{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T08:16:47Z","timestamp":1778228207424,"version":"3.51.4"},"reference-count":30,"publisher":"The Journal of Rheumatology","issue":"11","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2021,11]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the clinical and demographic characteristics of patients with juvenile idiopathic arthritis (JIA) in Chile and compare treatments and outcomes before and after the introduction in 2010 of the Explicit Health Guarantees (GES) for JIA, a national universal access program for diagnosis and treatment of this condition.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The clinical records of 280 patients with JIA followed at a private tertiary academic health network between 2007 and 2018 were reviewed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Seventy percent of patients with JIA were female, mean age at diagnosis was 8.5 \u00b1 4.8 years and mean follow-up was 4.0 \u00b1 3.7 years. After GES implementation (post-GES), time to evaluation by pediatric rheumatologist and diagnostic delay were significantly reduced (15.0 \u00b1 4.5 vs 9.0 \u00b1 4.2 months, <jats:italic>P<\/jats:italic> = 0.004). In addition, use of magnetic resonance imaging significantly increased post-GES (<jats:italic>P<\/jats:italic> &lt; 0.001). In terms of JIA treatments, before GES implementation, no patients received biologics. Of the 67 patients diagnosed before 2010 with continued follow-up at our center, 34% began biologic treatment after GES implementation. Of 196 patients diagnosed post-GES, 46% were treated with biologics. JIA remission rates were significantly higher in patients diagnosed post-GES compared to pre-GES (43% vs 29%, <jats:italic>P<\/jats:italic> = 0.02). Post-GES, we observed a significant decrease in uveitis complications among JIA patients (45% vs 13%, <jats:italic>P<\/jats:italic> = 0.04).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The implementation of a national government-mandated universal access program for guaranteed JIA diagnosis and treatment led to earlier access to a pediatric rheumatologist and JIA diagnosis, increased rates of treatment with biologic drugs, higher rates of clinical remission, and lower rates of uveitis complications in Chilean children with JIA.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.210011","type":"journal-article","created":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T12:20:43Z","timestamp":1619871643000},"page":"1725-1731","source":"Crossref","is-referenced-by-count":4,"title":["Changes in Treatments and Outcomes After Implementation of a National Universal Access Program for Juvenile Idiopathic Arthritis"],"prefix":"10.3899","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9930-6357","authenticated-orcid":false,"given":"Sara","family":"Concha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9778-3766","authenticated-orcid":false,"given":"Pamela S.","family":"Morales","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4048-8640","authenticated-orcid":false,"given":"Eduardo","family":"Talesnik","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7904-262X","authenticated-orcid":false,"given":"Arturo","family":"Borzutzky","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2021,5,1]]},"reference":[{"key":"2022062114101790000_48.11.1725.1","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1002\/acr.23871","article-title":"2019 American College of Rheumatology\/Arthritis Foundation guideline for the screening, monitoring, and treatment of juvenile idiopathic arthritis-associated uveitis","volume":"71","author":"Angeles-Han","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2022062114101790000_48.11.1725.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12969-020-00443-8","article-title":"Global prevalence estimates of three chronic musculoskeletal conditions: club foot, juvenile idiopathic arthritis and juvenile systemic lupus erythematosus","volume":"18","author":"Dave","year":"2020","journal-title":"Pediatr Rheumatol Online J"},{"key":"2022062114101790000_48.11.1725.3","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1016\/j.berh.2018.01.001","article-title":"Recent therapeutic advances in juvenile idiopathic arthritis","volume":"31","author":"Giancane","year":"2017","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"2022062114101790000_48.11.1725.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-210511"},{"key":"2022062114101790000_48.11.1725.5","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s12969-017-0161-5","article-title":"A survey of national and multi-national registries and cohort studies in juvenile idiopathic arthritis: challenges and opportunities","volume":"15","author":"Beukelman","year":"2017","journal-title":"Pediatr Rheumatol Online J"},{"key":"2022062114101790000_48.11.1725.6","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10198-016-0786-1","article-title":"Social\/economic costs and health-related quality of life in patients with juvenile idiopathic arthritis in Europe","volume":"17","author":"Kuhlmann","year":"2016","journal-title":"Eur J Heal Econ"},{"key":"2022062114101790000_48.11.1725.7","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1186\/s12891-016-1129-1","article-title":"Socioeconomic costs and health-related quality of life in juvenile idiopathic arthritis: a cost-of-illness study in the United Kingdom","volume":"17","author":"Angelis","year":"2016","journal-title":"BMC Musculoskelet Disord"},{"key":"2022062114101790000_48.11.1725.8","doi-asserted-by":"crossref","first-page":"361","DOI":"10.2147\/CEOR.S197117","article-title":"Treatment patterns and economic outcomes in patients with juvenile idiopathic arthritis","volume":"11","author":"Marshall","year":"2019","journal-title":"Clinicoecon Outcomes