Cardiovascular Health

Premature atherosclerosis and coronary heart disease (CHD) are long-term adverse events that occur at much greater frequency among patients with SLE than would be expected. Patients with SLE have a five- to six-fold increased risk of CHD, and in young women between 20 and 40 years, this risk is reported to be as high as 50-fold greater than peers (26). Although the actual risk of a cardiac event related to atherosclerosis is relatively low in adolescence, clearly the process of accelerated...

Dual Energy XRay Absorptiometry

DXA is the most widely used technique even in children, adolescent, and young people, because of the availability of instruments, accuracy, and precision (reproducibility). It has been much studied both in vivo and Table 1 Primary and Secondary Osteoporoses in Children and Adolescents Primary osteoporosis Idiopatic juvenile osteoporosis Heritable disorders of connective tissue Secondary osteoporosis Neuromuscolar disorders Cerebral palsy Duchenne muscular dystrophy Prolonged immobilization...

Management Short Stature

Despite the availability of GH, the primary consideration in the management of growth failure in chronic rheumatic disorders remains aiming for Table 4 Differential Diagnosis of Amenorrhea Postpubertal Onset Primary amenorrhea with puberty onset Polycystic ovary ultrasound androgens Mullerian duct anomalies (adysplasia of Pelvic ultrasound vagina cervix uterus) Gonadal dysgenesis Elevated LH FSH, Karyotype Hyperprolactinaemia Prolactin levels Testicular feminization Minimal adrenarche,...

What Makes For A Good Rheumatology Clinic For Young People Aged 10 To 19 Yearsfrom Their Perspective

Clinics need to be a places where you can learn about your condition and how you can make living with your condition as easily and comfortably as possible. The people in the clinic need to treat young people with respect and with good manners. When you leave a clinic you should feel you have learned something new about your condition. I also feel that clinics should give information on work for young people with a chronic condition. Lot's of fun, games, fast service, magazines, more teen books...

Rheumatic

Adolescents with back pain related to JIA are most likely to have either enthesitis-related arthritis (ERA) or psoriatic arthritis. Back pain in these disorders results from inflammation of the spine and or sacroiliac (SI) joints. In contrast to the pattern seen with mechanical back pain, inflammatory back pain is worsened by rest (i.e., morning stiffness), and improved by activity. ERA is more common in adolescent Caucasian boys and in those with a family history of HLA-B27-associated diseases...

Case History

A 14-year-old girl of Caucasian origin was presented to her local hospital with a 2-month history of rash, fatigue and irritability. More recently, she complained of significant weakness and aching with activities. In particular, she had difficulty climbing stairs and brushing her own hair. She had fevers up to 39oC. She became short of breath and had difficulty in swallowing. She had one episode of nasal regurgitation. On examination, she had a typical rash, with heliotrope discoloration over...

Patterns of Clinical Presentation

Symptom pattern recognition is the key to diagnosis in any age group. Tumors are characterized by nocturnal, constant, and severe pain that often limits activities (Fig. 4). While the pain associated with the benign tumors of osteoid osteoma and osteoblastoma are often dramatically relieved by NSAIDs, pain associated with other tumors is generally not relieved by analgesics. Some mechanical causes such as disk herniation and spinal or sacral fracture usually present acutely or following a...

References

Pain syndromes in children. Curr Rheumatol Rep 2000 2(4) 337-42. 2. Malleson P, Clinch J. Pain syndromes in children. Curr Opin Rheumatol 2003 15(5) 572-80. 3. Sternbach RA. Pain and 'hassles' in the United States findings of the Nuprin pain report. Pain 1986 27(1) 69-80. 4. Brattberg G. Do pain problems in young school children persist into early adulthood A 13-year follow-up. Eur J Pain 2004 8(3) 187-99. 5. Jones GT, Silman AJ, MacFarlane GJ. Predicting the onset of widespread body...

Delayed Puberty

Management should begin with counseling and reassurance. If possible, underlying causes of pubertal delay should be treated. If this is not possible, management is either directed towards puberty induction with short courses of low dose sex steroids in those with reversible delayed puberty, or to long-term sex hormone replacement therapy (Box 5). Short courses of sex steroids induce puberty which then continues spontaneously, albeit sometimes at a slower rate. This is usually enough to result...

