title: Time to diagnosis in juvenile idiopathic arthritis: a french perspective.
abstract: Juvenile idiopathic arthritis (JIA) is a rare disease that is not widely known by paediatricians and general practitioner (GP) leading to diagnostic error and delayed care provision. We aimed to analyse patient's journey and time to diagnosis of JIA (delay from the first symptom to the diagnosis of JIA). We performed a retrospective cohort study of 67 patients diagnosed with JIA and seen in the paediatric rheumatology department of the Kremlin Bicêtre Hospital, between July 2002 and January 2015. Patients were selected for analysis in order to represent an equal distribution of five JIA subtypes: oligoarticular onset (21), polyarticular onset (13), enthesitis-related arthritis (17), and systemic onset (16).
  
  
  
  Sixty-seven patients were finally analysed (42 girls). Before JIA diagnosis was made, patients had visited a mean of three physicians (3.6 ± 1.4 (mean; SD)). Emergency room physicians (52%) were the first patient's referral before GP (42%). Paediatric rheumatologists were mostly seen as third referral (52% versus 3% at first referral). Reactive arthritis (34%) and septic arthritis (24%) represented both the most common initial diagnosis. JIA was suspected after an average median time delay of 3 months (0.26-81.2) except for 25 patients (37%): SJIA (n = 9), ERA (n = 7), OAJIA (3) and POJIA (n = 6) for whom diagnosis was suspected straightaway. In most cases (88%), JIA was established by paediatric rheumatologists. Surprisingly, the median total time to diagnosis in our population was rather short (3 months). Paediatric rheumatologist played a major role in making the diagnosis but the journey to reach them was long and complex with multiple referrals. These results reinforce the necessity of improving GP and emergency physician's awareness and education on paediatric rheumatic diseases as the importance of a strong network in paediatric rheumatology to improve patient's level of care.
  
  
  
  We highlighted the complex patient's journey to diagnosis in children with JIA and made assumptions that reference center might reduce time to diagnosis although not statically proven. Further analysis with a larger number of patients might be needed to better investigate this probability.
authors.affiliation: Division of Pediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, Cedex, 94270, France.
authors.forename: Laura
authors.initials: L
authors.lastname: Aoust
authors.affiliation: Division of Pediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, Cedex, 94270, France.|Reference Center for Auto-inflammatory Disorders CEREMAI, Paris, France.
authors.forename: Linda
authors.initials: L
authors.lastname: Rossi-Semerano
authors.affiliation: Division of Pediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, Cedex, 94270, France.|Reference Center for Auto-inflammatory Disorders CEREMAI, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Koné-Paut
authors.affiliation: Division of Pediatric Rheumatology, Bicêtre Hospital, APHP, University of Paris SUD, 78 rue du Général Leclerc, Le Kremlin-Bicêtre, Cedex, 94270, France. perrine.dusser@gmail.com.
authors.forename: Perrine
authors.initials: P
authors.lastname: Dusser
mesh_terms: D000293:Adolescent; D001171:Arthritis, Juvenile / Q000175:diagnosis* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies
keywords: Arthritis; Health surveys; Juvenile arthritis; Juvenile/diagnosis*; Pediatrics; Referral and consultation/statistics & numerical data*; Retrospective studies; Rheumatology