What is pediatric rheumatology?

What is rheumatology?

Rheumatology is a branch of internal medicine and pediatrics and it deals with autoimmune or autoinflammatory diseases.
Auto = oneself
Immune = belonging to the immune system.
Inflammatory = from inflammation

What does all this mean?

Rheumatology deals with diseases in which the immune system gets confused, and instead of protecting the body and attacking bacteria or viruses, which is what it is supposed to it, it attacks the body itself.
Historically, these diseases included (and still include) all the joint diseases and that is why most of you are familiar with rheumatologists as “joint doctors”. You may have also come across other names such as rheumatism, which is a general name used to describe chronic pain in the joint and in the connective tissue surrounding it, due to the immune system attacking them by mistake.
But the immune system knows how to attack different types of connective tissue, and in fact, any organ in the body (not only the joints) and that is why the field of rheumatology is complex, very challenging, and deals with a wide range of diseases.

What is pediatric rheumatology?

Pediatric rheumatology is a large branch of pediatrics that deals with autoimmune or autoinflammatory diseases (see the definitions above) in children.
What is the difference between adult rheumatology and pediatric rheumatology? Oh, such a big difference! Children are not small adults.
Diseases in children, in any field by the way, are often specific to children. Even if sometimes the names of the diseases in children and adults overlap, the characteristics are usually different (the clinical manifestations, the complications, treatments, significance etc.).
And this is the reason why a whole world of medicine has developed around these diseases, some of which are only found in children. This is the reason why there is a specialty dedicated to this field. Pediatric rheumatologists are physicians who first completed a specialty in pediatrics (3-5 years depending on where it is done in the world) and then a sub-specialty in pediatric rheumatology (2.5-3 years).

What kind of symptoms require a consult from a rheumatologist?

I will divide the answer to this question into two:
• These are the “classic” complaints that are related to rheumatology:
Joint pain, swelling and excessive flexibility – it is important to distinguish between rheumatologic pain and biomechanical pain that is a result of friction or an abnormal mechanical activity in the tendons, muscles and/or joints. The immune system is not involved in biomechanical pain and this type of pain is treated by orthopedists. There is often an overlap between the symptoms, however, and that is why rheumatologists are familiar with the orthopedic problems that cause joint pain.
Growing pains – rheumatologists will rule out inflammation in the joints as a cause of the pain. Learn more about growing pains here.
Recurrent febrile illnesses – I would first suggest you read the post about recurrent febrile illnesses in children here. Part of the differential diagnosis for recurrent fever is rheumatological illnesses in children.
Recurrent throat infections – here too, I suggest you read the post about streptococcal throat infections and PFAPA syndrome (a rheumatological disease).
Monitoring children following the diagnosis of a rheumatological disease – for example, Juvenile Idiopathic Arthritis, Henoch-Schonlein Purpura, Familial Mediterranean Fever, Kawasaki disease, the post-COVID-19 syndrome called PIMS (link here), Lupus and more…

• And there is also the important role rheumatologists play as medical detectives, reminding us of the physician from the show Dr house. As mentioned previously, rheumatological diseases can involve any organ or tissue in the body and sometimes rheumatologists are involved in the workup and diagnosis of patients who present with non-specific complaints (fever, pain, weight loss, enlarged lymph nodes, rash, vision problems, hair loss etc.) or abnormal lab results, when the association between all the symptoms is not always clear to begin with. The combination of their sharp clinical intuitions, wide knowledge, experience and adequate investigations is critical for the confirmation or ruling out of certain diseases and for the selection of the correct treatment.

In summary, this is an exciting field that we encounter on a daily basis as pediatricians, and its diseases are part of the differential diagnosis of many common and important conditions in pediatrics (limb pain, recurrent sore throat, recurrent fever, etc.)
I would like to invite you to read the posts on this website under rheumatology and to benefit from finding answers to your questions.