PEDIATRIC RHEUMATOLOGY

Schneider Children's Hospital is the site of an internationally known pediatric rheumatology program which is the only such program on Long Island providing comprehensive services to children with the rheumatic diseases of childhood, including:

• juvenile rheumatoid arthritis
  
• systemic lupus erythematosus
  
• scleroderma
  
• Lyme arthritis
  
• dermatomyositis
  
• systemic vasculitis
  
• Henoch-Schoenlein purpura
  
• Kawasaki Disease.

Few physical or occupational therapists have sufficient expertise in childhood arthritis. The Division physical therapist is available to coordinate on site, home or school therapy programs and offers specific advice to physical therapists involved in the patients' care.

The rheumatic disorders of childhood differ significantly from analagous diseases in adults. Furthermore, optimal care of children with rheumatic diseases requires unique developmental, educational and nutritional considerations. For these reasons, children with rheumatic disease should ideally be cared for by pediatric not adult rheumatologists. Children with rheumatic diseases often require a coordinated multidisciplinary team approach to complex musculoskeletal and extra-articular manifestations of their diseases requiring input from physical medicine and rehabilitation, orthopedics, and ophthalmology, for optimal care. The Pediatric Rheumatology Division is able to offer comprehensive services including state of the art immunodiagnostic testing, physical and occupational therapy, as well as psychosocial and nutritional services. Additionally, the Division provides the ability to do intra-articular injections or aspirations under conscious sedation in a Day Hospital.

Specific programs available

1. Juvenile rheumatoid arthritis: Patients are evaluated using standard history and physical examination techniques. The patient and family are educated as to the nature of the disease. An individualized pharmacotherapy program as well as a physical therapy program devised. Parents are instructed in exercises to be performed at home when possible. More severely affected children with significant deformities or contractures may require a physical or occupational therapist to perform the therapy for a limited period of time which is arranged by the Divison. Home physical therapy is also coordinated when necessary by the Division. Drug toxicity monitoring and follow up is coordinated by the Division. If necessary, intra-articular injections of corticosteroids under conscious sedation, or anesthesia, can be performed as an outpatient. The Division performs investigational protocols to test the efficacy of newly developed drugs to treat resistant JRA. Dr. Gottlieb is the principal investigator on amulticenter international study funded by the Arthritis Foundation to look at clinical outcomes in JRA. The goal of the study is to learn more about the course of JRA, what features may identify a child most at risk for aggressive arthritis, and what medications may most effectively treat children with arthritis.
   
2. Fibromyalgia, chronic fatigue, and maladaptive coping styles to pain: Patients are diagnosed using standard history and physical examination techniques. More serious and organic disorders are excluded. The patient and the family are educated as to the nature of the diagnosis. For patients who are dysfunctional because of the disorder, a cognitive behavioral intervention program is coordinated by the Division using local or Schneider Children's Hospital clinical psychologists. Pharmacotherapy is provided for patients resistant to cognitive behavioral intervention. Appropriate follow up is arranged.
   
3. Lyme disease: Patients with musculoskeletal symptoms which may be secondary to Lyme disease are evaluated. State of the art immunodiagnostic and molecular diagnostic techniques are available in the institution. Appropriate oral or intravenous therapy is coordinated at home by the Division.
   
4. Systemic Lupus Erythematosus: Comprehensive care is coordinated by the divisional nurse clinicians. This often involves input from pediatric nephrology and neurology. The Division performs investigational protocols to test the efficacy of newly developed drugs to treat childhood SLE, and has a special interest in atherosclerosis prevention in SLE.
   
5. Dermatomyositis: Comprehensive care is coordinated by the nurse clinicians. The division is involved in national studies of the epidemiology, pathogenesis and treatment of juvenile dermatomyositis.