About Paediatric Rheumatology
Joint pain is a common symptom in childhood. While the majority of these are benign, it is important to detect the significant causes early and treat appropriately to limit deformities and complications.
The causes and manifestations of arthritis are not the same in children as in adults; besides, children with arthritis have growth and developmental problems, hence the assessment and management styles may vary.
Paediatric Rheumatology is a subspecialty of Paediatrics which is gaining recognition in India. As with most chronic diseases, the use of appropriately aggressive treatment early can greatly improve the long-term outcome as well as reduce the cumulative exposure to several medications.
Juvenile Idiopathic Arthritis
This is the most common form of arthritis seen in childhood. The disease is estimated to affect nearly 1 million children across India. This is a common cause for deformity and disability in children. There are different subtypes of this disease namely- Polyarticular, Oligoarticular, Enthesitis related, and Systemic Onset. Occasionally, the disease can affect structures other than joints such as eyes. These diseases are eminently manageable if diagnosed and treated early on. The most important prognostic factor is the subtype of JIA and the duration of untreated disease. If left untreated, the disease causes significant pain and deformities leading to poor quality of life, loss of school days, and lifelong disability.
The diagnosis is made by clinical examination and relevant laboratory investigations. Management includes the use of Disease Modifying Anti Rheumatic Drugs (DMARDs), and judicious use of NSAIDs, Corticosteroids, and biological agents in case of refractory disease.
Juvenile Systemic Lupus Erythematosus
This is an uncommon but serious disease affecting children. The disease has a multi-system presentation with involvement of joints, skin, kidneys, brain, and other vital organs. Left untreated, the disease can have significant morbidity and mortality. Diagnosis is by clinical examination and blood and urine tests. The disease requires careful monitoring preferably under rheumatology supervision.
Juvenile Dermatomyositis
This is an inflammatory disease that affects muscles in addition to skin, joints, lungs, and other vital organs. The disease can present with joint pain, prolonged fever with muscle weakness. Diagnosis is by clinical examination and blood and urine tests. Occasionally, MRI or EMG may be needed for diagnosis. The management includes judicious use of steroids and other immunosuppressants. Untreated, the disease is often relentlessly progressive with irreversible muscle weakness or lung damage.
Juvenile Scleroderma
This is an uncommon rheumatic disease in children presenting with progressive skin thickening, Raynaud's phenomenon, and other vital organ involvement. The disease is diagnosed by clinical evaluation and blood tests. Occasionally, a CT scan or an ECHO may be required to assess heart or lung involvement. Treatment involves the use of corticosteroids and immunosuppressants.
Vasculitis
These are uncommon diseases in children. The disease is characterized by inflammation of small blood vessels. The disease can affect any organ including skin, joints, nerves, kidneys, etc. Prompt diagnosis and appropriate management can be life-saving.
Henoch Schonlein Purpura
These are uncommon diseases in children. The disease is characterized by inflammation of small blood vessels. The disease can affect any organ including skin, joints, nerves, kidneys, etc. Prompt diagnosis and appropriate management can be life-saving.
