INDICATIONS FOR THE REFERRAL OF CHILDREN WITH RHEUMATIC DISEASE TO A PEDIATRIC RHEUMATOLOGIST

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This page is provided by Thomas J. A. Lehman MD

Delivering the best care - with great care

 Dr. Lehman is the author of many textbook chapters and articles on the care of children and young adults with rheumatic diseses.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

 

Introduction:

The rheumatic diseases of childhood are an important cause of both short and long term disability in childhood. Proper diagnosis and early aggressive intervention can minimize both the short and long term morbidity of these conditions, and thereby minimize the cost of caring for these children. Without proper therapy acute rheumatic fever, systemic lupus erythematosus, dermatomyositis, progressive systemic sclerosis, and many forms of vasculitis may be fatal. Other conditions such as juvenile rheumatoid arthritis and spondyloarthropathies do not threaten life, but may be associated with a lifetime of chronic disability. All of the rheumatic diseases of childhood may have profound effects on the physical and psychological growth of the child. Disruption of the family unit, divorce, and other psychological stresses which affect all members of the family are common. Specialized pediatric rheumatology centers are able to provide a team of individuals accustomed to dealing with children with chronic disabilities and their families. This comprehensive team approach is often associated with a superior outcome at a lower overall cost.

Recommendations:

Children with each of the following diagnoses should have the diagnosis confirmed and their treatment plan monitored by a physician experienced in pediatric rheumatology.
acute rheumatic fever
lyme disease with arthritis
systemic lupus erythematosus
mixed connective tissue disease
progressive systemic sclerosis
linear scleroderma
dermatomyositis
polymyositis
polyarteritis nodosa
Wegener's granulomatosis
psoriatic arthritis
ankylosing spondylitis
systemic onset juvenile rheumatoid arthritis
Behcets disease
unexplained joint pains

In addition all children with musculoskeletal complaints whose disease does not remit with therapy (including all of the diagnoses listed above), as well as the following:
pauciarticular onset juvenile rheumatoid arthritis
polyarticular juvenile rheumatoid arthritis
recurrent 'tendonitis'
unexplained 'low back pain'
recurrent 'toxic synovitis'

In the presence of a known rheumatic disease or unknown musculoskeletal complaints any of the following are indications for referral to a specialized pediatric rheumatology center.

·       any child who because of his arthritis is developing persistent flexion contractures

·       any child who is requiring home tutoring

·       any child who is requiring the use of a wheel chair or stroller (as age appropriate).

·       any child requiring hospitalization

·       any child requiring corticosteroid therapy

The following diagnoses require ongoing management by a physician experienced in pediatric rheumatology
Systemic lupus erythematosus
Dermatomyositis
Polyarteritis nodosa
Mixed connective tissue disease
Wegener's granulomatosis
Behcet's disease
sarcoidosis
systemic onset juvenile rheumatoid arthritis

 

For more information designed for pediatricians, family practitioners, nurses and families, you may wish to consult my book.

Click here to order at a discount from Amazon.com!!

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    Dr. Tom Lehmans experience and compassion are evident on every page of this book, and they help guide the readerchild, parent, and healthcare professional alike through the world of childhood arthritis.  This book is an absolute gem written with a single goal in mind:  improve the lives of kids with arthritis. -- Jack Klippel, M.D. President and CEO of the Arthritis Foundation

 

     Dr. Lehman has given parents and families of children with arthritis the first book that speaks to the parent and child as equals.  His book explains the illnesses, the medications, the lab tests, and the disease course in simple, understandable lay language and givens them valuable insight into how a pediatric rheumatologist thinks.  Bravo!-- Charles Spencer, M.D., Professor of Clinical Pediatrics, University of Chicago, La Rabida

 

 

It’s not just growing pains.
A guide to childhood muscle, bone, and joint pain,
rheumatic diseases and the latest treatments

 

Click here to see the table of contents

 

It has always been a frustration trying to answer the many questions I have received from people over the web.  I can’t take the time and give them the detail I would like to.  I have to take care of my patients.  This book is a distillation of my experience answering questions for parents and health professionals over 25 years of practice.  If you want to know about the diseases, the tests, the medications, or how to be sure you are getting the best care– If you are the family member of a child with joint pains, this book will give you the answers.  If you are a general physician, a pediatrician, or a nurse who cares for children with these diseases it will answer many of the questions families ask you, and you can recommend it to them.  It will also answer many of your questions about what shots to give, what precautions to take, and the other questions families, pediatricians, and other health care providers have asked me over the years.

Dr. Lehman is the author of many textbook chapters and articles on the care of children and young adults with rheumatic diseases including SLE, JRA, dermatomyositis, scleroderma, Kawasaki disease and related conditions.  He practices in New York City.  Click here for more information about Dr. Lehman or the Hospital for Special Surgery.

Click here for BOOKS dealing with childhood rheumatic diseases

This site provided by Thomas J. A. Lehman MD
Chief, Division of Pediatric Rheumatology
The Hospital for Special Surgery
535 E 70 St,
New York, NY 10021
212-606-1151, fax 212-606-1938, e-mail goldscout@aol.com

 

Click here if you are interested in making an appointment to see Dr. Lehman or in referring a child.

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