A chronic rheumatic disease in a child or teenager is a surprise both for the patient and his family, arising different fears and questions: Is it possible for a chronic disease to develop at such a young age? Doesn't a rheumatic disease only occur in older people? Is there any family predisposition? Was it transmitted by parents? Will siblings also have the disease? Is there no cure for the disease? What does remission mean? There are many different rheumatic diseases, with different symptoms, characteristics and prognoses. Some of these typically appear in pediatric age . Several factors can contribute but in many cases the disease is referred to as idiopathic, that is, without a known cause. Classically, rheumatic diseases were divided into two groups – autoinflammatory and autoimmune. However, in light of current knowledge, this division no longer makes sense; instead, the concept of immunological disease continuum is used, which links the two groups. Each rheumatic disease is referred to as a dysregulation by excess or defect of the various components that make up the immune system. As in other areas of medicine, instead of a specific disease, each patient with a specific rheumatic disease must be treated individually. This has led pediatric rheumatology to define individualized therapeutic goals for each patient. This is what is called treat to target. On the other hand, although many rheumatic diseases have no cure, if diagnosed and treated in time, it is possible, nowadays, to evolve into remission, that is, to a state in which the patient has no clinical manifestations of the disease. Signs/symptoms that should motivate the search for a pediatric rheumatologist Joint swelling (arthritis) lasting more than 6 weeks; Edema and pain in the entheses, that is, in the places where the tendons are inserted into the bones; Lameness with pain and without associated trauma. It may be possible to place the foot on the floor, but the patient tends to have the lower limb in flexion to avoid pain; Pain with an inflammatory pattern, for example in the morning or at the end of the day; Stiffness of movement after a prolonged period of immobilization, for example after getting up in the morning or after a trip; Chronic fatigue; Chronic low back pain lasting more than 12 weeks; Recurrent or persistent fever lasting more than 7 days; Recurrent or persistent rashes (skin spots) or in unusual locations, for example butterfly-shaped on the face, hands, knuckles, purplish or red spots with edema around the eyelids, in the elbow or knee area; Red eye and/or eye pain with decreased visual acuity or changes in vision; Recurrent aphthosis, especially when it affects the mouth and genital region; Parotitis (swelling of the parotid gland) or recurring swelling of other salivary glands; Hyperpigmentation of the skin with subsequent skin atrophy or inability to make skin folds in one or more areas of the body; Raynaud's phenomenon: change in the color of the fingers, toes, ears, tongue, nose, with a pale, red or purple color, sometimes simultaneously, and especially if it happens during all seasons of the year. There are few rheumatic diseases in which only exams allow diagnosis. But in most cases, diagnosing a rheumatic disease requires: A detailed clinical history; Careful observation of the child or adolescent; Regular monitoring. Exams are most useful for defining prognoses, classifying diseases, evaluating responses to established therapies , excluding other diagnoses when there is some doubt, and evaluating sequelae of diseases and treatments. Pediatric rheumatic diseases are true family diseases. Often, their appearance requires a family adaptation through the necessary involvement of everyone, from parents, siblings who must also have their needs and desires responded to, grandparents who can see themselves in complaints and even other family members. Due to their chronic nature, these diseases also require responses from the community. The families of these patients need help that goes beyond medical and nursing care. School and sports should be aids and not obstacles. Sport is recommended for rheumatic patients, but if the disease is not controlled, the activity can even cause pain and should be limited or adjusted to the patient's complaints. The regular control and surveillance that these patients must also allow their caregivers to have some work flexibility and the community efforts to guarantee accessibility and mobility for everyone. Author: João Miguel Nascimento Meet the pediatrics clinical team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
