Rheumatic diseases in children

Paediatric rheumatic diseases refer to a range of musculoskeletal, arthritic, and connective tissue disorders that can develop in childhood. These diseases can affect a child’s eyes, joints, skin, muscles and gastrointestinal tract. Although these autoimmune and inflammatory conditions share some common symptoms such as pain, heat and swelling, each also has specific symptoms. Rheumatic diseases can affect children of any age and any ethnic background

There are 4 main types of paediatric rheumatic disease:

Juvenile idiopathic arthritis (JIA): the most common form of arthritis in children. It includes the following sub-types:

• oligoarthritis (up to four joints are affected)
• polyarthritis (five or more joints are affected)
• systemic (joint inflammation, rashes, fever, fatigue, aches)
• enthesitis-related (joint arthritis and tendon swelling)
• juvenile psoriatic (joint arthritis and scaly skin rash).

Juvenile dermatomyositis: an autoimmune inflammatory disease which causes muscle weakness and a skin rash on the
eyelids and knuckles.

Systemic lupus erythematosus: a disease of the immune system and commonly affects the joints, skin, kidneys, blood
and other areas of the body. The condition is difficult to diagnose and can be mistaken for multiple sclerosis or juvenile
idiopathic arthritis.

Juvenile scleroderma: describes a group of conditions that cause the skin to tighten and harden.

What causes rheumatic disease?

The cause of rheumatic disease is still unknown and in many cases, the cause may vary depending on the type of disease. There is currently no cure but many children will go into remission or have infrequent symptoms.

Signs and symptoms

Symptoms of rheumatic disease can change dramatically throughout a single day or week. Periods where rheumatic symptoms are particularly active are called ‘flares’ (see below).

Depending on your child’s specific diagnosis, symptoms will vary but may include the following:

• stiffness, swelling and pain in the joints (particularly in the morning)
• persistent fatigue
• muscle weakness
• difficulty sleeping.

Try to learn about your child’s symptoms and be responsive when they occur. If they’re unwell they will need more rest and support than normal to engage in their daily activities.

Common emotional responses

Each child will respond differently to their illness. However, common responses may include:

• social withdrawal
• preoccupation with pain
• anxiety
• fear of joint damage
• self-consciousness.

Rheumatoid symptoms usually involve discomfort and pain. Children can be frightened and confused by the persistent pain as they may not understand their condition.

It’s important to reassure your child that the pain is not their fault and is not caused by something they’ve done.

How is rheumatic disease diagnosed?

The process of diagnosing a paediatric rheumatic disease begins with a physical exam and review of your child’s medical history. A range of blood tests and other tests including X-rays and medical imaging, urine tests, skin and muscle biopsies may also be ordered.

Treatment

Treatment will depend on your child’s symptoms, age, and general health. The goal of treatment in rheumatic disease is to relieve inflammation, control pain and improve quality of life. Most treatment plans involve a combination of medication, physical activity and healthy eating.

Symptoms can be effectively managed and reduced by using a combination of medication and treatments by a rheumatologist, occupational therapist and physiotherapist.

Strategies for managing pain

• Use prescribed pain killers as appropriate.
• Look for patterns that cause ‘flare-ups’ (use a diary).
• Learn the early signs of pain (have a ‘pain plan’).
• Encourage hot showers in the morning (helps relax muscles).
• Encourage the use of ice or heat packs (to relax muscles and reduce swelling).
• Build in rest breaks and energy conservation methods.
• Learn correct joint protection principles.
• Protect joints by splinting fingers or hands to support or restrict movement. An occupational therapist will create the splint and provide instructions on how, when and where it should be worn.
• Incorporate relaxation and distraction techniques (music, meditations).

Note: All pain management strategies should be approved by your child’s treating team as they may vary depending on your child’s needs.

Managing flare-ups

When JIA is active, or symptoms worsen, it’s known as a ‘flare’ or ‘flare-up’. Flares may last for days or even weeks. They can develop after your child has had an infection or without any warning or apparent trigger. They can be treated and managed. It’s important to treat flare-ups as soon as they occur to alleviate pain and prevent lasting joint damage. Find out more about juvenile idiopathic arthritis flare-ups.

Developed by the Rheumatology Service, Queensland Children’s Hospital. We acknowledge the input of consumers and carers.

Resource ID: FS215. Reviewed: March 2022.

Disclaimer: This information has been produced by healthcare professionals as a guideline only and is intended to support, not replace, discussion with your child’s doctor or healthcare professionals. Information is updated regularly, so please check you are referring to the most recent version. Seek medical advice, as appropriate, for concerns regarding your child’s health.