Preface

The exemplars of childhood-onset chronic illnesses usually listed in the adolescent health literature rarely include rheumatic disease despite its having a similar or greater prevalence than other conditions, such as childhood diabetes or cystic fibrosis, and significant reported morbidities. Young people with rheumatic disease and their families therefore richly deserve a book dedicated solely to them and their health care.

Adolescent Rheumatology aims to provide a unique clinical approach that concentrates on the adolescent-specific aspects of health and rheumatic disease. We hope it will be useful and informative to the whole multi-disciplinary rheumatology team, pediatric as well as adult, and to the other professionals who come into contact with young people with rheumatic disease. The international group of contributors was specifically selected to reflect the multidisciplinary nature of adolescent rheumatology and to include both pediatric and adult rheumatology professionals and young people themselves.

Adolescent Rheumatology starts with chapters that describe the context of being a young person in the twenty-first century, highlighting the impact of rheumatic disease on adolescent development. The interplay of the biological, psychological, and social elements of adolescent development and the interface with peers, family, and the wider community are fundamental to adolescent rheumatology. This importance is reflected in the attention developmental medicine receives throughout Adolescent Rheumatology. The next chapters address specific adolescent issues related to the main conditions in the adolescent rheumatology spectrum, namely juvenile idiopathic arthritis, systemic lupus erythematosus, chronic idiopathic pain syndromes, back pain, sports injuries, and osteoporosis. The following chapters remind us that young people with rheumatic disease are teenagers first and foremost. They explore the generic issues that characterize adolescence, including the "sex, drugs, and rock 'n' roll." Evidence suggests that young people with rheumatic disease are just as exploratory and risk-taking as their healthy peers but face a "double whammy" from both the potential dangers of such behaviors and the effect such behaviors can have on their condition and/or therapy. Chapters addressing parenting and peer issues in the context of rheumatic disease are also included, reflecting the importance of the dynamic nature of relationships with parents and friends throughout adolescence.

Envisioning futures is an important characteristic of adolescent rheumatology whether it be choosing the proactive rather than reactive approach to care or considering the prognosis of rheumatic disease into adulthood. The final chapters of Adolescent Rheumatology are therefore future-focused, addressing the coordination of the transition process as young people move from child- to adult-centered care and, in particular, how the vocational aspects of adolescent development are addressed in this process. The penultimate chapters of the book address two areas rarely included in standard pediatric rheumatology books that are of particular importance in the relatively new world of adolescent rheumatology— training in adolescent health and quality improvement. Although training programs are well established in Australia and North America, they are currently in their relative infancy in Europe. This has obvious implications for the quality of adolescent service provision such specialties as rheumatology. The consultation with and participation of young people is an important quality criteria of young person-friendly rheumatology services. The book's final chapter has been uniquely written by young people with rheumatic disease from several countries, enabling some of their voices to be heard. Young people truly have the last word!

Janet E. McDonagh Patience H. White

The editors, Washington, D.C., 2003!
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