Referral pathways to pediatric rheumatology care in juvenile idiopathic arthritis: a multicenter study in France and Switzerland

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.

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Journal
Pediatric Rheumatology
Published
2026-10-29
DOI
https://doi.org/10.1186/s12969-026-01288-3
Primary Topic
Autoimmune and Inflammatory Disorders Research
Type
article
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article

Referral pathways to pediatric rheumatology care in juvenile idiopathic arthritis: a multicenter study in France and Switzerland

Laëtitia Sparsa, Eva Adank, Céline Lambert, Stéphane Echaubard et al.
Pediatric Rheumatology
Autoimmune and Inflammatory Disorders Research
article

Referral pathways to pediatric rheumatology care in juvenile idiopathic arthritis: a multicenter study in France and Switzerland

Laëtitia Sparsa, Eva Adank, Céline Lambert, Stéphane Echaubard, Linda Rossi‐Semerano, Caroline Freychet, Alexandre Bélot, Valérie Devauchelle‐Pensec, Héloïse Reumaux, Daniela E. Kaiser, Michaël Hofer, Aurélie Chausset, Federica Vanoni, Claire Ballot, Catherine Barbier, Elvira Cannizzaro, Pascal Pillet, Sylvaine Poignant, Raffaella Carlomagno, Veronique Despert, Aurélia Carbasse, Anne Lohse
article en

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.

Pediatric Rheumatology
Hôpital Necker-Enfants Malades (FR), Inserm (FR), University of Zurich (CH), Centre Hospitalier Universitaire Vaudois (CH), Centre Hospitalier Universitaire de Bordeaux (FR), Centre Hospitalier Universitaire de Lille (FR), Centre Hospitalier Universitaire de Nantes (FR), Hôpital Femme Mère Enfant (FR), Institut Necker Enfants Malades (FR), Centre Hospitalier Universitaire de Besançon (FR), Centre de Référence des Maladies Autoinflammatoires et des Amyloses (FR), Hospices Civils de Lyon (FR), Luzerner Kantonsspital (CH), University Children's Hospital Zurich (CH), Centre Hospitalier Universitaire de Clermont-Ferrand (FR), Centre Hospitalier Régional Universitaire de Brest (FR), L'Hôpital Nord Franche-Comté (FR), Hôpital Arnaud de Villeneuve (FR), Kantonsspital Graubünden (CH), Centre Hospitalier Universitaire de Rennes (FR), Centre International de Recherche en Infectiologie (FR), Hôpital Albert Michallon (FR), Bicêtre Hospital (FR), Hôpital Maison Blanche (FR), Istituto Pediatrico della Svizzera Italiana (CH), University of Lausanne (CH)
Good health and well-being
Openalex Percentile: Top 12%
Autoimmune and Inflammatory Disorders Research
DOIOpen Access PDFOpenAlex
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