Pediatric Rheumatology

Pediatric Rheumatology

MEDENS is the first and the only hospital in the region to provide dedicated ‘Pediatric Rheumatology’ services. Dr Aman Gupta completed his DM in Pediatric Clinical Immunology & Rheumatology from PGI, Chandigarh. He is among the first 5 Pediatricians in India to have this qualification. He gained international experience at the best centres for Pediatric Rheumatology in UK. He had been a clinical observer at the Bristol Royal Hospital for Children, Bristol, UK and the Great Ormond Street Hospital, London, UK.

 Introduction to Rheumatic Diseases in Children

Pediatric Rheumatic diseases are a wide group of chronic illnesses characterized by inflammation of musculoskeletal structures (joints, muscles), blood vessels and various other tissues. Most of these conditions are systemic disorders that require great expertise for prompt diagnosis and appropriate treatment. Pediatric Rheumatologists are specialists with expertise in managing arthritis and autoimmune diseases in children.

When to suspect a Rheumatic illness in children?

A Rheumatic illness should be suspected in every patient, irrespective of age, who has:

  1. Fever lasting weeks to months/Longstanding fever
  2. Fever not responding to antibiotics
  3. Recurrent episodes of fever without other symptoms
  4. Fever with rash
  5. Skin rash
  6. Joint pains or swelling, morning stiffness
  7. Lower backache and stiffness
  8. Oral and genital ulcers
  9. Seizures (due to stroke or thrombosis)
  10. Muscle weakness and difficulty in standing and walking
  11. Tightening of skin
  12. Blue or black discoloration of fingertips and toes
  13. Dryness of mouth and eyes
  14. Unexplained loss of body fat
  15. Unexplained high blood pressure

Spectrum of Rheumatic diseases in children

  1. Arthritis
  2. Kawasaki disease
  3. Multisystem Inflammatory Syndrome in Children (MIS-C) or Pediatric Multisystem Inflammatory Syndrome (PIMS)
  4. SLE (Lupus) – including neonatal lupus
  5. Antiphospholipid syndrome, Catastrophic APS
  6. Juvenile dermatomyositis (JDM): muscle weakness with skin rash
  7. Scleroderma: localized and systemic
  8. Raynaud phenomenon
  9. Sjogren syndrome
  10. Mixed Connective Tissue Disease (MCTD)
  11. Henoch-Schonlein purpura (HSP) or IgA vasculitis
  12. Takayasu arteritis
  13. Polyarteritis nodosa (PAN) including DADA-2
  14. ANCA associated vasculitis
  15. Acute Rheumatic fever (ARF)
  16. Infection associated arthritis
  17. Behcet disease
  18. Blau syndrome/ Sarcoidosis
  19. Periodic Fever Syndromes (PFAPA etc)
  20. Non-infectious osteomyelitis (CRMO, SAPHO, DIRA)
  21. Macrophage activation syndrome


Treatment is available for all Rheumatic diseases in children and includes NSAIDs, oral and intravenous glucocorticoids, DMARDs (methotrexate, azathioprine, cyclophosphamide, mycophenolate mofetil, tacrolimus, tofacitinib and others) and biological agents (adalimumab, tocilizumab, infliximab, rituximab, etanercept, anakinra etc ). Careful observation over long periods is required for best results.