Rheumatology

Conditions We Treat

Autoinflammatory diseases are a group of disorders characterized by seemingly unprovoked inflammation. These conditions can present with recurring fevers and often happen with other symptoms like headaches, joint pains, abdominal pain and rashes. Some autoinflammatory diseases include:

• Cryopyrin-Associated Periodic Syndrome (CAPS)
• Familial Mediterranean Fever (FMF)
• Periodic Fever, Aphthous stomatitis, Pharyngitis, Adenitis (PFAPA)
• Tumor necrosis factor Receptor-Associated Periodic Syndrome (TRAPS)

Children with juvenile idiopathic arthritis (JIA) have joint inflammation called arthritis. When a joint has arthritis, it may feel warm, swollen, stiff, painful and tender when touched. These symptoms happen because of inflammation in the joint. Some children may only have mild symptoms in a few joints while others may have more serious symptoms like high fever, skin rash and swollen lymph nodes.  

The main types of JIA are: 

• Oligoarticular JIA: arthritis in four or fewer joints
• Polyarticular JIA: arthritis in five or more joints
• Psoriatic JIA: arthritis along with a personal or family history of psoriasis
• Enthesitis-Related Arthritis (ERA): a subtype of arthritis where larger joints, the spine, tendons or ligaments are affected
• Systemic JIA: arthritis along with fever, rash and swollen lymph nodes

Treatments are focused on decreasing pain, improving/maintaining function and movement, and preventing damage. Treatment often includes medicines that calm the immune system, such as steroids and disease modifying anti-rheumatic drugs (DMARDs), along with physical and occupational therapy to help improve strength and movement.

Inflammatory myositis, also called inflammatory myopathy, is a group of rare autoimmune diseases where the immune system attacks the muscles. This causes muscle inflammation, weakness, and pain. Other symptoms may include fatigue and rarely difficulty swallowing or breathing. Some patients with a condition known as juvenile dermatomyositis (JDM) also experience skin rashes along with muscle weakness. Treatments are focused on decreasing pain, improving/maintaining function and movement, and preventing damage.  Treatment often includes medicines that calm the immune system, such as steroids and disease modifying anti-rheumatic drugs (DMARDs), along with physical and occupational therapy to help improve strength and movement.

Sometimes muscle and joint pains are caused by reasons not explained by an autoimmune or rheumatologic condition (meaning it is not caused by the immune system attacking the muscles or joints). A rheumatologist can help rule out these other causes of pain, if needed. These primary pain conditions in which the nerves on the tissue send amplified pain signals to the brain include chronic widespread pains related to fibromyalgia or localized pain due to complex regional pain syndrome. Joint hypermobility, a condition in which tissues around the joints are very flexible, can sometimes be a cause of localized or more widespread pains. Examples include:

• Juvenile primary fibromyalgia syndrome (JPFS) is a long-term pain condition that affects children and teenagers. It causes pain all over the body, extreme tiredness, and problems with sleep. Many patients also have headaches, stomach pains, swelling, numbness/tingling and sometimes even mood symptoms like anxiety or depression. JPFS is most often diagnosed in teenagers around 14 to 15 years old and is more common in girls. Treatment usually includes physical therapy, regular exercise, and counseling, such as cognitive-behavioral therapy, to help children feel better and return to normal activities. Learn more about juvenile primary fibromyalgia syndrome (JPFS).
• Complex regional pain syndrome (CRPS) is a condition that causes severe pain in only one area of the body. It is a type of long-lasting pain where the pain itself is the main problem, not just a symptom of another condition. CRPS often starts after a serious or stressful event, such as injury, infection, sprain, surgery, or emotional stress. The nervous system then keeps sending extreme pain signals to the brain, even after the body should have healed. Treatment includes physical therapy and pain-focused counseling. Learn more about complex regional pain syndrome (CRPS).
• Hypermobility spectrum disorder (HSD) is a condition in children 6 years of age or older who have extra flexible joints or joint hypermobility.  In these patients, certain joints move significantly beyond their normal range and cause symptoms like pain or aching (especially after activities), tiring more easily/fatigue, and a frequent feeling that joints are popping in and out of place. Treatment is focused on pain management and stabilizing the joints through physical/occupational therapy, good sleep hygiene, excellent hydration, and more. Some patients also experience symptoms of fibromyalgia. Learn more about complex regional pain syndrome.
  
   

Scleroderma is a rare, long-term autoimmune disease. There are two main forms of scleroderma: localized (morphea) or diffuse (systemic). In general, scleroderma causes the skin and connective tissues in the body to become hard and tight because the body makes too much collagen. Scleroderma can affect only small areas of skin (localized), or it can affect the whole body (systemic). In severe cases, it can also damage internal organs like the heart, lungs and kidneys. There is no cure for scleroderma, but treatments can help manage symptoms and prevent damage. These may include medicines to lower immune system activity, improve blood flow, and reduce scarring. 

Uveitis is inflammation (swelling) of the eye's middle layer (uvea), often caused by autoimmune disorders, infections or injury, and can cause permanent vision loss if untreated. Some children may not experience any symptoms while others may have red, painful eyes, light sensitivity and blurry vision. Treatment is focused on reducing inflammation and preventing damage. Treatment usually involves steroids (eye drops, pills or injections) along with other disease modifying anti-rheumatic drugs (DMARDs). Prognosis is good especially if caught early.