The Importance of Finding a Rheumatologist Who Treats Children

By Mary Anne Dunkin

As any doctor can tell you, treating a child is not the same as treating an adult. Nor are juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases the same as the adult rheumatic diseases. If your child has one of these diseases, your first choice should be a pediatric rheumatologist. If there aren’t any near you, look for an adult rheumatologist who is trained in treating children, advises Sandra E. Pagnussat, MD, of Southwest Medical Associates in Las Vegas – one of the few doctors trained in rheumatology for adults and kids.

“Different rheumatology training programs require different levels of training in juvenile arthritis, so some rheumatologists will be more comfortable treating children than others,” she says. Contact several rheumatologists to see if they treat children and what ages, she adds.

Key Differences Between Children and Adults with Arthritis

When choosing a doctor for your child, consider these key differences between treating adult and pediatric rheumatic diseases:

Diagnosis focuses on history and exam. The diagnosis of juvenile idiopathic arthritis (JIA), the most common form of juvenile arthritis, is based almost entirely on a physical exam, since lab tests are often negative in children. A child’s description of symptoms is also unreliable for diagnosis, Dr. Pagnussat says. “Children may not complain of pain, but they may change the way they do certain activities – such as using their other hand to write or play, or the parent may find them limping.” 

Medications are prescribed differently. The same medications are prescribed for adults and children in some cases, but doses for children are often based on weight. Children tend to tolerate the medications better than adults do; they are generally healthier and their bodies clear meds quickly, so doctors can prescribe higher doses, relative to body size, for children than adults.

Any inflammation is too much. Treatment regimens and goals are very similar for children as adults. But for children, “No residual inflammation is allowed,” says Dr. Pagnussat. “In children, we treat very aggressively and early to prevent joint damage, chronic deformities and growth disturbances.” However, adults may choose to live with low-grade inflammation if the adverse effects of the drugs required to completely stop inflammation outweigh the benefits.

JIA can affect the eyes. JIA is often accompanied by eye inflammation that can, without symptoms, lead to irreparable eye damage. Children with JIA should have an ophthalmology exam when diagnosed, then every three to 12 months.

Bottom line, children with arthritis have special needs that require a doctor who really understands pediatric rheumatic diseases. However, even if there is a pediatric rheumatologist in your area, you may still want to consider a rheumatologist who treats children as often as adults. That way, your child's doctor can continue to provide care into adulthood and ease the transition into adult medical care.