Does your child complain of aches and pains? Parents often think it's because they have overexerted themselves. Although most believe that joint pain and rheumatoid arthritis disease are conditions for the elderly, juvenile rheumatoid arthritis affects children. Paediatric rheumatology is a relatively new sub-specialty of paediatrics, which deals with children having bone, joint, muscle and connective tissue diseases. Since these diseases have musculoskeletal manifestations, another name for paediatric rheumatology is ‘musculoskeletal medicine’.

Some children are prone to infections and illnesses, while some have severe allergies. These could be because of some malfunction in their immune system. This is where paediatric immunology helps.

Being new, this sub-specialty arrived in India about two decades ago and there are only a handful of centres in the country that offer complete and specialised care for children with these disorders. Narayana Health has a team of paediatric rheumatology and immunology specialists.

Paediatric Rheumatology: Symptoms

At Narayana Health, we evaluate and treat various rheumatology symptoms, including:

Joint and limb pains, with or without swelling of the joints
Backache
Limping
Unexplained, recurrent, or prolonged fever
Unexplained complaints of weakness, poor appetite, and fatigue
Loss of function of a body part or motor skills
Hair fall, anaemia or weight loss
Inflammation without identifiable causes
Skin rashes
Swellings of the lymph glands, with or without fever
Recurrent mouth ulcers
Eye inflammation

Paediatric rheumatologists may interact with or get referrals from other specialists, such as general paediatricians, orthopaedic surgeons, paediatric ophthalmologists, nephrologists, physiotherapists, psychologists or nutrition experts.

Paediatric Rheumatology: Diseases

Common diseases that paediatric rheumatologists treat include:

Juvenile Idiopathic Arthritis

Also known as juvenile rheumatoid arthritis disease, this chronic inflammatory disease mostly affects children below 16 years of age. This condition can cause severe growth problems, painful inflammation and even joint damage. Through physical therapy and management of medicines, our rheumatoid arthritis specialists for children focus treatment on managing pain, controlling inflammation, improving function, increasing the range of motion and preventing damage.

Vasculitis

This includes:

Henoch-Schonlein Purpura
Kawasaki Disease
Polyarteritis Nodosa

These diseases cause blood vessels to get inflamed, obstructing proper blood flow, which could damage various organs of the body. Corticosteroids may be prescribed to control the inflammation. In case vasculitis causes a bulge or ballooning in the wall of a blood vessel, the paediatric rheumatologist may recommend surgery.

Juvenile Localised Scleroderma and Systemic Scleroderma

While localised scleroderma affects the skin, systematic scleroderma can affect the internal organs. Localized scleroderma causes thickened patches of skin, while systematic scleroderma leads to joint pain, hardening of the skin and, in some cases, organ dysfunction. The rheumatoid arthritis specialist prescribes medicines, which may include topical creams, tablets, and/or intravenous drugs.

Pain Syndromes

This includes:

Growing Pains – Massaging, stretching exercises, hot pads, and pain-relieving medicines are used in the treatment.
Joint Hypermobility – Their joints move beyond the normal range of motion. The treatment may include exercises, wearing joint protection and support gear, physical therapy, and employing balancing techniques.

Hereditary Connective Tissue Disorders (HCTD)

HCTDs include over 200 conditions with similar symptoms and treatments in rheumatology. Advances in genetic technologies have improved their diagnosis and treatment. While many can be managed with medication and physical therapy, some may require surgical intervention. Infections of Bones and Joints

These include:

Bone Tuberculosis – Medicines are the first line of treatment, which could continue from 6 to 18 months.
Septic Arthritis and Osteomyelitis – Sepsis refers to a severe immune reaction to an infection. This is a serious condition, as it can cause life-threatening complications. Prompt diagnosis and treatment are also needed to prevent joint damage. Apart from antibiotics, the treatment may require removing fluid buildup in the joints or surgery to remove dead tissue.

Paediatric Allergy and Immunology: Symptoms

If your child experienced any of these symptoms, you could consult a paediatric immunologist:

Frequent bouts of sneezing, coughing, itchy eyes, sore throat or a runny nose that lasts for more than a week
Difficulty breathing and wheezing
Recurrent infections
Severe allergies to certain foods, medicines, insects or pets
Skin rashes

Paediatric and Immunology: Diseases

Narayana Health has a specialised team of paediatric immunologists that provides comprehensive diagnosis and therapeutic services for children. A paediatric immunologist treats diseases such as:

Systemic Lupus Erythematosus (SLE)

This is a chronic autoimmune disease where the immune system attacks the tissues of the body, causing inflammation and tissue damage. While hormonal, environmental and genetical factors play a role, infections, sunlight and stress can make the symptoms worse. The treatment depends on several factors, including the overall health of your child, family history, severity of the condition, and the affected part of the body.

Juvenile Dermatomyositis

This is a rare immune disorder that causes severe skin rashes and muscle inflammation. Along with regular monitoring and management of medicines, the doctor may recommend physical therapy to maintain mobility. The treatment plan could also include regulating the diet and taking supplements and vitamins.

Rheumatic Fever

Rheumatic fever is an autoimmune disease that can affect your child’s joints, skin, brain and heart. While fever and pain are common rheumatology symptoms, heart or brain inflammation is a serious condition. Rheumatic fever typically affects children and teenagers. Other post-infective conditions are also treated by our paediatric rheumatology team.

Periodic Fever Syndromes

Also known as auto-inflammatory syndromes, these conditions are mainly caused by genetic mutations which affect the immune system. While treatment includes anti-inflammatory medication, genetic testing and regular monitoring are important parts of a paediatric immunologist’s personalised treatment plans.

These syndromes include juvenile and hereditary sarcoidosis (Blau Syndrome), which manifests as granulomatous dermatitis, arthritis, and uveitis. The treatment plan for Blau Syndrome is created based on multidisciplinary efforts to maintain quality of life and prevent long-term complications.

Some other common immune system diseases that children suffer from are:

Anaphylaxis
Asthma
Allergic Rhinitis
Allergic Conjunctivitis
Antibiotic and Other Drug Allergies
Insect Allergies
Food Allergies
Urticaria (hives) and Angioedema
Eczema (atopic dermatitis)
Immunodeficiencies

The initial symptoms of some diseases may relate to bones and joints, even though they belong to other specialties. A simple vitamin D deficiency may cause your child to wake up from sleep due to pain in the bones or muscles. On the other hand, these symptoms could point to something much more serious. Blood diseases, such as leukaemia, sickle cell disease, and haemophilia, tumours of the bones and joints, primary and secondary immunodeficiencies, drug side effects, vitamin deficiencies, and even psychiatric disorders in children may present symptoms that bring parents to the paediatric rheumatology department.

At Narayana Health, we focus on accurate diagnosis, with the latest equipment and a multidisciplinary team of specialists. It’s only with accurate diagnosis that the correct treatment plan can be made, which plays a key role in your child’s speedy recovery.

Our paediatric rheumatology and immunology department provides specialised care, with individualised treatment plans that are tailored to each child’s unique needs. We are committed to excellence, providing the best care and support for children and their families. Our team focuses on helping children and their parents navigate challenging times in a compassionate and friendly environment.

Paediatric Clinical Immunology & Rheumatology