ArticleArthritis care & research2026
High Health Care Utilization Preceding Diagnosis With Juvenile Idiopathic Arthritis.
Article in Arthritis care & research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveAlthough early diagnosis improves long-term outcomes, patients with juvenile idiopathic arthritis (JIA) often experience prolonged, circuitous paths to diagnosis. To inform diagnostic improvement, we sought to characterize health care utilization in the year preceding diagnosis.
methodsWe identified 10,021 patients with an incident diagnosis of JIA and 20,042 age- and sex-matched healthy controls in the Merative MarketScan administrative datasets (2014-2022). Using negative binomial or hurdle models, we calculated incidence rate ratios (IRRs) comparing outpatient, inpatient, and emergency department or urgent care (ED/UC) utilization between patients with JIA and controls.
resultsIn the year before diagnosis, patients with JIA had significantly increased health care utilization compared to controls (IRR 2.55 [95% confidence interval (CI) 2.49-2.62], P < 0.001). Accounting for sex, age, and insurance, utilization was increased across care settings: outpatient (IRR 2.56 [95% CI 2.49-2.62], P < 0.001), inpatient (IRR 2.00 [95% CI 1.48-2.71], P < 0.001), and ED/UC encounters (IRR 1.76 [95% CI 1.67-1.86], P < 0.001). The most common visits by patients with JIA preceding diagnosis were to a general practitioner (91.8%), ED/UC (47.0%), and orthopedist (22.9%). Health care utilization increased as the index date approached. In patients insured by Medicaid, ED/UC care was more frequent (odds ratio 2.05 [95% CI 1.89-2.23]) and orthopedic care less frequent (odds ratio 0.27 [95% CI 0.24-0.34]) than in patients with commercial insurance.
conclusionIn the year before diagnosis, children with JIA have significantly higher health care utilization compared to healthy peers. There are differences in the patterns of utilization in patients with Medicaid versus commercial insurance. There may be opportunities for earlier identification of JIA in primary care, orthopedics, and ED/UC.
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