Paediatric rheumatology is a relatively new and possibly the youngest sub-specialty of paediatrics which deals with children having bone, joint, muscle and connective tissue diseases. Since several childhood diseases have musculoskeletal manifestations, another name for paediatric rheumatology is ‘musculoskeletal medicine’
The specialty is only about sixty years old and limited teaching and training opportunities exist. Hence there are about a thousand paediatric rheumatologists world-wide with most of them being concentrated in North America and Canada.
The specialty arrived in India about two decades ago there are a handful of centers in the country, offering complete and specialized care for children with these maladies. Fortunately the list is growing slowly but steadily.
A paediatric rheumatologist evaluates and treats a variety of symptoms, including
- Joint and limb pains, with or without swelling of the joints
- Prolonged fever, unexplained fever or recurrent fever
- Unexplained complaints of weakness, poor appetite, fatigue, and/or loss of function or skills
- Unexplained symptoms such as hair fall, anemia or weight loss
- Possible inflammatory disease
- Various types of skin rashes
- Swellings of the lymph glands, with or without fever
- Recurrent mouth ulcers
- Multi-organ diseases that may involve the skin, kidneys, brain or lungs
- Uveitis (a type of 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.
The common diseases which come under the purview of a paediatric rheumatologist include
- Juvenile Idiopathic Arthritis (formerly known as juvenile rheumatoid arthritis),
- Systemic Lupus Erythematosus (SLE),
- Juvenile Dermatomyositis,
- Vasculitis including Hennoch Schönlein purpura, Kawasaki Disease, polyarteritis nodosa etc.
- Juvenile localized and systemic scleroderma
- Pain syndromes of childhood including growing pains and joint hypermobility
- Hereditary / genetic disorders of bone and connective tissue
- Infections of bones and joints such as Tuberculosis and septic arthritis /osteomyelitis
- Rheumatic fever and other post infective conditions
- Periodic fever syndromes also now known as auto-inflammatory syndromes including juvenile and hereditary sarcoidosis (Blau syndrome) amongst others
There are several other diseases which surprise doctors since their initial symptoms relate to bones and joints even though they belong to other specialties. Blood diseases such as leukemia, sickle cell disease or hemophilia and benign / malignant tumours of bones and joints, primary and secondary immunodeficiencies, drug side effects, vitamin deficiencies, poisonings and even psychiatric disorders in children may first present to the paediatric rheumatologist.