 |
|
|
 |
Visiting Consultant Clinics to Study Prevalence Rates of Juvenile Rheumatoid Arthritis and Childhood Systemic Lupus Erythematosus Across Dispersed Geographic Areas
DAVID K. KURAHARA, ANDREW GRANDINETTI, LARISSA L.A. FUJII, ANGELA A. TOKUDA, JUDITH A. GALARIO, MARIE J. HAN, MARY J. TERRELL, KARA S. YAMAMOTO, KAREN M. YAMAGA, and DONALD A. PERSON ABSTRACT. Objective. Visiting consultant clinics (VCC) may provide pediatric rheumatologic care to children in rural populations, but the clinical demands have not been studied. We studied whether these clinics could be effective in determining prevalence rates of rheumatic illness like juvenile rheumatoid arthritis (JRA) and childhood systemic lupus erythematosus (SLE) across large dispersed geographic areas. Methods. The study population included children diagnosed with JRA or SLE at the only civilian pediatric rheumatology center in the State of Hawaii. Prevalence rates of these illnesses were then calculated for the urban and more rural neighbor island areas. VCC and prevalence data were calculated over a 10-year period. Results. We found a lower prevalence of JRA in the urban area (38.3 per 100,000) when compared to the rural neighbor islands (63.2 per 100,000). However, an equivalent prevalence of SLE was found in the urban (24.0 per 100,000) and neighboring islands (21.8 per 100,000). Clinical demands increased significantly with the success of the VCC, and with an increase in pediatric rheumatologic staffing. Conclusion. We found an increased prevalence of JRA in rural areas when compared to urban areas. Similar prevalence rates of SLE suggested the finding was not due to referral bias alone. VCC are useful to estimate disease prevalence over large areas, and therefore make it possible to identify areas at greater risk. Further investigations are needed to elucidate the possible environmental and genetic factors that may explain the regional differences in JRA prevalence. (First Release Jan 15 2007; J Rheumatol 2007;34:425–9) Key Indexing Terms:
PEDIATRIC RHEUMATOLOGY From the Department of Pediatrics, University of Hawaii-John A. Burns School of Medicine and Kapi'olani Medical Center for Women and Children; Pacific Basin Research Center and Department of Tropical Medicine and Microbiology, University of Hawaii; and Tripler Army Medical Center, Department of Defense., Honolulu, Hawaii, USA. Supported by grant number RR003061 from the National Centers for Research Resources, National Institutes of Health. Contents are solely the responsibility of the authors and do not necessarily represent the official views of the NCRR or NIH. Also supported by the Alexander and Baldwin Foundation, A&E Vidinha Charitable Trust, First Hawaiian Foundation, Garmar Foundation, Kapi'olani Children's Miracle Network, Shriner's Hospital for Children, and Weinberg Foundation. D.K. Kurahara, MD; L.L.A. Fujii, BA; A.A. Tokuda, MS; J.A. Galario, BS; M.J. Han, MD; M.J. Terrell, MD; K.S. Yamamoto, MD, Department of Pediatrics, John A. Burns School of Medicine and Kapi'olani Medical Center for Women and Children; A. Grandinetti, PhD, Pacific Basin Research Center; K.M. Yamaga, PhD, Department of Tropical Medicine and Microbiology, John A. Burns School of Medicine; D.A. Person, MD, Tripler Army Hospital, Department of Defense. Address reprint requests to Dr. D.K. Kurahara, 1319 Punahou St., #712, Honolulu, Hawaii 96826, USA. E-mail: davidk@kapiolani.org Accepted for publication November 9, 2006.
|
