Kids get arthritis, too: Q&A with a pediatric rheumatologist

Many people think of arthritis, lupus and vasculitis as diseases that affect only older patients. As a result, these conditions are often overlooked or misdiagnosed in children. But when they are diagnosed early, kids can be treated for rheumatologic conditions and often even go into remission before they become adults.

The University of Chicago Medicine Comer Children's Hospital is one of just two sites in Illinois that specializes in pediatric rheumatology. Here are answers to some common questions about rheumatologic conditions in kids.

What is a rheumatologist?

Rheumatologists treat disorders that cause inflammation of the connective tissues. This inflammation can affect the bones, joints, muscles, skin and the blood vessels. The list of conditions we treat is long, and includes arthritis, lupus, rheumatic fever, inflammatory eye diseases like uveitis, scleroderma, Kawasaki disease, sarcoidosis, vasculitis, fibromyalgia and chronic pain, and pediatric fever syndromes.

Are these conditions hereditary?

Some of them are. Some people are born with specific genetic mutations that lead to specific rheumatic diseases. However, more often the cause of these conditions is likely multifactorial. There’s likely a genetic component that increases a person’s risk of the immune system becoming overactive, but it’s also likely there is an environmental component that sets them over the edge. Different infections, as well as certain environmental or medical exposures, can play a part as well.

What is the most common diagnosis that you see?

Juvenile idiopathic arthritis (JIA) is our most common diagnosis. It’s one of the more common chronic diseases of childhood, and it’s often misdiagnosed. People have the idea that arthritis is really something that only happens in adults. Over 100,000 children in the U.S. ages 18 and younger have JIA. Other types of arthritis that we treat in kids are psoriatic arthritis, reactive arthritis, Lyme arthritis, and arthritis of the spine.

At what age can kids develop JIA?

JIA can present at any age. We have some patients who present in infancy, around 1 to 2 years old. They have trouble walking. We see it in older teenagers, where maybe they thought it was growing pains but they actually have arthritis.

How are these patients referred to you?

Usually we would get a referral from their primary care provider. We also get a fair number of referrals from orthopedic doctors or podiatrists. They’re seeing a patient with joint issues and they want to make sure it’s not something else.

How do you treat these diseases?

For a lot of our diseases, we have medications that target the immune system to help reduce inflammation. Over the last 10 to 20 years, a lot of new, very targeted medications have been approved in children to help treat their diseases and allow them to live healthy, active lives, even with these chronic illnesses. These diseases can limit a child or teenager's mobility if they have inflammation of the muscle and joints, so we also work closely with physical and occupational therapists to allow rehabilitation and strengthening.

Do rheumatologic diseases require surgery?

They used to, before some of the treatments we have now. Some children’s arthritis got so bad they required joint replacements. This has changed a lot since these new medications started coming out, and now children can have less pain and improved mobility without the need for surgery.

Can rheumatologic diseases be cured?

In some cases, we’re able to get the disease into remission and patients are able to live relatively normal lives, with the caveat that they need to take medication regularly.

Since kids are still growing and developing, there’s a chance for their immune systems to correct themselves. That doesn’t happen for everyone. But there are some patients who, after they’ve been treated successfully, we’ve been able to wean their medications and they can be medication and disease free.