What is Pediatric Rheumatology?
Pediatric Rheumatology is a subspecialty of Rheumatology dedicated to the diagnosis and treatment of inflammatory diseases and clinical disorders of the locomotor system (bones, muscles, joints and tendons), and connective tissue, as well as other diseases of autoimmune origin in children and/or adolescents. Rheumatologic diseases in children are different from those in adults. First of all because the body of a child is not the same as that of an adult, and presents its own characteristics in terms of symptoms, diagnosis, treatment and prognosis, to which is added the fact that the body is constantly growing.
What diseases does the rheumatologist treat?
The most common rheumatic diseases in children are:
- Juvenile idiopathic arthritis (JIA).
- Juvenile dermatomyositis.
- Pediatric vasculitis, such as Kawasaki disease (autoimmune disorder).
- Systemic lupus erythematosus (autoimmune disorder).
- Autoinflammatory syndromes, such as PFAPA syndrome.
- osteoporosis
- osteogenesis imperfecta
- Localized and systemic scleroderma.
- Arthritis.
- Juvenile rheumatoid arthritis (autoimmune disorder).
- Schönlein-Henoch purpura (HSP).
- joint hyperlaxity
- septic arthritis
- infantile idiopathic arthritis
- osteomyelitis
- Spondylodiscitis or sacroiliitis.
- Benign acute myositis.
What subspecialties are there within Pediatric Rheumatology?
There are no subspecialties within Pediatric Rheumatology because it is already a subspecialty in itself within Rheumatology. However, there are rheumatologists who specialize in each pathology, with experts in lupus, rheumatoid arthritis or other rheumatologic diseases. This super-specialization makes it possible to advance research into rheumatic diseases, many of which are unknown, and whose treatments are under constant experimentation.
When to see a rheumatologist?
Rheumatic diseases usually present with musculoskeletal symptoms but sometimes there are other findings that may be suggestive of them. Some of these signs may be that the patient has prolonged fever, skin lesions characteristic of some diseases, lymphadenopathy, visceromegaly, uveitis or oral thrush.
It is important to see a specialist in Rheumatology for the above symptoms and those that will be mentioned below. However, the specialist should make a correct anamnesis and an adequate physical examination, requesting the necessary imaging tests, without leading to confusion and, therefore, to misdiagnosis.
Some children with rheumatic diseases describe pain. However, the characteristics of this pain can guide the specialist towards one diagnosis or another. Thus, it should be assessed whether the pain is mechanical (appears with exercise and disappears at rest) or inflammatory (occurs at rest), whether the onset was related to trauma, how long the pain has been present, where it is located and where it radiates to, and whether it limits the child’s daily activities, totally or partially.
In addition, each rheumatologic disease may have specific symptoms that may raise suspicion:
- Juvenile idiopathic arthritis. Little intense pain but stiffness after rest. Entheses (inflammation at the insertion of tendons, fasciae and ligaments), typical of enthesis-related arthritis (ERA), a category within JIA, does present pain. Children with juvenile idiopathic arthritis also often have daily fever spikes, for at least several days.
- Schönlein-Henoch purpura (HSP). It causes abdominal pain from intestinal vasculitis and joint pain from subcutaneous edema, which resembles arthritis.
- Septic arthritis. It produces intense pain. It does not produce fever, unless associated with a respiratory infection.
- Joint hyperlaxity. It causes an exaggerated mobility, as a consequence of arthralgias, that is to say, a pain in the joints without swelling.
- Osteomyelitis. The pain is located in the fingertips.
- Acute benign myositis. It produces transitory functional impotence, by a painful inflammation of the muscles.
- Spondylodiscitis and sacroiliitis. They cause an abnormal gait and a refusal to sit as a consequence of low back pain.
- Systemic lupus erythematosus. It produces typical arthritic lesions in the small joints of the hands. It may also present with fever, weight loss, asthenia and even anorexia.
- Arthritis. Causes inflammation of the joints.
- Kawasaki disease. It produces joint inflammation that appears when the patient passes the acute phase.