Not Enough Pediatric Rheumatologists

A child who does not receive adequate treatment for a rheumatic condition may suffer dire lifelong consequences. Over 300,000 children have been diagnosed with rheumatic diseases, yet fewer than 400 pediatric rheumatologists practice in America. Rheumatologists who treat adults are doing their best to meet this care deficit, but they generally lack the expertise of pediatric specialists. The shortage persists amidst efforts to promote awareness of the need.

 

The structure of medical education may be a primary cause of the subspecialist shortage. The fellowships for pediatric rheumatology requires additional schooling. Because rheumatology is mainly an outpatient field, pediatrics residents do not normally have opportunities to see this field and develop an interest in it. Those residents who do observe pediatric rheumatology patients typically only see the sickest ones; they rarely study the spectrum of patients and how innovative therapies are reshaping the landscape of care for rheumatological diseases.

 

The American College of Rheumatology is striving to change this unfortunate scenario. In 2001, it initiated a residency program that pairs residents with mentors. The program has encouraged 73 percent of its students to pursue pediatric rheumatology training. Duke has set up a similar program that is turning more residents on to this subspecialty. Professors note that enabling the residents to survey the scope of inpatient and outpatient care has a significant impact.

 

These gains have not yet been enough to alleviate the shortage, which is expected to worsen. Meanwhile, more rheumatologists who specialize in adult care are forced to deal with pediatric patients. Pediatric specialists hope to increase awareness and provide counsel to these physicians.

 

The doctors who have not obtained specialized education to work with children face critical challenges with performing exams and prescribing medications for younger, smaller patients. Also, these adult rheumatologists often do not consider how differently children metabolize medications. The doctors need to consider the particular emotional needs of the sick children as well.

 

Most of the physicians who do treat children report dealing mainly with older teens. Although many of these adult rheumatologists are confident in diagnosing the most prevalent rheumatologic disease (JIA), many lack confidence in treating it. This trepidation could carry significant ramifications. Doctors must consider the impact of inflammatory conditions on a child’s growth when devising treatments. They need to understand how to take advantage of the limited chances to make progress with these patients during their formative years.

 

The Arthritis Foundation estimates that about one in four children receives proper care from a pediatric rheumatologist. Eight U.S. states have none of these specialists, and five states have only one. The average age of these doctors is over 50 years, so their retirement is critically imminent.

 

This stark reality shapes an increasing dilemma of access, but rheumatologists remain hopeful. They point to the host of resources that the ACR and disease foundations provide to educate care providers and families. Pediatric rheumatologists are also standing together and reaching out to promote awareness to future physicians.

 

Originally posted at MichaAbelesMD.net

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Rheumatoid vs Osteoarthritis: What’s the Difference?

Osteoarthritis (OA) and rheumatoid arthritis (RA) are both forms of inflammation of the joints but they are actually very different types of a broader condition called arthritis. There are many forms of arthritis, including gout, but RA and OA are two of the most common, affecting a combined 32 million people in the United States alone. Despite their similarities, the diseases have different causes and symptoms that can vary quite a bit in spite of some overlap.

What Is Osteoarthritis?

OA is a degenerative joint disease affecting the cartilage. Also known as wear-and-tear arthritis, it’s caused by a breakdown in cartilage of the joints that leads to pain and inflammation as bone rubs against bone without the protective cushion of the cartilage. OA may begin in a single joint and get progressively worse. This disease is most common among older adults with 70% of people over 70 showing some evidence of OA. It’s the most common form of arthritis.

What Is Rheumatoid Arthritis?

Rheumatoid arthritis also affects the joints but it’s considered an autoimmune disease that causes chronic inflammation of the lining of the joint and sometimes organs as well. As an autoimmune disorder, RA happens when the body believes the soft lining of the joints is a threat and attacks it much like it would a virus. RA usually affects multiple joints in the body and an estimated 75% of people with RA are women. Unlike OA, which usually occurs in older people over 65, rheumatoid arthritis is usually diagnosed between 30 and 60. There is no known cause of RA.

Symptoms of RA vs OA

Both RA and OA cause joint pain although the type, duration, and even location of the pain can vary. As a general rule, osteoarthritis causes pain in an affected joint after repeated activity or use. It usually causes stiffness in the joints in the morning for 30 minutes or less with pain that worsens later in the day. After inactivity, the joints may become stiff or swollen. A hallmark of OA is the development of bone spurs, enlargements called Heberden’s or Bouchard’s nodes, and reduced range of motion.

Rheumatoid arthritis also causes joint swelling, pain, and stiffness. There may be warmth and redness around the joint as well as reduced range of motion. RA also causes morning joint stiffness but it usually lasts for more than 60 minutes. A hallmark of RA is symmetrical joint involvement. While OA may affect one knee, for example, RA would affect both.

Osteoarthritis usually affects weight-bearing joints like the knees, hip, and back along with smaller joints in the fingers. Rheumatoid arthritis typically affects joint pairs, usually smaller joints like the ankles or small joints in the hands and feet.

 

Originally posted at MichaAbelesMD.net