title: Visiting consultant clinics to study prevalence rates of juvenile rheumatoid arthritis and childhood systemic lupus erythematosus across dispersed geographic areas.
abstract: OBJECTIVE
  Visiting consultant clinics (VCC) may provide pediatric rheumatologic care to children in rural populations, but the clinical demands have not been studied. We studied whether these clinics could be effective in determining prevalence rates of rheumatic illness like juvenile rheumatoid arthritis (JRA) and childhood systemic lupus erythematosus (SLE) across large dispersed geographic areas.
  
  
  METHODS
  The study population included children diagnosed with JRA or SLE at the only civilian pediatric rheumatology center in the State of Hawaii. Prevalence rates of these illnesses were then calculated for the urban and more rural neighbor island areas. VCC and prevalence data were calculated over a 10-year period.
  
  
  RESULTS
  We found a lower prevalence of JRA in the urban area (38.3 per 100,000) when compared to the rural neighbor islands (63.2 per 100,000). However, an equivalent prevalence of SLE was found in the urban (24.0 per 100,000) and neighboring islands (21.8 per 100,000). Clinical demands increased significantly with the success of the VCC, and with an increase in pediatric rheumatologic staffing.
  
  
  CONCLUSIONS
  We found an increased prevalence of JRA in rural areas when compared to urban areas. Similar prevalence rates of SLE suggested the finding was not due to referral bias alone. VCC are useful to estimate disease prevalence over large areas, and therefore make it possible to identify areas at greater risk. Further investigations are needed to elucidate the possible environmental and genetic factors that may explain the regional differences in JRA prevalence.
authors.affiliation: Department of Pediatrics, University of Hawaii-John A. Burns School of Medicine and Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii, USA. davidk@kapiolani.org
authors.forename: David K
authors.initials: DK
authors.lastname: Kurahara
authors.forename: Andrew
authors.initials: A
authors.lastname: Grandinetti
authors.forename: Larissa L A
authors.initials: LL
authors.lastname: Fujii
authors.forename: Angela A
authors.initials: AA
authors.lastname: Tokuda
authors.forename: Judith A
authors.initials: JA
authors.lastname: Galario
authors.forename: Marie J
authors.initials: MJ
authors.lastname: Han
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Terrell
authors.forename: Kara S
authors.initials: KS
authors.lastname: Yamamoto
authors.forename: Karen M
authors.initials: KM
authors.lastname: Yamaga
authors.forename: Donald A
authors.initials: DA
authors.lastname: Person
mesh_terms: D000293:Adolescent; D000328:Adult; D001171:Arthritis, Juvenile / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D006254:Hawaii / Q000453:epidemiology; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007223:Infant; D008180:Lupus Erythematosus, Systemic / Q000175:diagnosis / Q000453:epidemiology*; D010044:Outpatient Clinics, Hospital; D010372:Pediatrics / Q000379:methods*; D015995:Prevalence; D012017:Referral and Consultation / Q000706:statistics & numerical data* / Q000639:trends; D012219:Rheumatology / Q000379:methods*; D012424:Rural Population; D014504:Urban Health