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Published on August 07, 2013

MU Children's Hospital Rheumatology Program Provides Rare Care for Common Diseases

COLUMBIA, Mo. ― Anjali Patwardhan, M.D., a pediatric rheumatologist at University of Missouri Children’s Hospital, is one of only about 250 pediatric rheumatologists in the United States. Most of these specialists ― about 90 percent ― practice health care in larger cities, leaving gaps in more rural parts of the country. 

“Pediatric diseases such as juvenile idiopathic arthritis and lupus occur everywhere, not just in the more populated areas,” Patwardhan said. “Often, children in rural settings with rheumatologic conditions go undiagnosed. Obtaining specialty care for them is usually difficult.”

According to the Arthritis Foundation, an estimated 50 million Americans have arthritis, including 300,000 children. Nearly 1 in 250 kids is living with a form of arthritis, and juvenile idiopathic arthritis is one of the most common childhood diseases, affecting more children than cystic fibrosis and muscular dystrophy. 

"The name has changed from rheumatoid to idiopathic arthritis because the causes of this juvenile condition are not always known,” said Ellen Price, R.N., a nurse clinician with the pediatric rheumatology program at MU Children’s Hospital. “There are several factors that could contribute, including genetic and environmental factors. But while this type of arthritis is rheumatologic in nature, because it involves inflammation of the joint tissue, it is not the same as rheumatoid arthritis in adults.”

Unlike adult rheumatoid arthritis, pediatric idiopathic arthritis can go into remission and never return. However, early diagnosis and treatment is vital to prevent permanent damage to the affected joint. 

Damage from arthritis occurs near the ends of bones, where the joints are located. In children, these areas contain growth plates, or tissue, that allows bones to lengthen as a child grows. 

"If this growth plate tissue has rheumatologic inflammation and goes untreated, damage will occur,” Patwardhan said. “The bones will not grow properly due to this inflammation, and the joints will eventually become permanently deformed.” 

According to Patwardhan and Price, pediatric idiopathic arthritis is not the extremely painful condition that adult rheumatoid arthritis is. In fact, children seldom complain as their adult counterparts do about severe, chronic pain. 

“Children are extremely adaptable,” Price said. “And what we typically see are kids who have made adjustments to their posture that allow them to be comfortable as they go about their daily activities. What we look for when diagnosing this condition is that kind of posturing or accommodating.”

Other symptoms may include chronic limping, an inability to put weight on a joint or joint stiffness in the morning that seems to get better as the day progresses. 

There are several methods used to treat juvenile idiopathic arthritis. The most common are diet and exercise, along with medications to treat pain and alter the course of the disease to put it into remission and prevent joint damage. 

“In my opinion, there should not be one child suffering permanent joint damage from juvenile idiopathic arthritis,” Patwardhan said. “Today we have many different therapies for treating this condition. If you detect it early, you keep the disease from escalating to a level where that permanent damage occurs. This also reduces the need for more intensive treatment, and the side effects associated with it.” 

The experts in MU Children’s Hospital’s pediatric rheumatology program care for patients with many conditions involving joints, soft tissues, autoimmune diseases, vasculitis ― an inflammation of the blood vessels ― and genetic connective tissue disorders. For more information, please call (573) 882-2008 or (573) 875-9000.