Pos0767 the evaluation and importance of transition from pediatric to adult rheumatology care in rheumatological diseases

Background The transition from pediatric to adult health care often challenging for young adults with rheumatic diseases. During the transition period, disruptions, diagnostic changes, and treatment differences may occur. The successful transition of the young adult patient to adult care is an important milestone in pediatric rheumatology. Objectives In this study, we aimed to examine the diagnosis and treatment changes of transition patients and the characteristics of the transition period in our clinic. Methods This was retrospective observational study was carried out in Dokuz Eylul University Pediatric and Adult Rheumatology Department. Patients who followed-up in Pediatric Rheumatology Department transferred to the Adult Rheumatology Department within the last ten years and continued to visit at least once a year were included in this study. If the transition period of the patients was less than three months, it was defined as early transition. Demographic features and educational status, parental divorce, diagnosis changes, and diagnosis-specific treatment changes were recorded. Results In total, 962 transitional patients scanned and 210 of them met follow-up criteria. Of the patients, 117 (55.7%) were female, with a median age of 24 (IQR, 21 – 28). Most of patients followed-up juvenile rheumatoid arthritis (JIA) (n=79, 37.6%) and familial Mediterranean fever (FMF) (n=79, 37.6%). Median duration of pediatric rheumatology follow-up was 52 months (IQR, 23 – 87) and 47 (22.%) patients have been treated with biological agent (Table 1). Median transition time was 4 months (1-13 IQR) and the rate of early transition was 46.7%. We found that receiving biological therapy associated with early transition (59.6% vs 40.4%, p=0.040). We also found that Bachelor’s degree or higher educational status associated with late transition (40% vs 60%, p=0.025). Rheumatologic diseases were not associated with late transition except FMF, patients with FMF were prone to late transition (32.9% vs 67.1%, p=0.015). Gender and parents’ divorce did not associate with transition time (Table 1). The diagnoses of 13% of the participants were changed after they were followed-up in adult rheumatology. The median follow-up period for adult rheumatology was 40 months (15-75 IQR). Biological therapy was started for the first time in 21 patients, the biological therapy of 5 patients was changed, and the biological therapy of 7 patients was discontinued during adult rheumatology follow-up. Conclusion We found that most of the patients who were followed-up in pediatric rheumatology in our center did not transition to the adult rheumatology in the same center. Less than half (46.7%) of the patients started to be followed up in adult rheumatology within the first 3 months. Treatment with biological agents was found associated with early transition. Since patients who were treated with biological agent need for a doctor’s visit to reach the treatment was considered the main reason for these patients’ early transition. We found that Bachelor’s degree or higher educational status was associated with late transition. Patients often move to other cities for university may be the reason of the late transition. Transition time did not associate with the rheumatologic diseases except FMF. The reason for the late transition in FMF can be explained by the admission to the hospital frequently with attacks. Transition may be challenging in pediatric rheumatology. The ideal transition to adult rheumatological care should start in the early adolescence period of the patients, planned transition visits may increase the rate of follow-up. Reference [1]Ardoin SP. Transitions in Rheumatic Disease: Pediatric to Adult Care. Pediatr Clin North Am. 2018 Aug;65(4):867-883. doi: 10.1016/j.pcl.2018.04.007. PMID: 30031502 Acknowledgements: NIL. Disclosure of Interests None Declared.