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      Delivery of paediatric rheumatology care: a survey of current clinical practice in Southeast Asia and Asia-Pacific regions

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          Abstract

          Background

          Paediatric rheumatic diseases are a leading cause of acquired disability in Southeast Asia and Asia-Pacific Countries (SE ASIA/ASIAPAC). The aims of this study were to identify and describe the challenges to the delivery of patient care and identify solutions to raise awareness about paediatric rheumatic diseases.

          Methods

          The anonymised online survey included 27 items about paediatric rheumatology (PR) clinical care and training programmes. The survey was piloted and then distributed via Survey-Monkey™ between March and July 2019. It was sent to existing group lists of physicians and allied health professionals (AHPs), who were involved in the care pathways and management of children with rheumatic diseases in SE ASIA/ASIAPAC.

          Results

          Of 340 participants from 14 countries, 261 participants had been involved in PR care. The majority of the participants were general paediatricians. The main reported barriers to providing specialised multidisciplinary service were the absence or inadequacy of the provision of specialists and AHPs in addition to financial issues. Access to medicines was variable and financial constraints cited as the major obstacle to accessing biological drugs within clinical settings. The lack of a critical mass of specialist paediatric rheumatologists was the main perceived barrier to PR training.

          Conclusions

          There are multiple challenges to PR services in SE ASIA/ASIAPAC countries. There is need for more specialist multidisciplinary services and greater access to medicines and biological therapies. The lack of specialist paediatric rheumatologists is the main barrier for greater access to PR training.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12969-021-00498-1.

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          Most cited references31

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          2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features.

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            EULAR/PReS standards and recommendations for the transitional care of young people with juvenile-onset rheumatic diseases.

            To develop standards and recommendations for transitional care for young people (YP) with juvenile-onset rheumatic and musculoskeletal diseases (jRMD). The consensus process involved the following: (1) establishing an international expert panel to include patients and representatives from multidisciplinary teams in adult and paediatric rheumatology; (2) a systematic review of published models of transitional care in jRMDs, potential standards and recommendations, strategies for implementation and tools to evaluate services and outcomes; (3) setting the framework, developing the process map and generating a first draft of standards and recommendations; (4) further iteration of recommendations; (5) establishing consensus recommendations with Delphi methodology and (6) establishing standards and quality indicators. The final consensus derived 12 specific recommendations for YP with jRMD focused on transitional care. These included: high-quality, multidisciplinary care starting in early adolescence; the integral role of a transition co-ordinator; transition policies and protocols; efficient communications; transfer documentation; an open electronic-based platform to access resources; appropriate training for paediatric and adult healthcare teams; secure funding to continue treatments and services into adult rheumatology and the need for increased evidence to inform best practice. These consensus-based recommendations inform strategies to reach optimal outcomes in transitional care for YP with jRMD based on available evidence and expert opinion. They need to be implemented in the context of individual countries, healthcare systems and regulatory frameworks.
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              European evidence-based recommendations for diagnosis and treatment of childhood-onset systemic lupus erythematosus: the SHARE initiative

              Childhood-onset systemic lupus erythematosus (cSLE) is a rare, multisystem and potentially life-threatening autoimmune disorder with significant associated morbidity. Evidence-based guidelines are sparse and management is often based on clinical expertise. SHARE (Single Hub and Access point for paediatric Rheumatology in Europe) was launched to optimise and disseminate management regimens for children and young adults with rheumatic diseases like cSLE. Here, we provide evidence-based recommendations for diagnosis and treatment of cSLE. In view of extent and complexity of cSLE and its various manifestations, recommendations for lupus nephritis and antiphospholipid syndrome will be published separately. Recommendations were generated using the EULAR (European League Against Rheumatism) standard operating procedure. An expert committee consisting of paediatric rheumatologists and representation of paediatric nephrology from across Europe discussed evidence-based recommendations during two consensus meetings. Recommendations were accepted if >80% agreement was reached. A total of 25 recommendations regarding key approaches to diagnosis and treatment of cSLE were made. The recommendations include 11 on diagnosis, 9 on disease monitoring and 5 on general treatment. Topics included: appropriate use of SLE classification criteria, disease activity and damage indices; adequate assessment of autoantibody profiles; secondary macrophage activation syndrome; use of hydroxychloroquine and corticosteroid-sparing regimens; and the importance of addressing poor adherence. Ten recommendations were accepted regarding general diagnostic strategies and treatment indications of neuropsychiatric cSLE. The SHARE recommendations for cSLE and neuropsychiatric manifestations of cSLE have been formulated by an evidence-based consensus process to support uniform, high-quality standards of care for children with cSLE.
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                Author and article information

                Contributors
                sirirat.chv@mahidol.ac.th
                Journal
                Pediatr Rheumatol Online J
                Pediatr Rheumatol Online J
                Pediatric Rheumatology Online Journal
                BioMed Central (London )
                1546-0096
                23 January 2021
                23 January 2021
                2021
                : 19
                : 11
                Affiliations
                [1 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Siriraj Hospital, , Mahidol University, ; Bangkok, Thailand
                [2 ]GRID grid.413442.4, ISNI 0000 0004 1802 4561, Paediatric Rheumatology Unit, Selayang Hospital, ; Selangor, Malaysia
                [3 ]GRID grid.1006.7, ISNI 0000 0001 0462 7212, Paediatric Rheumatology, , Population Health Sciences Institute, Newcastle University, ; Newcastle upon Tyne, UK
                [4 ]GRID grid.10223.32, ISNI 0000 0004 1937 0490, Division of Rheumatology, Department of Paediatrics, Faculty of Medicine Ramathibodi Hospital, , Mahidol University, ; Bangkok, Thailand
                [5 ]GRID grid.414963.d, ISNI 0000 0000 8958 3388, Department of Paediatric Subspecialties, Rheumatology and Immunology Service, KK Women’s and Children’s Hospital, ; Singapore, Singapore
                [6 ]GRID grid.415742.1, ISNI 0000 0001 2296 3850, Division of Paediatric Rheumatology, Department of Paediatrics, , University of Cape Town, Red Cross War Memorial Children’s Hospital, ; Cape Town, South Africa
                [7 ]GRID grid.472342.4, ISNI 0000 0004 0367 3753, Newcastle University Medicine Malaysia, ; Johor, Malaysia
                Author information
                http://orcid.org/0000-0002-0506-6039
                Article
                498
                10.1186/s12969-021-00498-1
                7824936
                33485337
                c04e73ce-ce62-45bc-b9de-648888b08658
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 4 June 2020
                : 11 January 2021
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Pediatrics
                paediatric rheumatology,health care system,se asia/asiapac,clinical care,education and training,medicines,biological therapies,workforce

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