Res"},{"key":"2022062114101790000_48.11.1725.9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1056\/NEJMp1514202","article-title":"Innovation and change in the Chilean health system","volume":"374","author":"Bossert","year":"2016","journal-title":"N Engl J Med"},{"key":"2022062114101790000_48.11.1725.10","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.071843"},{"key":"2022062114101790000_48.11.1725.11","unstructured":"Superintendency of Health. Ministry of Health . Garant\u00edas Explicitas en Salud (GES). Juvenile idiopathic arthritis. [Internet. Accessed June 8, 2021.] Available from: www.supersalud.gob.cl\/difusion\/665\/w3-article-5992.html#accordion_3"},{"key":"2022062114101790000_48.11.1725.12","first-page":"390","article-title":"International League of Associations for Rheumatology classification of juvenile idiopathic arthritis: second revision, Edmonton, 2001","volume":"31","author":"Petty Ross","year":"2004","journal-title":"J Rheumatol"},{"key":"2022062114101790000_48.11.1725.13","first-page":"2290","article-title":"Preliminary criteria for clinical remission for select categories of juvenile idiopathic arthritis","volume":"31","author":"Wallace","year":"2004","journal-title":"J Rheumatol"},{"key":"2022062114101790000_48.11.1725.14","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1016\/S2352-4642(19)30027-6","article-title":"Phenotypic variability and disparities in treatment and outcomes of childhood arthritis throughout the world: an observational cohort study","volume":"3","author":"Consolaro","year":"2019","journal-title":"Lancet Child Adolesc Health"},{"key":"2022062114101790000_48.11.1725.15","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1007\/s00296-018-3944-1","article-title":"Cross-cultural adaptation and psychometric evaluation of the Juvenile Arthritis Multidimensional Assessment Report (JAMAR) in 54 languages across 52 countries: review of the general methodology","volume":"38","author":"Bovis","year":"2018","journal-title":"Rheumatol Int"},{"key":"2022062114101790000_48.11.1725.16","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.131503"},{"key":"2022062114101790000_48.11.1725.17","unstructured":"Wait Time Alliance (WTA) . Time to close the gap: report card on wait times in Canada (2014). [Internet. Accessed June 8, 2021.] Available from: www.waittimealliance.ca\/wta-reports\/2014-wta-report-card"},{"key":"2022062114101790000_48.11.1725.18","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s12969-020-0413-7","article-title":"Patient factors associated with waiting time to pediatric rheumatologist consultation for patients with juvenile idiopathic arthritis","volume":"18","author":"Barber","year":"2020","journal-title":"Pediatr Rheumatol Online J"},{"key":"2022062114101790000_48.11.1725.19","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s13023-017-0586-4","article-title":"Time to diagnosis in juvenile idiopathic arthritis: a French perspective","volume":"12","author":"Aoust","year":"2017","journal-title":"Orphanet J Rare Dis"},{"key":"2022062114101790000_48.11.1725.20","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207892"},{"key":"2022062114101790000_48.11.1725.21","unstructured":"The World Bank . World Bank open data. [Internet. Accessed June 8, 2021.] Available from: data.worldbank.org"},{"key":"2022062114101790000_48.11.1725.22","doi-asserted-by":"crossref","first-page":"1945","DOI":"10.1002\/art.41390","article-title":"New medications are needed for children with juvenile idiopathic arthritis","volume":"72","author":"Brunner","year":"2020","journal-title":"Arthritis Rheumatol"},{"key":"2022062114101790000_48.11.1725.23","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.120089"},{"key":"2022062114101790000_48.11.1725.24","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2012-202603"},{"key":"2022062114101790000_48.11.1725.25","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/kew048"},{"key":"2022062114101790000_48.11.1725.26","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1186\/s12969-020-00426-9","article-title":"Prevalence of co-existing autoimmune disease in juvenile idiopathic arthritis: a cross-sectional study","volume":"18","author":"Simon","year":"2020","journal-title":"Pediatr Rheumatol Online J"},{"key":"2022062114101790000_48.11.1725.27","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1002\/acr.23610","article-title":"Childhood Arthritis and Rheumatology Research Alliance consensus treatment plans for juvenile idiopathic arthritis-associated and idiopathic chronic anterior uveitis","volume":"71","author":"Angeles-Han","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2022062114101790000_48.11.1725.28","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1614160"},{"key":"2022062114101790000_48.11.1725.29","first-page":"S105","article-title":"Remission in juvenile idiopathic arthritis","volume":"24","author":"Ravelli","year":"2006","journal-title":"Clin Exp Rheumatol"},{"key":"2022062114101790000_48.11.1725.30","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1016\/j.semarthrit.2017.05.007","article-title":"How common is remission in juvenile idiopathic arthritis: a systematic review","volume":"47","author":"Shoop-Worrall","year":"2017","journal-title":"Semin Arthritis Rheum"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.210011","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,6,21]],"date-time":"2022-06-21T21:12:35Z","timestamp":1655845955000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.210011"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,1]]},"references-count":30,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2021,11,1]]},"published-print":{"date-parts":[[2021,11]]}},"alternative-id":["10.3899\/jrheum.210011"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.210011","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,1]]}}}