Synopsis
Deliver planned, developmentally appropriate transition for young people with juvenile idiopathic arthritis, preserving disease control, uveitis surveillance, medicine safety, self-management and continuity across paediatric and adult services.
- Transition is a planned process that begins early in adolescence; transfer is the single administrative event within it.
- Identify a named coordinator and adult service, involve the young person directly and adapt timing to developmental readiness rather than eighteenth birthday alone.
- Transfer a complete disease summary: JIA category, joint and extra-articular history, damage, uveitis, surgeries, medicines, failures, adverse reactions, monitoring, vaccines and current goals.
- Continue ophthalmic screening at the interval set by the paediatric ophthalmology pathway; quiet joints do not prove quiet uveitis.
- Teach the young person the medicine name, dose and schedule, laboratory plan, sick-day advice, contraception and pregnancy implications and how to request prescriptions.
- Provide private consultation time and assess adherence, mental health, education, alcohol, smoking, sexual health, safeguarding and family support without abruptly excluding carers.
- Methotrexate remains once weekly with folic acid separately; document pregnancy prevention and avoid accidental daily dosing during prescribing-system changes.
- Confirm the first adult appointment and prescription responsibility before paediatric discharge; no young person should leave with an unowned monitoring result.
Key red flags
Systemic-JIA fever with falling platelets, fibrinogen, liver dysfunction, coagulopathy or neurological change requires urgent multidisciplinary care.
Fever, one hot joint, respiratory compromise or systemic illness may be muted by treatment and needs acute infection assessment.
Investigation priorities
Identify knowledge, self-management, communication and practical gaps before transfer.
Management branches
A young person with JIA is approaching adolescence or adult-service transfer.
- Introduce transition early, identify a coordinator and assess disease knowledge, self-management, communication, education, mental health and family support.
- Provide repeated age-appropriate teaching on medicines, monitoring, uveitis, infection, reproductive health, prescriptions and emergency contacts with private consultation time.
- Agree a flexible transfer plan with paediatric and adult teams and the young person, including reasonable adjustments and explicit readiness gaps.
Key medicines
Methotrexate with folic acidContinue the verified specialist dose once weekly, commonly 7.5–25 mg in adult practice. Record one fixed dosing day and prescribe folic acid at least 5 mg once weekly on a different day.Never prescribe or take it daily. Confirm risk-based FBC, renal and liver monitoring and interacting medicines; withhold it during a serious infection until recovery and clinical review. For maternal exposure, low-dose methotrexate must be stopped at least 1 month before planned conception and is not compatible with pregnancy or breastmilk exposure; accidental pregnancy needs immediate cessation, folic acid 5 mg/day and specialist fetal-risk review. BSR regards paternal exposure at no more than 25 mg/week as compatible; ensure confidential contraception and specialist pre-conception planning before transfer.
AdalimumabContinue the verified age-, weight- and indication-appropriate specialist regimen; adult maintenance is commonly 40 mg subcutaneously every other week.Screen for tuberculosis and hepatitis and stop for a serious active infection with acute specialist review. Avoid live vaccines during treatment; review demyelinating disease, and do not use in NYHA III or IV heart failure. When exposure continues beyond 28 weeks of pregnancy, document the BSR plan to defer infant live vaccines until 6 months.