Pediatric rheumatismRheumatism is generally regarded as a disease of older people. It is less well known that children and adolescents can also suffer from this disease. Of the chronic inflammatory rheumatic diseases alone, rheumatism in the narrower sense, at least 20.000 children and adolescents affected nationwide. The most common form is rheumatoid arthritis, a chronic inflammation of the joints known technically as juvenile idiopathic arthritis (JIA). JIA is a very heterogeneous clinical picture that can occur in several forms, which are differentiated according to the number of joints affected and organ involvement (e.g.B. skin) differ from each other.
In addition to JIA, the term "pediatric rheumatism" also includes other disease patterns, which include.a. Connective tie diseases such as systemic lupus erythematosus (SLE) or dermatomyositis fall. In this group of diseases, very complex inflammatory processes can take place in almost all body ties. In order to achieve permanent joint or. To prevent organ damage, maintain quality of life and thus participation in life for young rheumatics in the long term, the disease must be detected as soon as possible and treated properly.
Joint rheumatism in children has many faces
Joint rheumatism (Juvenile Idiopathic Arthritis, or JIA) is the most common inflammatory rheumatic disease in adolescents: about one in 1.000 children and adolescents are affected. Nationwide there are about 15.000. The JIA shows itself with quite different faces. Is therefore often difficult to diagnose. The clinical picture ranges from inflammation of one joint or a few joints (oligoarthritis) to inflammation of many joints (polyarthritis) to a highly acute febrile illness with skin rash (arthritis with tendency to enthesitis) and inflammation of internal organs (systemic JIA, psoriatic arthritis). Typically, those affected by rheumatoid arthritis fall ill at the age of 2-3 years. In this phase of life, they are not yet able to talk about their pain. Therefore, parents usually recognize a JIA by a swelling of the joints and/or a changed movement pattern. Gentle postures and a reduced joy of movement go along with it.
. informs on its website about the categories of JIA and its symptoms and about treatment concepts. This society sees itself as a link between pediatrics and rheumatology. Its members are mainly pediatricians specializing in rheumatism.
Pediatric rheumatism: not the same as adult rheumatism
Juvenile idiopathic arthritis differs markedly from adult rheumatic diseases in its clinical presentation, possible concomitant diseases, and prognosis. However, what it has in common with them is that its treatment must be consistent and long-term. The earlier the treatment, the better the results. A combination of drug, physiotherapeutic, occupational therapy and orthopedic therapy in conjunction with psychosocial measures is usually used. The goal of therapy is no longer just to alleviate symptoms, but to completely suppress rheumatic inflammation so that children and adolescents with the disease can lead a normal life with as high a quality of life as possible in the long term.
Optimal care for young rheumatics
In order to achieve optimal care for young rheumatics, the current care situation must first be recorded and evaluated. This includes both rheumatological care and the investigation of the medical, psychosocial and economic consequences of the disease. Important ies include:
– How quickly do affected adolescents reach a rheumatologist after the onset of the disease?? Which medications are used at the beginning. Prescribed as the disease progresses? – Which concomitant diseases can occur in the course of the disease? – How do ill adolescents deal with their disease??
Extensive studies are being carried out to specifically address these questions.
Cohort studies: data treasures on the care situation of young rheumatic patients
The foundation of epidemiological research at the DRFZ regarding pediatric rheumatism is formed by three large nationwide cohort studies, which have been conducted in collaboration with physicians and rheumatism centers for many years:
– The core documentation of children and adolescents with rheumatoid arthritis, which accounts for nearly 14 per year.000 patients throughout Germany, – the JIA early cohort ICON with 975 JIA patients and ca. 500 healthy peers, – the JuMBO biologics registry for young adults with JIA with over 1.700 participants
Further information and results of the cohort studies and other projects can be found on the pages of the AG Kinder- und Jugendrheumatologie.
Understanding disease processes in JIA
In addition to epidemiology, the DRFZ is also researching the fundamentals of Juvenile Idiopathic Arthritis (JIA). JIA is a disease in which the immune system turns against its own body (autoimmune disease). Different cells of the immune system initiate an excessive immune response that leads to chronic joint inflammation. It is amed that certain environmental influences, such as z.B. infections and nutritional patterns in children with certain genetic conditions influence the inflammatory process. However, it has not yet been possible to decipher the underlying cause of this misdirected immune response. Modern techniques now make it possible to characterize the properties of individual "inflammatory cells" with the highest resolution (z.B. "single cell sequencing "). Since cells migrate from the blood to the joint and back again, certain disease processes in the joint can also be studied by analyzing cells from the blood. Researchers are using this detailed analysis of inflammatory processes to:
– to decipher causes of chronic inflammation, – to describe markers that can be used for diagnosis and therapy monitoring – and to identify possible therapeutic approaches.
In a new research project of DRFZ and Charite, funded by the Leibniz Association, corresponding analyses are performed in children with JIA who are observed over a longer period of time. Another interesting question is why some of the young patients experience a spontaneous remission of the disease, while others do not.