PEDIATRIC RHEUMATOLOGY UPDATE

A NEWS LETTER FROM

THE DIVISION OF
PEDIATRIC RHEUMATOLOGY

HOSPITAL FOR SPECIAL SURGERY

535 E. 70TH ST. NEW YORK, NY 10021

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 and other rheumatic diseases.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

 

Cold hands?

Skin mottling?

"funny" blood tests?

What do you say when parents or an adolescent complain about cold hands?

Do you worry about children who always seem to have mottled skin?

We all know you have to evaluate children with prolonged clotting studies, but what do you do if you notice the PT or PTT is unusually short?

Can these things possibly be related to each other? If they are, should you care??

Recognizing that many of the complaints highlighted are often benign is one of the biggest challenges in writing a newsletter. At the same time I see children with serious conditions who clearly had all the associated findings which should have made their doctors suspicious but went undiagnosed for a long time. The trick is to know what questions to ask in order to quickly decide whether the complaint needs to be pursued further.

Anticardiolipin antibodies (ACLs) have now been recognized to be a major cause of childhood strokes and other bleeding problems - both excessive clotting and excessive bleeding. When questioned many of these children have a long history of cold hands, and livedo reticularis. Some children are detected when they have abnormal clotting times when tested before routine surgery. Either too short, or too long. Others are discovered when they complain of 'heavy periods' and are discovered to have profound menorrhagia. When VDRL testing was routine, many children with ACLs were discovered because of false positive VDRL or RPR tests.

With more widespread testing we now know that ACLs may be the cause of stroke, chorea, cardiac vegetations, unexplained emboli or excessive bleeding. Most often these problems first appear in adolescence, but they can occur in younger children. You certainly aren't going to screen every child, but chronically cold hands and mottled skin are the most frequent associated symptoms. When they are present we should ask about other findings and consider further testing.

Birth control pills increase the risk of problems in girls who are ACL positive. This makes teenage girls the most important group to consider. They probably aren't asking their pediatricians for birth control pills, but you may learn that the patient is on them, or be asked for advice. A teenage girl with cold hands, who was put on birth control pills because she had extremely heavy periods, ought to be worked up for ACLs. Many won't be positive, but we need to be careful.

The routine work-up for ACLs is easy. You want to test for anticardiolipin or antiphospholipid antibodies, and you want to check the PT and PTT. Unfortunately not all laboratories are equal when it comes to these tests. All of these tests could be normal in your lab and the patient might still have problems. Any one of the tests being abnormal warrants further investigation. There's a lot of discussion about how best to do the tests and how to interpret them and respond. We'll be glad to help you out with that part. If you have a suspicious patient we can have specialized tests performed by outstanding experts in the field of ACLs here at the Hospital for Special Surgery.

The Division of Pediatric Rheumatology at HSS continues to grow. We’re adding faculty, and we’ve received grants to expand both our teaching programs and our research into the causes and care of childhood rheumatic disease. Thank you for your continued support!

We’re in White Plains!

If you have patients who don’t want to come into NYC we can see them at the Burke Rehabilitation Center in White Plains. Call our NYC office 212-606-1151 for appointments.

 

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, Kawasaki disease and related conditions.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

 

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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.

 

 

Dr. Lehman is the author of many textbook chapters and articles on the care of children and young adults with SLE.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

Click here for The Lupus Foundation web page

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,
New York, NY 10021
212-606-1151, fax 212-606-1938, e-mail goldscout@aol.com

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