THE OFFICIAL NEWS SOURCE OF ACR CONVERGENCE 2022 • NOVEMBER 10-14



Role of occupational and physical therapy in JIA continues to evolve

Katherine (Karen) Marzan, MD
Katherine (Karen) Marzan, MD

Biologics and new therapies have greatly improved the lives of children with juvenile idiopathic arthritis (JIA) and have led to a decrease in occupational therapy (OT) and physical therapy (PT) referrals, but occupational and physical therapists still have an important role to play in improving the quality of life in children with JIA.

“We’re in a different age now in terms of pediatric rheumatology, which is quite exciting for all of us in the field, because there are more and more effective medications available that have changed the face of what we do and the outcomes for our patients,” said Katherine (Karen) Marzan, MD, Associate Professor of Clinical Pediatrics at Keck School of Medicine, University of Southern California, and Attending Rheumatologist at Children’s Hospital Los Angeles.

Dr. Marzan will begin the ARHP sessionJIA Action Steps: Occupational and Physical Therapy Referrals, which takes place Sunday from 2:30 – 4:00 pm in Room W184a, with a review of the clinical manifestations and challenges of JIA and a discussion about the impact of newer medications and therapies on the needs of patients with JIA and the changing focus of priorities.

“In the past, many children with JIA had significant limitations, and they would be commonly admitted to inpatient rehabilitation, but with the introduction of biologics, that is really not happening much anymore,” Dr. Marzan said. “Yet, in our minds, both as pediatric rheumatologists as well as occupational and physical therapists, there is still a great need and an important role for therapy in our patients’ overall well being and in their future outcomes.”

Jill R. Blitz, PT, DPT, ATP
Jill R. Blitz, PT, DPT, ATP

Even in children with well-controlled JIA, studies show that they are still less active than their peers, according to Jill R. Blitz, PT, DPT, ATP, a physical therapist in the Division of Pediatric Medicine at Children’s Hospital Los Angeles. In her presentation, Blitz will review current research relevant to therapies, outline the benefits of OT and PT for kids with JIA, discuss current practices, and identify challenges for referring children.

“Since the introduction of biologics, patients with JIA have shown improvement in their disease process; however, they are still significantly less active, more sedentary, compared to their peers without JIA,” Blitz said. “Why they are less active can be attributed to a number of factors, including pain, fatigue, proprioceptive balance issues, as well as expectations or fears from the patient or family. These factors need to be addressed so that patients can live up to their full potential.”

The ultimate goal, and where PT and OT can play a strong role, she said, is to help children with JIA become more active and get involved in community activities where they can participate with other children.

“Physical activity is still really beneficial, and they can show improvement with exercise, regardless of their level of disease activity,” Blitz said. “Unfortunately, we’re seeing a lot less referrals these days, and I think that needs to change. It’s important, not only for the proven physical benefits, but also for the psychosocial benefits that being involved in community activities can offer children with JIA.”

Talitha Cox, MA, OTR/L
Talitha Cox, MA, OTR/L

How and when to refer children with JIA for OT and PT, as well as suggestions for meeting common referral challenges, will be the subject of a talk by Talitha Cox, MA, OTR/L, Occupational Therapist at Children’s Hospital Los Angeles.

“Although the overall numbers and frequency of JIA referrals is less than what it used to be, most children who are diagnosed with JIA have an encounter with a pediatric physical or occupational therapist at some point,” Cox said. “However, it’s still an uncommon referral outside of pediatric rheumatology, so if you don’t work in a pediatric rheumatology practice, it may be an unfamiliar referral for you.”

In her talk, Cox will describe various strategies for successful OT and PT referrals, including an algorithm/decision tool developed to help rheumatologists, fellows, and primary care providers make effective and appropriately timed referrals.

“Often, a challenge people face is finding the right therapist—someone with experience working with children with JIA, because treatment for kids with arthritis is different than treating adults with arthritis,” she said. “And before making the referral, it’s crucial to involve the patient and the family in the discussion to determine the right time for referral, depending on where they are in their disease process, where they are in their lives, the family schedule, school, and all the different considerations that you may not have as much with adult patients. If you make a referral that is not going to work for them, you’ve made a worthless referral.”