Rheumatic disease mimics in childhood

Aches and pains in children can arise from multiple problems, varying from a reaction to minor intercurrent infection that rapidly improves to the presence of severe skeletal lesions such as malignancy; they can also be part of a skeletal dysplasia. All cases require a good history (including family history), a full examination, and basic blood tests, which include the erythrocyte sedimentation rate, hemoglobin, white count, platelets, rheumatoid factor, and antinuclear factor. Other tests need be performed only when suspicion has been aroused. Recognition of unusual syndromes is important; no child should be labeled as having juvenile idiopathic arthritis unless there is a clear history with the presence of soft tissue swelling in appropriate sites and other causes for joint pain have been excluded. The conditions that most frequently mimic systemic onset juvenile arthritis are infections, which may have been partially treated, inflammatory bowel disease, malignancy, familial Mediterranean Fever, and the rarer connective tissue diseases, in particular systemic lupus erythematosus. Bacterial infection should be suspected in a child who is feverish and toxic, with a single hot swollen joint that has limited movement and is often rigidly guarded. Should such a child have already received antibiotics, general symptoms may well be minimal, so one is left with the history and a swollen and painful joint. Aspiration for investigation of the synovial fluid as well as blood tests should be undertaken immediately to establish the nature of any underlying infection.     

Rheumatic manifestations of parasitic diseases

OBJECTIVES: To consolidate the spectrum and frequency of parasite-related rheumatic syndromes, which have largely been regarded as exceedingly rare by the general medicine, infectious disease, and rheumatology literature. METHODS: A MEDLINE search was performed for articles on rheumatic syndromes related to parasitic infections published from 1966 through December 2000. Identified articles included clinical and epidemiologic studies describing cases of rheumatic syndromes associated with verified parasitic infection. RESULTS: Rheumatologic syndromes, including inflammatory arthritis, inflammatory myositis, and vasculitis, have been described among multiple different parasite infections of all parasitic divisions, including Protozoa, Nematoda, and Platyhelminthes. Individual parasitic divisions are often associated with particular rheumatic syndromes, such as reactive arthritis and spondyloarthropathy, inflammatory or infectious myositis, and reactive or parainfectious vasculitis. CONCLUSIONS AND RELEVANCE: Parasitic infection may underlie the clinical presentation of some rheumatic conditions. Given the continued and growing number of patients at risk for parasitosis by virtue of their country of origin, travel habits, and an immunocompromised state, potential parasitosis must be considered in patients undergoing evaluation for rheumatic complaints.     

Rheumatic diseases in an Inuit population

Prevalence and incidence rates for rheumatic diseases were found to be minimal among the Inuit people in the Keewatin District of the Northwest Territories, Canada. Patient identification was achieved by a review of medical records. All identified patients were interviewed and examined by a participating rheumatologist. Among women, the prevalence of rheumatoid arthritis, adjusted for age of the Manitoba population, was 1,822 per 100,000 and was comparable with that observed in other populations; no cases of rheumatoid arthritis in men were confirmed. The age-adjusted prevalence of osteoarthritis, 1,219 per 100,000 in men and 2,144 per 100,000 in women, was apparently low. A moderately high incidence of Reiter's syndrome, 24.9 per 100,000, was found. The findings in children suggested a high frequency of seronegative spondylarthropathies (yearly incidence 60.1 per 100,000), although the adjusted yearly incidence for juvenile rheumatoid arthritis also appeared to be high, 23.6 per 100,000. The frequencies of HLA antigens in patient groups were compared with those found in 19 patients with musculoskeletal complaints but no rheumatic disease. Both HLA-B27 and HLA-DR4 appeared to be common in these controls, 36.8% and 63.2%, respectively. Nevertheless, there was a higher frequency of HLA-B27 in patients with seronegative spondylarthropathies (87%) than in controls (P = 0.001). Because of the small numbers of patients who had rheumatoid arthritis, no associations with HLA were made for this condition. Although the findings suggest differences in the distribution of rheumatic diseases compared with those found in other populations, more complete studies are required to confirm these observations.     

