Clinician-to-Clinician Update Clinician-to-Clinician Update

Preventing Lifelong Complications from Childhood Rheumatic Diseases

December 2015

— Pediatric rheumatologist Richard Vehe, MD, attends to a patient. Prompt diagnosis and treatment are essential to effectively treating arthritis in children.

Rheumatic diseases affect approximately 300,000 children in the United States 1, and the vast majority of these children first present to their pediatrician or family physician. Although many musculoskeletal problems in children are temporary, prompt identification and appropriate treatment of the more serious or chronic conditions are essential to preventing lifelong damage and consequent pain or disabilities. Unfortunately, education and training programs to date have not left most primary care providers as well equipped to recognize the signs of rheumatic disease as they would like to be. Surveys reveal that about 85% of pediatricians obtain less than 4 weeks’ exposure to the rheumatology clinic during residency training; 48% report no exposure at all.2 What often results for the patient and family are referrals to specialties that lack expertise in rheumatic disease, a delayed diagnosis, and unnecessary testing and stress.3

When a child presents with musculoskeletal pain, the physical examination should include a search for signs and symptoms of arthritis. These include joint capsule swelling (due to increased synovial fluid or synovial tissue), or any 2 of the following: unusual joint warmth, decreased joint range of motion, or pain with range of motion. (See Figure 1.) Isolated musculoskeletal pain, in the absence of other signs or symptoms, is almost never a presenting picture of children with chronic forms of arthritis.4

juv-arthritis Fairview-105048-200x238
— Figure 1. Normal joint

Of note, in the primary care setting, anti-nuclear antibody and rheumatoid factor testing do not have diagnostic utility in evaluating children with musculoskeletal complaints and can be avoided.4 If signs of arthritis or other rheumatic diseases are detected, prompt referral to pediatric rheumatology is of the utmost importance to optimizing patient outcomes.

At University of Minnesota Masonic Children’s Hospital, our expert pediatric rheumatologists provide individualized care for patients with known or suspected rheumatic conditions. We offer a full range of treatment options, including oral and intravenous antiinflammatory and immunosuppressive therapies, subcutaneous and intravenous biologic response modifiers, physical and occupational therapy, and orthotics. Because prompt treatment results in better patient outcomes, we encourage primary care providers to have a low threshold for calling us to discuss patients and possible next steps.


1. Sacks JJ, Helmick CG, Luo YH, et al. Prevalence of and annual ambulatory health care visits for pediatric arthritis and other rheumatologic conditions in the United States in 2001-2004. Arthritis Rheum. 2007;57:1439-1445.

2. Correll CK, Spector LG, Zhang L, et al. Barriers and alternatives to pediatric rheumatology referrals: survey of general pediatricians in the United States. Pediatr Rheumatol Online J. 2015;13:32.

3. Henrickson M. Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics. Pediatr Rheumatol Online J. 2011;9:23.

4. McGhee JL, Burks FN, Sheckels JL, Jarvis JN. Identifying children with chronic arthritis based on chief complaints: absence of predictive value for musculoskeletal pain as an indicator of rheumatic disease in children. Pediatrics. 2002;110(2 Pt 1):354-359.

When to refer

We manage all arthritis-related conditions, including:

  • Juvenile idiopathic arthritis of all types
  • Other rheumatic diseases, such as
    • Behcet’s disease
    • Cryopyrin-associated periodic syndromes
    • Dermatomyositis
    • Mixed connective tissue disease
    • Periodic fever syndromes
    • Relapsing polychondritis
    • Sjögren’s syndrome
    • Systemic lupus erythematosus
    • Systemic scleroderma
    • Systemic vasculitis
    • Other spondyloarthropathy (enthesitis-arthritis) syndromes
    • Ankylosing spondylitis
    • Arthritis of inflammatory bowel disease
    • Reactive arthritis
  • Infection-related arthritis (Lyme arthritis, post-infectious arthritis, viral arthritis)

To refer patients to our clinic, please call our physician referral line at 888-KIDS-UMN (888-543-7866). For patient appointments with pediatric rheumatologists at the Explorer Clinic, please call 612-365-6777.

Collaborative Care

At University of Minnesota Children’s Hospital, our pediatric rheumatologists collaborate with other pediatric medical specialists—including ophthalmologists, dermatologists, and orthopedists—to offer a range of treatments tailored to your patient’s unique needs. Our referring physicians are an integral part of the multidisciplinary care team, and we are committed to frequent communication with you to ensure the best outcome for your patient.

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