Paediatric rheumatology & Immunology is a speciality branch of Paediatrics that deals with diseases of the immune system which may affect the joints, skin, eyes and/or any other organ system in the body.
Due to genetic or environmental factors or both, the immune system in a child may either not function optimally (immunodeficiency) or may go into overdrive and attack the child’s own tissues and organs (auto-immunity). These children may present with fever, rashes, joint pains, joint swelling, and symptoms due to inflammation in the eyes, kidneys, liver, brain, heart or lungs.
Children with Primary Immunodeficiencies (PID) may give a history of repeated infections and not growing well or present as seriously ill children to the ICU. Whereas conditions like Kawasaki disease are acute and have excellent outcomes if diagnosed and treated in time, many others such as Juvenile Idiopathic Arthritis (a type of arthritis that starts in childhood) or Systemic lupus erythematosus (an auto-immune disease) maybe chronic (long-standing).
Some of the symptoms and signs in a child that mandate referral to a Paediatric Rheumatologist are listed below:
- Prolonged fever or repeated fevers
- New onset or recurrent skin rash
- Joint pains and/or joint swelling or deformities
- Limb pains, limping or change in gait
- Muscle weakness or decrease in activities
- High blood pressure in a child (Hypertension)
- Inflammation in eyes (uveitis)
- Any condition that may cause multi-system involvement and serious illness (more than one organ system is affected)
- Repeated infections needing hospitalisation
- Abnormalities in blood tests indicating inflammation etc
They need early diagnosis and prompt treatment by a multi-disciplinary team of doctors including Paediatric Rheumatologist & Immunologist, Intensive care specialists, Cardiologist, Neurologist, Ophthalmologist, Physiotherapist etc. The Paediatric rheumatologist usually plays the role of the anchorperson who coordinates with all other specialists, plans the treatment and continues to follow up with the child. With the right medications and regular follow-up, it is indeed possible to achieve good disease control, prevent joint deformities and other complications even in chronic diseases and ensure that the child has as normal a quality of life as his peers.
Treatment options are individualised and include Non-steroidal anti-inflammatory drugs (NSAIDs), oral and injectable steroids, joint injections (intra-articular steroids), Disease-modifying anti-rheumatic drugs (DMARDs), Biologics, Intravenous immunoglobulin (IVIg) infusion and even Bone marrow or Haematopoietic stem cell transplant for PIDs.
This is a relatively new speciality of Paediatrics but recent advances in diagnosis and treatment of these conditions have led to vastly improved outcomes, ensuring patient, parent and physician satisfaction.