Juvenile Idiopathic Arthritis in Chad: Delayed Diagnosis, Clinical Patterns and Limited Access to Biologics

Abstract

Background: Juvenile idiopathic arthritis (JIA) is the leading cause of chronic inflammatory rheumatism in children, yet data from Central Africa remain scarce. This study aimed to describe the clinical patterns, diagnostic delay and access to biologic therapies in children with JIA in Chad. Methods: Retrospective study (2020–2024) including 85 ILAR-confirmed JIA cases among 111 pediatric systemic diseases. Data included clinical, biological, radiologic, CHAQ, JADAS and treatment patterns. Results: Mean age at onset was 11.26 years; diagnostic delay averaged 4.2 years. RF-negative polyarthritis and ERA each accounted for 30.6% of cases. Uveitis was noted in 15.3% of patients. CRP was elevated in 63.3% and HLA-B27 positive in 60% of those tested. CHAQ mean was 0.78 ± 0.34, and JADAS median was 8.4 (IQR 4.3–14.6), indicating significant functional impairment and persistent disease activity in many children. Methotrexate was used in 72.9% of children, biologics in 4.7%. CHAQ and JADAS indicated substantial functional impairment and persistent activity. Conclusion: JIA in Chad is characterized by long diagnostic delays, significant disability and minimal access to biologics. Improving referral pathways and access to advanced therapies is urgently needed.