Growing Up

Updates from the ACR Convergence 2023 Review Course, part 2

SAN DIEGO—In a field as vast as rheumatology how can a one-day review course cover many of the highest yield topics that matter to clinicians and patients? Under the leadership of moderators Noelle Rolle, MBBS, assistant professor in the Division of Rheumatology, associate program director of the Rheumatology Fellowship at the Medical College of Georgia, Augusta University, and Julia Schwartzmann-Morris, MD, associate professor, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, N.Y., accomplishing this goal proved possible at the pre-ACR Convergence 2023 Review Course on Saturday, Nov. 11.

Transitions

Dr. Rebecca Sadun

Rebecca Sadun, MD, PhD, assistant professor in medicine and pediatrics, Duke University School of Medicine, Durham, N.C., focused on transitions from pediatric to adult rheumatology care for patients with juvenile idiopathic arthritis (JIA).

Did you know that about 50% of patients with JIA are lost to follow-up when they are meant to be transitioning from pediatric to adult care?¹ In addition, said Dr. Sadun, about 20% of patients with JIA who achieve disease remission will go on to have recurrence, sometimes many years later in life;² thus, it’s important to make sure that these patients are followed closely over time and not lost to follow-up. Moreover, adult patients with a history of JIA are at risk for significant complications of their disease, including contractures, erosions and vision loss due to uveitis.

Dr. Sadun explained that, when thinking about these transitions of care, two elements are very important:

1. Understanding the disease process in JIA, and
2. Understanding the psychology and expectations of patients.

The Disease(s)

JIA is not one disease, but rather an umbrella term for a number of specific conditions, said Dr. Sadun.

Oligoarticular JIA is the most common form of JIA and can be painless (e.g., children may have joint effusions but not report any associated pain with this inflammation). There is not a clear adult equivalent for oligoarticular JIA.

In contrast, rheumatoid factor (RF) positive JIA and RF negative JIA can be thought of as the pediatric equivalents of adult seropositive and seronegative rheumatoid arthritis (RA), respectively.

Psoriatic arthritis in children and adults share most of the same features.

For all of these patients, adult rheumatologists should ask about a history of uveitis and of temporomandibular joint (TMJ) involvement, both of which can occur independent of peripheral arthritis.