PEDIATRIC RHEUMATOLOGY UPDATE
Thomas J. A. Lehman MD, Chief
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
PHONE 212-606-1151 FAX 212-606-1938
EMAIL GOLDSCOUT@AOL.COM ON THE INTERNET HTTP://WWW.GOLDSCOUT.COM
Your joints hurt!
How’s your stomach?
We all recognize that children who have inflammatory bowel disease (IBD) may develop arthritis. But it is also important to recognize that children with arthritis may have unrecognized IBD or other gastrointestinal conditions.
Everyday in pediatrics there’s the child with complaints about everything. He complains that his arms hurt, he always has tummy aches, he’s not as active as his friends. We’ve all seen children like this who truly had nothing wrong them. However, these can be the presenting symptoms of a variety of rheumatologic and gastrointestinal diseases as well.
In pediatric rheumatology with many of the children taking NSAIDs it’s even more difficult. We can’t send every child with complaints to the gastro-enterologist. Fortunately there are a variety of new screening tests that can help us detect these children earlier.
Celiac disease is found far more often
in European population studies than in the
Although the typical child presents with gluten sensitivity early in life, some children have much milder disease. We have seen several children with chronic joint aches and a sense of not doing well who we found to have celiac disease when they were teenagers. The diagnostic test is a small bowel biopsy. We can’t do these on every complaining child. Reliance on testing for anti-gliadin antibodies is difficult because there is a very high frequency of false positive results. However new tests evaluating for IgA antibodies directed against tissue transglutaminase have a much higher sensitivity and specificity. These can be ordered as IgA anti-tTG or IgA anti-endomysial antibodies.
With more and more children surviving extensive stays in the NICU we are also seeing an increased number of children who may have had full fledged NEC or merely suspected NEC. Years later they show up with joint complaints. There are no reported series of these yet. However, they mimic what has been found in adults with short bowel syndrome. This was well studied when they were doing jejunal bypass surgery for morbid obesity in the 1980s. Many of those patients developed arthritis because their gut wasn’t able to cope with the antigenic load. These children have similar complaints. It’s easy for us to treat these children once we recognize the etiology.
The association of IBD and arthritis is well recognized. However, it is important to ask for a family history of gastro-intestinal disease. Ten to twenty percent of IBD patients have a positive family history, but when the family is in your office with joint pains, they don’t think to tell you about family members with IBD. You have to ask.
Whenever we are suspicious that a child might have IBD we send them off to GI. However, in the case of children who seem to be complaining more than we expect, but lack a compelling reason for GI referral we can test for pANCA and ASCA. Again these tests aren’t infallible, but positive results stimulate us to send children for GI evaluation who we might otherwise have continued to watch.
The Division of Pediatric Rheumatology at HSS is here to help you. If you have children with arthritis or rheumatic disease or just confusing complaints, that’s what we do. Thank you for your continued support!
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.
If you have
patients who don’t want to come into NYC we can see them at the