Children are not simply “small adults”, Doctors who are trained to treat rheumatological conditions in children may be paediatricians who have developed particular skills in the area of paediatric rheumatology and are known as a “paediatric rheumatologist”. Alternatively, rheumatologists who predominantly treat adults may have developed an expertise in the care of children in this speciality.
Children and adolescents can be difficult to diagnose with symptoms often being associated with ‘growing pains’. Appropriate diagnosis and early intervention from a paediatric rheumatologist and specialist multi-disciplinary team is crucial in reducing the short and long-term effects of musculoskeletal and rheumatic diseases e.g. childhood arthritis.
Here in Norwich, we provide a specialist paediatric rheumatology service for the Norfolk and Suffolk area, extending further afield in the Eastern Region and are based at the Jenny Lind Children’s Hospital. The team comprises of a paediatric rheumatologist, two clinical nurse specialists, specialist physiotherapists, a clinical psychologist and a paediatric occupational therapist. The team also extends to include the services of a paediatric ophthalmologist and paediatric orthopaedic services for patient assessment and support when required. We work closely with local colleagues in Kings Lynn, Great Yarmouth/Gorleston, Bury St Edmunds and Ipswich, to provide rheumatology care for our paediatric population. We also have strong links with Cambridge University Hospital and the larger paediatric rheumatology centres in Birmingham, London and Nottingham.
For the most part, care is provided within our ambulatory service; the Children’s Day Ward (CDW), the Children’s Assessment Unit (CAU) and the Jenny Lind Outpatients. Inpatient care is provided on the general paediatric ward, Buxton.
The conditions commonly seen in our unit include:
- Juvenile idiopathic arthritis
- Arthritis associated with infection
- Reactive arthritis
- Connective tissue disorders
- Juvenile Systemic Lupus Erythematosus
- Juvenile Dermatomyositis
- Primary vasculitis – Kawasaki, Henoch-Schönlein purpura
- Overuse syndromes – chondromalacia patellae, tenosynovitis
- Skeletal dysplasias – osteochondroses, epiphyseal dysplasia
The services we provide
We provide a tertiary level paediatric rheumatology service in Norwich. The service is well developed and caters for approximately 200 children with active rheumatology conditions, almost 100 of whom are currently on methotrexate as their Disease Modifying Anti-Rheumatic Drug (DMARD), and 60 receiving biologic anti-rheumatic therapies.
There is a twice weekly single clinic consultant list expanding to a double list monthly with one of the adult rheumatologists, Dr Karl Gaffney, who has considerable experience of paediatric rheumatology and there is also an active adolescent transition programme.
There are weekly clinical paediatric rheumatology meetings, joint ophthalmology and rheumatology meetings once every two months and twice monthly joint radiology, orthopaedic and rheumatology clinical meetings aiming to provide clear communication, optimal and timely care.
A Paediatric nurse led clinic is held twice each week and a specific Adult Rheumatology Practitioner clinic is held once every two months for adolescents aged 16 years and above who have moved on to the adult service. We have a dedicated list for joint injections under general anaesthetic every week and in addition provide joint injections in the older age group under local anaesthetic (Entonox). Patients also have access to the paediatric rheumatology nurse led advice line with confidential message service on 01603 287 911 for support and information if required.
We are able to offer:
- Management of common musculoskeletal and soft tissue syndromes, aches and pains in the growing child, (e.g. anterior knee pain, hypermobility, sports injuries)
- Management of acute, sub-acute, medium and long-term inflammatory joint disease.
- Management of childhood vasculitis and connective tissue disease (including cytotoxic management)
- Management of auto inflammatory conditions (e.g. periodic fevers)
- Diagnosis and management of uncommon syndromes and unusual symptom complexes (e.g. skeletal dysplasias)
- Assessment, prevention and management of osteoporosis in children (i.e. secondary to steroid, not only for rheumatology patients).
- Nursing support, physio, occupational and psychological therapies for children, young people and their families who live with a rheumatological condition.
How you can access our services
Access to our services is via a referral from your GP or paediatric specialist.
The department is very active in research, taking part in a number of multi-centre studies; looking at the safety and efficacy of methotrexate and biological therapies in children with arthritis, the long term outcomes in juvenile dermatomyositis and Systemic lupus erythematosus amongst others.
Research in paediatric Rheumatology is generally on a multi-centre basis because of the relative rarity of the conditions. In addition we have been the recipient of a National Institute for Health Research grant to look at the potential benefits of active therapy in hypermobility.
Adolescent Activity Weekend
Each year the regional paediatric rheumatology team encourages our adolescents to challenge themselves physically and mentally through a fully funded activity weekend. The group, alongside their healthcare team, have an excellent time, learning about themselves, others and their conditions. These young people come from a variety of backgrounds, areas and experiences; each takes away a unique and positive memory. Each of them grows in confidence and the benefits of this are seen in how they now interact with their health care team. One of the most memorable comments from the Activity staff was ‘Which kids have got arthritis?’ A testament to the character of each young person and the benefits of the therapies now available to these young people.
We have locally developed guidelines for:
- Henoch – Schönlein Purpura (HSP) in Children.
- Interruption of Biologic Therapy (Anti-TNF Therapy) for Elective Surgery in Adults and Children.
- Diagnosis and management of Kawasaki Disease in children.
- Management of Methylprednisolone Sodium Succinate Infusion for Child or Young Person.
- Management of: Disodium Pamidronate infusion in children.
- Joint Trust Guidelines for the Limping Child with No History of Trauma Guideline for the use of Tocilizumab in Children With Juvenile Idiopathic Arthritis. In addition, we also use the national guidelines produced by the British Society for Paediatric and Adolescent Rheumatology (BSPAR).
Medical and Nursing Students
At certain times of the year we have medical and nursing students in the paediatric rheumatology department. We don’t usually have more than one student per clinic room. If you or your child prefers not to have a student present then please let one of the nurses know.
The students are good for the doctors and nurses in the department. Most of the team spend time giving seminars, tutorials and lectures to the students and also to qualified members of staff who wish to learn more about the speciality. Teaching helps keep doctors and nurses completely up to date with the latest advances and developments in medicine, nursing and communication skills.