Decoding Diagnosis Delay in Juvenile Idiopathic Arthritis (JIA)
Author(s)
Raju Gautam, PhD1, Ratna Pandey, MSc2, Radha Sharma, PhD3, Shilpi Swami, MSc1.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3ConnectHEOR, Edmonton, AB, Canada.
1ConnectHEOR, London, United Kingdom, 2ConnectHEOR, Delhi, India, 3ConnectHEOR, Edmonton, AB, Canada.
OBJECTIVES: JIA is the most common chronic rheumatic disease in children, characterized by heterogeneous clinical manifestations. Early diagnosis and initiation of appropriate therapy are critical to prevent irreversible joint damage and disability. However, diagnostic delays remain a significant challenge globally. We aimed to understand the delay in diagnosing JIA and the reasons for its delay.
METHODS: A targeted literature review was conducted using Embase and Medline databases to identify the studies published since January 2012. The search terms (and relevant MESH terms) comprised ‘juvenile idiopathic arthritis’ and ‘diagnosis delay’. Papers published in English were included. Data on study details, clinical characteristics, and diagnosis delay and its factors were extracted.
RESULTS: Of the 1842 retrieved citations, 26 unique studies (21 full papers; 5 conference abstracts) were included. Most studies were from Turkey (n=6), followed by China (n=4), and India (n=3). Eighteen studies were of retrospective design. Twenty-five studies reported diagnostic criteria (23 of these used ILAR criteria). The diagnosis delay varied greatly across JIA subtypes, ranging from 2.3 weeks to 4.3 years. In 7 studies comparing diagnostic delays across various JIA subtypes, the delay was usually longest for enthesitis-related arthritis (5-13 months), followed by polyarticular JIA (2-12 months), oligoarthritis (3-6 months), psoriatic JIA (1-6 months), and systemic JIA (1-5 months). However, in three of these studies, polyarticular JIA showed a longer delay (4-12 months). Six studies reported reasons for diagnostic delay; common factors included overlap with more prevalent conditions, heterogeneous clinical presentations, repeated consultations with multiple or the same providers prior to referral, limited awareness among primary care physicians, and inadequate access to diagnostic facilities.
CONCLUSIONS: The study highlights the need for increased clinical awareness, early referral pathways, and improved diagnostic strategies to facilitate timely diagnosis and management of JIA, ultimately aiming to reduce its disease burden and long-term complications.
METHODS: A targeted literature review was conducted using Embase and Medline databases to identify the studies published since January 2012. The search terms (and relevant MESH terms) comprised ‘juvenile idiopathic arthritis’ and ‘diagnosis delay’. Papers published in English were included. Data on study details, clinical characteristics, and diagnosis delay and its factors were extracted.
RESULTS: Of the 1842 retrieved citations, 26 unique studies (21 full papers; 5 conference abstracts) were included. Most studies were from Turkey (n=6), followed by China (n=4), and India (n=3). Eighteen studies were of retrospective design. Twenty-five studies reported diagnostic criteria (23 of these used ILAR criteria). The diagnosis delay varied greatly across JIA subtypes, ranging from 2.3 weeks to 4.3 years. In 7 studies comparing diagnostic delays across various JIA subtypes, the delay was usually longest for enthesitis-related arthritis (5-13 months), followed by polyarticular JIA (2-12 months), oligoarthritis (3-6 months), psoriatic JIA (1-6 months), and systemic JIA (1-5 months). However, in three of these studies, polyarticular JIA showed a longer delay (4-12 months). Six studies reported reasons for diagnostic delay; common factors included overlap with more prevalent conditions, heterogeneous clinical presentations, repeated consultations with multiple or the same providers prior to referral, limited awareness among primary care physicians, and inadequate access to diagnostic facilities.
CONCLUSIONS: The study highlights the need for increased clinical awareness, early referral pathways, and improved diagnostic strategies to facilitate timely diagnosis and management of JIA, ultimately aiming to reduce its disease burden and long-term complications.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
SA28
Topic
Study Approaches
Topic Subcategory
Literature Review & Synthesis
Disease
Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)