PEDIATRIC RHEUMATOLOGY UPDATE
A NEWS LETTER FROM
THE DIVISION OF
This page is provided by Thomas J. A. Lehman MD
Delivering the best care - with great care
Dr. Lehman is the
author of many textbook chapters and articles on the care of children and young
adults with SLE. He practices in
Abdominal pains, joint pains, and fevers.
A wide variety of viral infections can produce these symptoms. This time of year it seems everyone has picked up a 'flu bug.' Sometimes it's merely a respiratory syndrome. Sometimes there's a little nausea and diarrhea. Some children are aching all over. Occasionally there's a rash. For most children the symptoms resolve in three to five days and life quickly gets back to normal. What to think about when the symptoms persist?.
Echo viruses often cause abdominal complaints followed by arthritis. EBV, parvovirus, or CMV also may cause prolonged malaise with arthritis or arthralgias. Lyme disease may present as a flu like illness with arthralgias. Bacterial infections such as Salmonella, Shigella, Strep, Klebsiella, and Yersinia also may cause abdominal pain, fever and joint complaints. GC can also do this.
Children or adolescents with inflammatory bowel disease are often initially thought to simply have 'a chronic bug.' Many rheumatic diseases can also present in this fashion. Henoch Schoenlein purpura is usually easy to recognize because of the rash over the legs and buttocks. Polyarteritis nodosa frequently presents as fever, abdominal, and joint pains. Behcet's disease often presents with fever, fatigue, skin ulcers and pains. So can sarcoid.
Dermatomyositis, SLE, and scleroderma may present with abdominal pain due to serositis or small bowel involvement.
The vast majority of children in a pediatric practice with a 'flu syndrome' will be better in a few days. When a 'few days' have gone by and the child hasn't gotten better there are lots of 'easy' explanations. When a few days turns into weeks careful evaluation is warranted.
Once the cultures are negative and stools for O&P have been checked, what to do next? Other infectious diseases like TB need to be excluded first. After that it depends on the predominant symptoms. If there's a lot of abdominal pain we need to make sure GI doesn't find anything - chronic appendicitis, IBD, etc. If there's joint pain or multisystem complaints consider rheumatic diseases.
The child who isn't getting better when he should, the older child or teenager who is 'failing to thrive,' the child who is always missing school. These children all have an extensive differential diagnosis. Some have a rheumatic disease. Many do not. We're here to help with the complicated and difficult children in your practice. If we find a rheumatic disease, we'll strive to fix it. If we don't, we'll endeavor to find out what is wrong, and get the child to the appropriate specialist.
The Division of Pediatric Rheumatology at HSS continues to grow. We’ve received grants to expand our research and teaching programs Need a grand rounds speaker? Call us!! We like to teach. That's why we're here. Thank you for your continued support!
If you have patients who
don’t want to come into NYC we can see them at the
Dr. Lehman is the author of many
textbook chapters and articles on the care of children and young adults with
rheumatic diseases including SLE, JRA, dermatomyositis, scleroderma,
“Dr. Tom Lehman’s experience and compassion are evident on every page of this book, and they help guide the reader—child, parent, and healthcare professional alike – through the world of childhood arthritis. This book is an absolute gem written with a single goal in mind: improve the lives of kids with arthritis.” -- Jack Klippel, M.D. President and CEO of the Arthritis Foundation
“Dr. Lehman has given parents and families of children with
arthritis the first book that speaks to the parent and child as equals. His book explains the illnesses, the
medications, the lab tests, and the disease course in simple, understandable
lay language and givens them valuable insight into how a pediatric
rheumatologist thinks. Bravo!”-- Charles Spencer, M.D.,
Professor of Clinical Pediatrics,
It’s not just
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments
It has always been a frustration trying to answer the many questions I have received from people over the web. I can’t take the time and give them the detail I would like to. I have to take care of my patients. This book is a distillation of my experience answering questions for parents and health professionals over 25 years of practice. If you want to know about the diseases, the tests, the medications, or how to be sure you are getting the best care– If you are the family member of a child with joint pains, this book will give you the answers. If you are a general physician, a pediatrician, or a nurse who cares for children with these diseases it will answer many of the questions families ask you, and you can recommend it to them. It will also answer many of your questions about what shots to give, what precautions to take, and the other questions families, pediatricians, and other health care providers have asked me over the years.
is the author of many textbook chapters and articles on the care of children
and young adults with SLE. He practices
The Arthritis Foundation also works with children with lupus.
This site provided by Thomas J. A. Lehman MD
Chief, Division of Pediatric Rheumatology
The Hospital for Special Surgery
535 E 70 St,
212-606-1151, fax 212-606-1938, e-mail email@example.com