Current concepts in pediatric rheumatology

Purpose of review: The discipline of pediatric rheumatology has derived significant benefit from recent advances in diagnosis and therapy. As the molecular understanding of inflammatory joint disease has increased, more specifically targeted biologic therapies for arthritis have come available. Children with advanced joint disease on biologic therapies may be referred to orthopedists for consideration of surgical procedures. Orthopedists should be familiar with both newer diagnostic methods and treatments for childhood arthritis. Recent findings: Improved ultrasound and magnetic resonance imaging now afford better sensitivity in the diagnosis of inflammatory arthritis in both peripheral and axial joints. Laboratory assessment of pediatric patients with suspected joint disease remains supportive with clinical exam findings being far more reliable indicators of disease. Juvenile rheumatoid (idiopathic) arthritis is the focus of this review. Other etiologies for inflammatory joint findings, such as rheumatic fever, periodic fever, and drug-induced disease, are also briefly considered. Therapies with biologic agents, anti-tumor necrosis factor constructs in particular, have significantly changed the care and early outcomes of patients with juvenile arthropathies. Reports of more aggressive use of previously available agents, such as methotrexate and injected corticosteroids, are also encouraging. Summary: Orthopedists are a critical link in the recognition of inflammatory joint diseases in children. A better understanding of the appropriate laboratory work-up, the most sensitive imaging, and the most effective available therapies will go far toward improving the quality of care and long-term outcomes for these children.