Published in UAB Insight, Summer 2008
A Much-Needed Specialty Now Available at UAB
Until recently there were no practicing pediatric rheumatologists in Alabama, although as many as 6000 of the state's children have juvenile arthritis. This lack of doctors reflects a national shortage - fewer than 200 board certified pediatric rheumatologists practice in this country, according to a recent report by the US Health Resources and Services Administration.
The Arthritis Foundation, Alabama Chapter remedied this problem, partnering with UAB and Children's Health System to establish a full-service pediatric rheumatology program with a dedicated clinical facility. The Alabama Center for Childhood Arthritis and Rheumatic Disorders opened in September 2007 led by pediatric rheumatologist Randy Q. Cron, MD, PhD, director of UAB's new Division of Pediatric Rheumatology, and colleague Timothy G. Beukelman, MD, also a pediatric rheumatologist.
Juvenile idiopathic arthritis is one of the most common chronic illnesses among children. Poorly controlled, the disease retards growth and development and profoundly affects quality of life. Overly cautious treatment in early disease stages can cause long-term damage, including bony deformities, micrognathia, and joint contractures, says Cron.
Rheumatic diseases are genetically and phenotypically different in adults and children. Childhood rheumatic diseases vary enormously, and disease phenotypes may encompass several different rheumatic disorders. "Proper diagnosis frequently involves a broad array of studies, and physicians specializing in pediatric rheumatic diseases are best equipped to diagnose and treat these conditions," Cron says.
Treatment advances during the last 15 years have dramatically improved outcomes, and early, aggressive intervention can reduce the short- and long-term morbidity of childhood rheumatic diseases. Children's higher tolerance for many medicines allows more aggressive immunosuppressive therapy. Low-dose weekly methotrexate combined with biologic agents, such as tumor necrosis factor inhibitors and interleukin-1 antagonists, quickly and effectively manage inflammation in the majority of children with chronic arthritis. Judicious use of intra-articular corticosteroids can control disease locally, sparing use of excessive systemic medications. "We now achieve remission in more than 50% of cases. Most people do not even know these children have arthritis," Cron says.
Cron and Beukelman also treat lupus, dermatomyositis, vasculitis, and scleroderma as well as specific comorbidities such as childhood temporomandibular joint arthritis and macrophage activation syndrome.
The clinic accepts pediatric patients with known or suspected rheumatic disease, but physicians may want to call the clinic for advice before ordering tests and referring. "Antinuclear antibody [ANA] testing does not assist in diagnosis of childhood arthritis," Beukelman says. "Up to 20% of the healthy population will have a positive ANA. Rheumatoid factor is equally unhelpful. Fewer than 4% of children with chronic arthritis will be positive."
The timing could not be better for the advent of this specialized center. "With rapid developments in biologic therapies for autoimmune diseases, we are seeing a greatly improved future for children with arthritis," says Cron.
FOR MORE INFORMATION:
Dr. Randy Cron
Dr. Timothy Beukelman
1.800.UAB.MIST
mist@uabmc.edu