Musculoskeletal diseases in adolescence.

JIA has a prevalence of approximately 130 per 100,000 children. The classification has recently been changed (Table 1). Although principally a disease of younger children, JIA presents between the ages of 10 and 16 years in 25% of patients. Those who develop systemic or polyarticular disease at a younger age have a higher incidence of destructive joint disease. The common belief is that JIA ‘burns out’ before or during adolescence, so the ensuing problems improve or remain static, but in fact in one-third of these children inflammatory activity continues into adult life1,2. Approximately 20% of children with JIA will be unable to perform some aspect of self-care1: the longer the follow-up, the greater both the disability3 and the deterioration in psychosocial function1. Unemployment is common and, significantly, does not correlate with educational achievement2,4. While many people with major disabilities enjoy happy, fulfilled lives, others with much milder functional impairment lead seriously restric ted lives limited by factors, often simple, that may be avoided. Now that 90% of children with chronic disabilities reach their 20th year5, attention has been focused on their successful transition to adulthood. The key elements have been identified for an effective transition programme for adolescents with various chronic illnesses leaving the paediatric service6–8. While the key elements also apply to adolescents with JIA, the details of the ideal transition programme for this group are far from established. Only 20% of the paediatric rheumatology departments in the UK provide a transition service6 and their standards are variable. To appreciate the late CM E Adolescent m edicine – I I