17 topics with brief breakdowns: definitions, key facts, and class questions.
Pediatric rheumatology is one of the most challenging branches of pediatrics. This section covers systemic connective tissue and vascular diseases that require rapid differential diagnosis and early therapy to prevent disability in a child.
In this chapter, we explore all key nosologies: from joint syndromes (juvenile idiopathic, psoriatic, and reactive arthritides) to systemic vasculitides (hemorrhagic vasculitis, Kawasaki syndrome, polyarteritis nodosa, and Takayasu arteritis). A separate section is dedicated to severe systemic pathologies: lupus erythematosus, antiphospholipid syndrome, juvenile scleroderma, and dermatomyositis.
During clinical classes and exams, instructors most frequently ask about the classification criteria for JIA, the differential diagnosis of hemorrhagic vasculitis, and the triad of signs in Kawasaki syndrome (which is critical for preventing fatal coronary artery aneurysms). Pay special attention to treatment algorithms—in pediatric rheumatology, they are based on strict international protocols.
Are viral infections the cause of JIA development?
No, the role of infectious agents as a primary cause has not been proven at present. They are considered solely as triggers that initiate the autoimmune process in genetically predisposed patients.
What is the difference between persistent and extended oligoarthritis?
In the persistent variant, the number of inflamed joints does not exceed four throughout the entire course of the disease. In the extended subtype, 1–4 joints are affected in the first 6 months, but then 5 or more joints become involved.
Can the diagnosis of systemic JIA be confirmed solely by the presence of rheumatoid factor?
No. In children with JIA, rheumatoid factor and anti-CCP are detected extremely rarely (in only 5–6% of cases). The diagnosis is based on the clinical presentation and is a diagnosis of exclusion.
Why aren't ordinary prednisolone tablets used to treat JIA?
Oral intake of glucocorticoids is associated with a large number of severe systemic side effects. In life-threatening conditions, a short intravenous pulse therapy is much more effective and safer.
What is the characteristic feature of disease onset in children compared to adults?
In half of the cases in children, arthritis begins before the appearance of typical skin rashes, which are often mild or atypical.
Can glucocorticoids be used systemically as a long-term course?
No, systemic glucocorticoid use in psoriatic arthritis is strictly limited. Preference is given to intra-articular injections of depot formulations. Systemic drugs (e.g., methylprednisolone) are used only as a short 3-day course of pulse therapy to relieve acute conditions.
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