Large Vessel Vasculitis

The ACR classification criteria describe the characteristic features of sub-clavian or aortic bruit, age < 40 years at onset, decreased brachial artery pulse, blood pressure difference of > 10 mm Hg between arms, claudication of extremities, and arteriographic evidence of narrowing or occlusion of aorta, its primary branches, or large arteries in the proximal, upper or lower extremities (21). In Japan almost a fifth of cases occur in 10 to 19 year olds Table 2 Nomenclature of Systemic...

Patellofemoral Stress Syndrome

Patellofemoral stress syndrome (PFSS) is a broad, nondescript term used in sports medicine to describe anterior knee pain when the true etiology is multifactorial or unknown. Multiple factors such as an increased Q angle, femoral anteversion, foot hyperpronation, gluteal hip weakness, tight hamstrings, and patellar malalignment are suggested contributors to anterior knee pain. PFSS is commonly seen in adolescent females but occurs in males and females of all ages. Pain can be unilateral or...

Peer Support In Hospital Settings

Hospitals can play an important role in facilitating peer support. One very successful programme is the Chronic Illness Peer Support (ChIPS) programme in Melbourne, Australia, which has been effective in creating peer support networks for young people with chronic illness (21). ChlPS is a generic program recognizing that young people with any chronic illness face many similar psychosocial issues irrespective of illness type. Initially the program begins with an eight- week group for eight-...

Medial Epicondyle Apophysitis Little League Elbow

Apophysitis

Little league elbow, seen in throwers aged 8 to 14 years, especially pitchers and catchers, is an overuse injury to the fusing medial epicondyle apophysis from repetitive throwing. During the acceleration phase of pitching or the pull through during swimming a large valgus stress is placed on the medial elbow. Athletes typically present with medial elbow pain during throwing and sometimes at rest. Weakness and pain are present with resisted wrist flexion and pronation. The athlete has pain with...

Mechanical Traumatic

Mechanical problems are the most commonly diagnosed causes of back pain in adolescents. Some of these, such as Scheuermann's disease develop or progress during the adolescent growth spurt. Adolescent athletes are more likely to have back pain secondary to spondylolysis, spondylolisthesis, hyperlordotic mechanical back pain, or a herniated disk, especially in sports that require repetitive flexion, extension, or rotation of the spine (7) (see Chapter 11). Although many mechanical etiologies of...

Chronic Salter Harris I Fracture of the Distal Radius in Gymnasts

Case 19 A 12-year-old level 8 gymnast has had right wrist pain for the past three months. The pain began with tumbling activity and now occurs with all weight bearing activity including conditioning. He says the wrist occasionally swells. He has pain along the distal radial physis and discomfort with forced dorsiflexion. He has a normal neurologic examination. Gymnasts are unique in that they bear up to four times their body weight on their arms when they tumble and perform their sport. Many...

The Role of Parents During Adolescent Development

Parents can help their adolescent cope with growing up, provide a good example, establish consistent firm limits, being always involved and warm (4). Parents are the child's and adolescent's first role model and teacher. From his her parents, the child will learn that he she is unique and deeply loved. These feelings can last a lifetime. Parenting involves the care, teaching, and guidance that enable adolescents to make appropriate decisions for themselves. Adolescents are still immature in...

Spondylolysis

Case 9 A 16-year-old level 9 gymnast has had right sided low back pain for the past three weeks. She denies a specific injury but notes pain with bending backwards or backwards tumbling. She has no radiation of pain and notes no improvement with ibuprofen or ice. She has pain with palpation just lateral to the right L5 spinous process and has pain with hyperextension and one legged hyperextension (Stork test) on the right. Spondylolysis is the most common cause of low back pain in adolescents...

Epidemiology

It is difficult to establish the true epidemiology of musculoskeletal disease in adolescents. There are practical difficulties measuring incidence and prevalence of disease in a patient group that may be under pediatric or adult care and for whom there is no universally accepted age range (Chapter 1). There is an estimated 2589 incident cases of rheumatic conditions per 100,000 population in the 0-15 age group, and 8935 per 100,000 population in the 16-24 year old age group (1). However, this...

Enthesitis Related Arthritis

This subset was previously referred to as either juvenile ankylosing spon-dylitis or type II pauciarticular arthritis. It is a spondyloarthropathy usually manifesting as a predominantly lower limb arthritis and enthesitis (inflammation of the insertions of tendon, ligament, or joint capsule into bone). It is the only form of JIA to show a male preponderance (19), usually occurring in the early teens. There is a reduced incidence of sacroiliitis, with 23.4 of enthesis-related JIA showing...

