Many of you must have heard of a specialist doctor called a Rheumatologist looking after someone with arthritis in your family. Have you ever heard of a children’s Rheumatologist?
At present, children with chronic arthritis or other autoimmune conditions are being managed by either general pediatricians, adult rheumatologists or orthopedic doctors. Many of these children need to seek specialist opinions outside Rajasthan due to nonavailability of such specialists within the state.
Disease burden in India and Rajasthan – India’s current population is estimated to be around 1.38 billion out of which an estimated 28.6% are children under the age of 15 years (NFHS IV 2015-2016). As per the Aadhar Statistics, the Rajasthan population in 2020/2021 is 78.23 Million. An estimated 1 in 1000 children can develop chronic arthritis as early as the age of 1 year. This gives us a rough estimate as to the extent of the disease burden in Rajasthan itself. It is difficult to give accurate epidemiological data for individual diseases in Rajasthan as its not available, but we do know that many of these diseases are widely prevalent.
Diseases Pediatric Rheumatologists look after – Children with joint swellings (JIA) or biomechanical joint pains, Connective tissue diseases such as SLE or Juvenile dermatomyositis etc. Vasculitis such as Kawasaki disease, IgA vasculitis (HSP), ANCA vasculitis etc
How to identify and when to refer – Symptoms of prolonged or recurrent fevers, joint swellings, rashes, red eyes, excessive hair loss, mouth and genital ulcers, blue hands/feet (Raynaud’s phenomenon), red tongue, bone pain, muscle weakness. The medications used are often immunosuppressive medications such as Steroids, Methotrexate and Biologics which should be only prescribed by a specialist as the side effects need to be considered before starting such medications.
Multidisciplinary approach – The first step forward is to make the parents and the general pediatricians aware of such a specialty service in Jaipur, Rajasthan. These children also need input from physiotherapists, occupational therapists, child psychologists and other specialties (most commonly dermatology, ophthalmology, cardiology, nephrology, gastroenterology and hemat-oncology).
The children need to be reviewed every 3-4 months for their condition and need to visit their general pediatricians for all other issues and vaccinations in-between visits.