PEDIATRIC RHEUMATOLOGY UPDATE
A
NEWS LETTER FROM
THE DIVISION OF
PEDIATRIC RHEUMATOLOGY
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!
We’re in
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,
My
book –click here to order at a discount from Amazon.com
at
Amazon.com
“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
growing pains.
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments
Click here to see the table of
contents
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.
Click here to go to
the Pediatric Rheumatology Home page
Dr. Lehman
is the author of many textbook chapters and articles on the care of children
and young adults with SLE. He practices
in
The Arthritis Foundation also works with
children with lupus.
Click for BOOKS dealing with SLE
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 goldscout@aol.com