Referral pathways to pediatric rheumatology care in juvenile idiopathic arthritis: a multicenter study in France and Switzerland
Year: 2026
Type: article
Study design: Observational Study
Abstract: Timely access to pediatric rheumatology (PR) care is critical for improving outcomes in juvenile idiopathic arthritis (JIA), yet, referral delays remain frequent. We aimed to examine the trajectories leading to PR care across two national healthcare settings. We conducted a multicenter study to characterize referral pathways to PR care among children with incident non-systemic JIA from the JIRcohort in France and Switzerland. We examined the sequence, number, and type of healthcare providers (HCPs) consulted before the first PR visit and assessed predictors of prolonged delays. Multiple correspondence analysis was used to explore patterns in referral trajectories. Among 227 patients, the median time from symptom onset to the first PR visit was 2.5 months [1.5; 6.3] in France and 3.0 months [1.2; 7.6] in Switzerland ( p = 0.99). Referral pathways differed between the two settings, particularly in the number and type of HCPs involved, with fewer HCPs and more frequent pediatrician involvement in Switzerland. Multiple correspondence analysis identified four distinct referral pathway profiles combining clinical and referral characteristics, with differences in HCP involvement, clinical presentation, and referral time. A diagnosis of enthesitis-related arthritis and a higher number of HCPs involved were significantly associated with a longer time before the first PR visit (HR: 0.45, 95% CI: 0.29 to 0.71, and HR: 0.74, 95% CI: 0.63 to 0.87) in multivariable analysis. Conversely, contact with an emergency care practitioner was associated with a shorter time before the first PR visit (HR: 1.81, 95% CI: 1.31 to 2.49). Despite similar overall referral times, referral pathways differed in the number and type of HCPs involved before PR assessment. These findings suggest that summary delay measures alone may not fully capture differences in pathways to PR care.
Source: Pediatric Rheumatology
Authors: Aurelie Chausset, Celine Lambert, Alexandre Belot, Stephane Echaubard, Elvira Cannizzaro, Linda Rossi-Semerano, Claire Ballot, Valerie Devauchelle-Pensec, Sylvaine Poignant, Raffaella Carlomagno, Anne Lohse, Catherine Barbier, Veronique Despert, Aurelia Carbasse, Laetitia Sparsa, Eva Adank, Federica Vanoni, Heloise Reumaux, Pascal Pillet, Daniela Kaiser, Caroline Freychet, Michael Hofer
Institutions: Inserm, Centre Hospitalier Universitaire de Clermont-Ferrand, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Centre International de Recherche en Infectiologie, University of Zurich, University Children's Hospital Zurich, Centre de Référence des Maladies Autoinflammatoires et des Amyloses, Bicêtre Hospital, Centre Hospitalier Universitaire de Besançon, Centre Hospitalier Universitaire de Nantes, Centre Hospitalier Universitaire Vaudois, University of Lausanne, L'Hôpital Nord Franche-Comté, Hôpital Albert Michallon, Centre Hospitalier Universitaire de Rennes, Hôpital Arnaud de Villeneuve, Kantonsspital Graubünden, Istituto Pediatrico della Svizzera Italiana, Centre Hospitalier Universitaire de Lille, Centre Hospitalier Universitaire de Bordeaux, Luzerner Kantonsspital, Hôpital Necker-Enfants Malades, Institut Necker Enfants Malades
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,090
OpenAlex ID: W7224162610