RHEUMATOLOGIC CONDITIONS MOST COMMONLY MISDIAGNOSED
L. Nandini Moorthy *
Assistant Professor of Pediatrics Chief, Division of Pediatric Rheumatology UMDNJ/RWJ Medical School Department of Pediatrics One Robert Wood Johnson Place PO Box 19/MEB/Room 396A New Brunswick, NJ 08903.*
Pediatric rheumatic diseases comprise a complex array of chronic diseases with fluctuating courses leading to significant morbidity that are often challenging to diagnose and manage. These diseases often cause disability that may be permanent and affect different aspects of children's growth and development.

Ocular inflammation is associated with pediatric rheumatic diseases such as juvenile idiopathic arthritis. If this is left untreated, it may lead to blindness. These diseases significantly impact the overall quality of life of the affected children and their families. Children with transient synovitis of the hip are often thought to have septic arthritis. Those with reactive arthritis may be confused with having juvenile idiopathic arthritis. Children with large vessel vasculitis frequently present with vague complaints and are rarely referred to the rheumatologist. Linear scleroderma and morphea, which commonly present as a rash, can be missed for many years until deep tissue involvement and apparent deformity.

Early diagnosis, appropriate referral and management of these children are critical in order to prevent longterm complications, which include impairment of functional status and quality of life. The complicated diagnostic processes along with the dangers associated with untreated rheumatic diseases make it imperative for every pediatrician to become proficient in taking a thorough history and proper pediatric rheumatology examination techniques, which will lead to accurate and timely diagnosis of these disorders. Furthermore, in the last few decades, new biologic medications have come into the forefront that can significantly improve the outcome of these diseases and it is important to understand their pharmacology, clinical benefits and adverse effects. Additionally, it is important to appreciate the need for a multimodal approach combining medical, psychosocial and rehabilitative techniques for the care of these children.
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