Real life experience of paediatric rheumatologic diseases in a South Indian tertiary hospital: A prospective study of 3 years

Introduction: Paediatric rheumatic disorders are increasingly common worldwide, resulting in growth impairment, developmental impairment, behavioural issues and mortality.  
Objectives: To analyse the clinical presentations, investigations, management and prognosis of children who had rheumatologic disease in the paediatric and rheumatology department of a South Indian tertiary hospital from 2017 to 2019 after an average follow-up of at least 12 months (till December 2020).
Method: In this prospective study children were broadly classified into 3 groups viz. juvenile arthritis, vasculitis and connective tissue disorders. Immunologic workup was done in most cases included in the connective tissue group.
Results: Juvenile idiopathic arthritis (JIA) was the commonest paediatric rheumatologic disease (35.5%) followed by systemic lupus erythematosus (SLE) (23.9%). Children presented with fever (62.8%), joint swelling/pain (63.6%), myalgia/ muscle weakness (75.2%), weight loss (72.7%) in all 3 groups. Among systemic features, skin (38.8%) and kidney (21.4%) were predominantly involved. Most JIA (50/56) and vasculitis (20/22) cases were autoantibody negative. Children in connective tissue and vasculitis groups were primarily treated with steroids- oral (78.5%) or pulse therapy (55.4%). In juvenile arthritis group, non-steroidal anti-inflammatory drugs were started initially but 48.5% required intravenous steroids, 12% required intra-articular steroids and 45% required oral steroids during subsequent visits. Among disease-modifying antirheumatic drugs, methotrexate (59%) was commonly used in polyarticular and oligoarticular JIA.
Conclusions: JIA was the commonest paediatric rheumatologic disease followed by SLE. Children commonly presented with fever, joint swelling/pain, myalgia/muscle weakness and weight loss. Among the systemic features, skin and kidney were predominantly involved.