Paediatric Rheumatology

Pediatric rheumatology, the study of rheumatic diseases in children, had its origins in the first half of the 20th century, principally as a study of chronic arthritis; however, children with these disorders were occasionally recognized prior to then, and archeological evidence supports the existence of chronic arthritis in children as long ago as 900 AD.

The eminent British rheumatologist, Dr. Eric Bywaters, in referring to the origins of the specialty, said, “Pediatric rheumatology is one of the latest arrivals and one of the smallest, although I would not say premature. Dr. Bywaters and his colleague Dr. Barbara Ansell, at the Canadian Red Cross Memorial Hospital in Taplow, England, were among the earliest workers in the field (1940s, 1950s). Dr. Elizabeth Stoeber, at Garmisch-Partenkirchen, Germany, also pioneered the field.

Although chronic arthritis has always been the core of pediatric rheumatology, the broader scope of the discipline gradually emerged with the recognition in children of systemic lupus erythematosus (SLE), dermatomyositis, vasculitis, infection-related disorders, such as Lyme disease, and, most recently, the autoinflammatory disorders.

Today the specialty of pediatric rheumatology is concerned with a diverse group of disorders, most of which are systemic disorders that require great expertise for prompt diagnosis and optimal management.

Of all of the specialties, rheumatology, one of the most stimulating and challenging areas in all of medicine, may deal with the broadest spectrum of disease, both organ-specific and systemic. It is sometimes considered a “gray area” of medicine, because there are few useful diagnostic tests, sparse pathognomonic clinical signs, and therapy that often lacks specificity. This specialty requires a diagnostic and therapeutic approach to the “whole” child and family unit, patience, careful observation over long periods, and a heightened ability to tolerate ambiguity and uncertainty. Sometimes only the passage of time makes a diagnosis possible.