title: Factors associated with a longer time to access pediatric rheumatologists in Canadian children with juvenile idiopathic arthritis.
abstract: OBJECTIVE
  The Research on Arthritis in Canadian Children Emphasizing Outcomes (ReACCh Out) cohort is a prospective inception cohort of patients with newly diagnosed juvenile idiopathic arthritis (JIA) seen in 16 Canadian pediatric rheumatology (PR) centers. We used data from this cohort to explore factors associated with longer time from symptom onset to the first visit to (PR), and with longer time from first visit to a diagnosis of JIA.
  
  
  METHODS
  We included children enrolled in ReACCh Out within 6 months of JIA diagnosis, for whom the dates of symptom onset and first PR visit were recorded. We used Cox proportional hazard modeling to investigate the effects of history, physical examination, and laboratory evaluation on the interval from JIA symptom onset to first PR assessment.
  
  
  RESULTS
  In total, 319 children from the cohort were included. Having a fever (hazard ratio 1.80, 95% CI 1.10, 2.93), any part South Asian ethnicity (HR 1.75, 95% CI 1.04, 2.95), highly educated parents (HR 1.69, 95% CI 1.18, 2.44), and limp (HR 1.55, 95% 1.16, 2.06) were significantly associated with shorter time from symptom onset to first PR assessment, while a history of heel pain or enthesitis (HR 0.61, 95% 0.38, 0.97) was significantly associated with a longer time to first PR visit.
  
  
  CONCLUSIONS
  Children with a history of a fever, limp, any part South Asian ethnicity, or highly educated parents were more likely to see PR sooner than patients without these features, while children with a history of enthesitis received PR care later than those without enthesitis.
authors: Department of Paediatrics, University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada. nshiff@cw.bc.ca
authors: Natalie J
authors: NJ
authors: Shiff
authors: Lori B
authors: LB
authors: Tucker
authors: Jaime
authors: J
authors: Guzman
authors: Kiem
authors: K
authors: Oen
authors: Rae S M
authors: RS
authors: Yeung
authors: Ciarán M
authors: CM
authors: Duffy
mesh_terms: D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000628:therapy*; D002170:Canada; D002648:Child; D006297:Health Services Accessibility; D006801:Humans; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012219:Rheumatology