Juvenile Arthritis: Meeting the Benchmark with Health Technology

Introduction

Juvenile idiopathic arthritis (JIA) care has long faced challenges in meeting best practice benchmarks. Despite advancements in molecular medicine and legislative changes to boost paediatric research, many children with JIA still receive suboptimal care. A paper recently published in Current Rheumatology Reports explores how digital health technologies can improve access to treatment, offering a more integrated and efficient approach to JIA management.

The Benchmark Today

As recommended by various global disease authorities, including the British Society for Paediatric and Adolescent Rheumatology and the American College of Rheumatology, the current benchmark for managing JIA emphasises early referral to specialists in paediatric rheumatic diseases for prompt diagnosis and treatment initiation. Treatment should be frequently assessed and adjusted to achieve inactive disease and no pain. To achieve the best health outcomes, long-term management by a diverse interdisciplinary team is essential.

Specialised Paediatric Rheumatology (PR) Centres, usually located in tertiary children’s hospitals in major cities, provide comprehensive support and treatments tailored to both rheumatological and paediatric needs. These centres offer a holistic approach, addressing the unique differences between adult and paediatric care. For instance, physiotherapists guide physical education and home programs, nurses offer strategies and medication advice, podiatrists monitor foot health and development, and ophthalmologists screen eye health in young children. An interdisciplinary care model is key to effective management.

Global Challenges in Managing Juvenile Idiopathic Arthritis

Globally, PR services struggle to meet the current standards of care relative to the projected demand, with a global PR workforce shortage of 88%. A significant factor is the shortage of paediatric rheumatologists, which leads to delayed diagnoses and treatment. For instance, a study of 130 PR centres across 49 countries found that diagnostic delays were more pronounced in low GDP countries. Africa and Asia are the hardest hit – Africa has only 10 PR centres across 54 countries, and China has only 50 centres across over 1.4 billion people. The short supply of PR healthcare providers causes delays in adequate treatment, worsening disease, and poor patient outcomes. Moreover, general practitioners and emergency room physicians often overlook joint swelling and restriction, further hindering timely referrals to specialists.

The Role of Digital Health Technologies

Digital health technologies offer a promising solution to these challenges. Mobile devices like smartphones, tablets, and smartwatches can monitor and assess important health indicators in real-time. For example, electronic pain diaries have been shown to reduce recall bias, while quality of life questionnaires assessed through apps can help gauge disease activity. These tools not only improve efficiency during consultations but also promote psychosocial conversations between patients and healthcare providers.

Telehealth and Remote Monitoring

The COVID-19 pandemic has accelerated the adoption of telehealth in paediatric rheumatology. Although physical examinations are essential, telehealth consultations have proven effective in verifying diagnoses and treatment responses. However, there is room for improvement. Current assessment tools need validation or adaptation for virtual use. For instance, the Video-pGALS (video paediatric Gait Arms Legs Spine) and eVAS (electronic visual analogue scale) are examples of tools that can enhance virtual examinations.

Future Directions and Conclusion

To address the longstanding health disparities in JIA care, it is crucial to integrate digital health technologies into clinical practice. This approach can create an integrative care model involving children, general practitioners, and paediatric rheumatologists. By improving service delivery and interdisciplinary care coordination, we can ensure timely support and better outcomes for children with JIA. Future research should focus on advancing digital health interventions that further reduce health inequalities, especially for those in remote or under-served areas.