Objectives: Across diagnosis groups, transition of adolescents and young adults from children's hospitals to adult care associates with decreased treatment adherence and suboptimal treatment results. Our aim was to compare the health-related quality of life (HRQoL) and disease activity of juvenile idiopathic arthritis (JIA) patients after the transfer of care to the adult clinic and adult patients in the same outpatient clinic.
Methods: All consecutive JIA patients aged 16 to 20 years who visited the transition clinic between September 2016 and August 2017 and all consecutive adult onset arthritis patients between December 2016 and August 2017 in the rheumatology outpatient clinic of Helsinki University Hospital were evaluated. HRQoL was measured by a generic instrument, 15D.
Results: A total of 291 patients, 130 JIA, and 161 adults were identified with respective median disease durations of 6.5 and 4.0 years. Adults had lower HRQoL measured by 15D (median 0.90 vs. 0.96, P < 0.001) and higher Disease Activity Score 28 (DAS28) than JIA patients (median 2.4 vs. 1.6, P < 0.001). Adults smoked more frequently than JIA patients (22% vs. 7%, P < 0.001). In multiple regression, female gender, smoking, disease activity, and obesity were associated with poorer HRQoL. Smoking adults had more active disease (DAS28 median 3.1 vs. 2.1, P = 0.031) and lower HRQoL (15D median 0.86 vs. 0.93, P < 0.001) than non-smoking adults.
Conclusions: Transition phase JIA patients had acceptable HRQoL and lower disease activity than patients with adult onset rheumatic diseases with similar disease duration. Smoking was associated with more active disease and lower HRQoL.
Keywords: Disease-modifying antirheumatic drugs; Juvenile idiophatic arthritis; Rheumatoid arthritis; Smoking; Transition of care.