Rheumatic diseases in the Corpus Hippocraticum

Medicine of V and IV centuries B.C. attested in the Corpus Hippocraticum ascribes all diseases to the rheuma, i.e. the flux of humours into the body. This flux produces not only the rise of cold, hoarseness, cough, reddening, dropsy, but also arthritis, sciatica, gout.     

Rheumatic diseases among Civil War troops

There are extensive existing medical records of Federal Civil War troops. More than 160,000 cases of "acute rheumatism" occurred among these soldiers, and acute rheumatic fever was known to be the main cause. Infectious arthritides were frequent but not understood; gout was rare. "Chronic rheumatism" was diagnosed more than 246,000 times; prolonged rheumatic fever and reactive arthritis following dysentery were probably the major causes. Over 12,000 soldiers were discharged because of chronic rheumatism, many with "lumbago," which was probably spondylarthropathy.     

Rheumatic diseases in North America''s indigenous peoples

OBJECTIVES: There are at least 3 million North American Indians and Eskimos in North America. The epidemiology of rheumatic diseases in Native North Americans differs from that described for the remainder of the North American population. An enhanced understanding of rheumatic diseases in these indigenous people may provide valuable clues to the cause of these disorders and improve rheumatologic care. METHODS: The world literature was searched for all reports of rheumatic diseases in North American Indians and Eskimos. The reports were reviewed and the findings summarized by disease process. RESULTS: Many Native American groups have high prevalence rates of rheumatoid arthritis (RA), systemic lupus erythematosus, connective tissue diseases, and spondyloarthropathies. There appears to be a correlation between the pattern of rheumatic diseases in Native North Americans and the patterns of migration and ancestry. In general, Amerind Indians have increased rates of RA and connective tissue disease, while Na-Dene Indians and Eskimos have high rates of spondyloarthropathies. The RA seen in Native Americans is generally severe, seropositive, with an early age of onset, and frequent extraarticular manifestations. Many Native American groups have very high frequencies of the RA shared epitope. The majority of Native American and Eskimo groups also have high frequencies of HLA-B27, and some of the world's highest prevalence rates of spondyloarthropathies are described in these groups. Although some groups show a marked tendency to develop either Reiter's syndrome or ankylosing spondylitis, psoriatic and enteropathic arthritis are rare. CONCLUSIONS: The excess rheumatic disease seen in this population is most likely genetic in origin. Because of the combination of high rates of rheumatic disease and relative genetic homogeneity, Native North Americans represent a singular opportunity to study genetic contributions to rheumatic disease. For clinicians, the index of suspicion for rheumatic diseases in North American Indians and Eskimos should be high, and the severe disease and sometimes atypical presentations kept in mind.     

Rheumatic diseases in advanced age--psychological aspects]

This paper discusses the importance of cognitive representation and individual patterns of behavior for coping with chronic disease. Chronically ill patients differ very much in their psychic situation. Biographical and situational factors and the future perspective contribute to these interindividual differences. Diagnostic and therapeutical tools are discussed from a psychological perspective.     

Rheumatic diseases and pregnancy: a perspective

The interaction between certain rheumatic diseases, sex hormones and their wide fluctuation during pregnancy and postpartum may be responsible for the variable course of rheumatic diseases during pregnancy. Important issues include effects on the mother and fetus by the disease, pregnancy and maternal drug therapy.     

Thromboembolic diseases of childhood

Over the last decade, pediatric thrombophilia programs have emerged around the world as a new discipline in pediatric hematology. These programs specialize in the diagnosis, prevention and treatment of children with thromboembolic events (TEs) in both the venous and arterial systems. The need for separate pediatric programs has been discussed previously. (J Pediatr Hematol Oncol 1997; 19: 7-22.) The following article will update previous reviews (Hematol Oncol Clin North Am 1998; 12: 1283-1312; Thromb Haemost 1997; 78: 715-725) and will concentrate on three aspects: (1) The risk factors for acquiring TEs; (2) The confirmatory diagnostic tests used in children with TEs; and (3) The different antithrombotic agents used for prevention and treatment. The current knowledge in respect to the above points is only the "tip of the iceberg". Well-designed prospective trials are required to establish the contribution of congenital prothrombotic disorders, appropriate diagnostic strategies, and optimal therapy for children with TEs.