Clinical aspects
Paediatric-to-adult transition experience in vasculitis: report of a model of care and outcomes
I. Mulla1, R.S. Yeung2, D.G. Noone3, A. Bell-Peter4, C. Pagnoux5
- Vasculitis clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
- Division of Rheumatology, Toronto SickKids Hospital, University of Toronto, Ontario, Canada.
- Division of Nephrology, Toronto SickKids Hospital, University of Toronto, Ontario, Canada.
- Division of Rheumatology, Toronto SickKids Hospital, University of Toronto, Ontario, Canada.
- Vasculitis clinic, Division of Rheumatology, Mount Sinai Hospital, University of Toronto, and Division of Rheumatology, Toronto SickKids Hospital, University of Toronto, Ontario, Canada. christian.pagnoux@sinaihealth.ca
CER15322
2022 Vol.40, N°4
PI 0772, PF 0778
Clinical aspects
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PMID: 35238755 [PubMed]
Received: 09/11/2021
Accepted : 19/01/2022
In Press: 28/02/2022
Published: 04/05/2022
Abstract
OBJECTIVES:
Transitioning from paediatric to adult care can be challenging. Whereas transition models of care have been shared in some rheumatological conditions, reported experience in vasculitis is lacking.
METHODS:
Retrospective chart review of adolescents aged 16-18 years assessed at the vasculitis transition clinic by paediatric and adult rheumatologists, and then scheduled for follow-up at the Adult Vasculitis Clinic (Toronto, Canada) from January 2013 until May 2020.
RESULTS:
Twenty-eight patients were seen at the transition clinic and included. Mean age at transition was 17 years and 11 (± SD 2) months, with a mean follow up from diagnosis of 32 (± 24) months. Most patients had ANCA-associated vasculitis (N=19, 39%), followed by Takayasu’s arteritis (N=4, 14%); all but one were in remission at the time of transition. Twenty-six (93%) patients showed up for their first booked adult visit (two did not, were called and rebooked), after a mean of 4 (± 2) months after transition clinic. Subsequently, two patients missed 1 appointment, and three missed ≥ 2 appointments; only one (4%) stopped coming, while in remission for >2 years post-transition. Five (18%) patients were identified to have medication non-adherence after transition. With a mean follow up post-transition of 32 (± 25) months, 7 (25%) patients had minor and five (18%) had major relapses, at a mean of 17 (± 9) and 25 (± 15) months post-transition, respectively (compared to 12 (43%) and 9 (32%) prior to transition). At their last visit, all were in remission, 18 (64%) off glucocorticoids, and damage had remained stable.
CONCLUSIONS:
This model of care of vasculitis transition clinic resulted in favourable outcomes, as reflected by continuity of follow-up, and no increased risk of relapse.
