from an arthritis specialist. Further research and action should focus on this issue so that outcomes may be optimized.