PEDIATRIC RHEUMATOLOGY UPDATE
A NEWS LETTER FROM
THE DIVISION OF
PEDIATRIC RHEUMATOLOGY
HOSPITAL FOR SPECIAL SURGERY
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
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
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,
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My
book –click here to order at a discount from Amazon.com
at
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“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.
Dr. Lehman
is the author of many textbook chapters and articles on the care of children
and young adults with SLE. He practices
in
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,
212-606-1151, fax 212-606-1938, e-mail goldscout@aol.com
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