Multidirectional Instability of the Shoulder Causing Impingement

Case 17 A 14-year-old year round right handed swimmer has three months of intermittent right shoulder pain. The pain usually occurs with butterfly stroke. She feels as though the shoulder clicks and slips with certain movements. She denies paresthies or an injury. She has limited internal rotation of her shoulder and weakness with resisted external rotation and supraspinatous testing. She has a positive sulcus sign along with a positive apprehension and relocation test. She has scapulothoracic...

Uveitis and Visual Impairment

Ocular involvement in JIA is a particular problem and can take many forms. An acutely painful red eye may be seen in the anterior uveitis associated with enthesis-related JIA. Sicca syndrome is known to be associated with Table 6 Percentage of Patients in Each Subset with Prosthetic Joints Table 6 Percentage of Patients in Each Subset with Prosthetic Joints rheumatoid factor positive polyarthritis JIA, as it is in adult rheumatoid arthritis. The most common problem in the oligo-arthritis JIA...

Medium Vessel Vasculitis

The peak age-of-onsetis at one year of age and 80 to 85 of cases occur at less than five years of age. Kawasaki disease (KD) is defined by the presence of fever persisting for at least five days, together with the presence of at least four of the following changes of extremities (acute erythema of palms, soles oedema of hands, feet, and subacute periungual peeling of fingers, toes in weeks 2 and 3) polymorphous exanthema bilateral bulbar conjunctival injection without exudates changes in lip...

Impact Of Chronic Rheumatic Disease On Growth And Development

Pubic Hair Male

The two main disturbances of growth and pubertal development seen in young people with chronic rheumatic disease are growth failure and Table 1 Average Age of Pubertal Development Table 1 Average Age of Pubertal Development Abbreviations B, breasts G, penis and scrotum O, testes volume as per orchidometer P, pubic hair. Abbreviations B, breasts G, penis and scrotum O, testes volume as per orchidometer P, pubic hair. pubertal delay. Young people with such conditions may experience either...

Chronic Recurrent Multifocal Osteomyelitis and Synovitis Acne Pustulosis Hyperostosis and Osteitis Syndromes

Chronic recurrent multifocal osteomyelitis (CRMO) is a sterile inflammatory disorder that usually occurs at multiple sites, e.g., long bones, spine, Table 6 Musculoskeletal Infections in Adolescents Gonococcal arthritis (Neisseria gonorrhoea) Bacterial arthritis and osteomyelitis (Staphylococcus, Streptococcus, Pseudomonas aeroginosa, gram-negative infections) Reactive arthritis (Salmonella, Shigella, Yersinia) 40 mono-arthritis 30 oligo-arthritis 30 polyarticular Asymptomatic tenosynovitis in...

Systemic Sclerosis

Pediatric patients make up only 3 of all cases of systemic sclerosis (95). Disease expression is influenced by genetic, ethnic, and environmental factors (97,104). In adults, females out number males, with a ratio of 3-14 1, although sex distribution ratio varies with age (97,104). The disease is more common in African-Americans, with a younger mean age-of-onset and increased risk of diffuse disease (105). Systemic sclerosis includes diffuse disease (formally known as progressive systemic...

Assess Diagnose and Treat Your Rheumatology Microsystem

Helpful tools and methods are available including Clinical Micro-systems' A Path to Health Care Excellence Toolkit Quality by Design www.clinicalmicrosystem.org to support busy clinical care teams to move forward to assess, diagnose and treat their clinical microsystem. The path forward includes the following steps 4 Create an interdisciplinary lead improvement team. This lead improvement team will guide the process of assess, diagnose and treat the rheumatology microsystem. The members of the...

Localized Scleroderma

Localized scleroderma morphea or linear scleroderma involves the skin and subcutaneous tissue in one area, although there may be involvement of other organ systems. Presentation tends to be indolent, starting with superficial erythema of the skin that gradually spreads. There may be central clearing with a lilac ring appearance. With time, there is hardening of the skin or subdermal structures, leading to an ivory-like appearance of the tissue 95 . Loss of hair and anhydrosis is common along...