Subspecialty referrals for pauciarticular juvenile rheumatoid arthritis

Objectives: To examine referral patterns from primary care physicians for c hildren with pauciarticular juvenile rheumatoid arthritis (JRA) and to dete rmine whether children with pauciarticular JRA referred to pediatric rheuma tologists differ in clinical presentation from children referred to other s pecialists. Design: A retrospective records review of 49 patients with pauciarticular J RA was performed. Records were reviewed to determine the specialty of the r eferring physician and whether the children referred had symptoms and signs compatible with a synovitis at the time primary care was sought. Setting: Inner-city tertiary pediatric rheumatology referral center. Participants: Children with pauciarticular JRA. Main Outcome Measures: Identification of referral patterns of primary care physicians. Associated morbidity owing to JRA was ascertained at the time o f referral Results: Most children with pauciarticular JRA (62%) were referred to ortho pedic surgeons prior to referral for pediatric rheumatology care. No differ ences in clinical symptoms were seen between children referred to pediatric rheumatologists and those referred to orthopedic surgeons. Children referr ed initially to orthopedic surgeons were younger than those referred to ped iatric rheumatologists. Conclusion: A notable number of children with pauciarticular JRA are referr ed to orthopedic surgeons prior to the establishment of that diagnosis, eve n when such children present with unequivocal signs of synovitis. This may be owing to the misconception that arthritis is rare in preschool-aged chil dren or to the difficulty of ascertaining the presence of synovitis in youn ger children.