Which specialist consultation are needed for the management of juvenile idiopathic arthritis (JIA)?

Updated: Jul 25, 2019
  • Author: David D Sherry, MD; Chief Editor: Lawrence K Jung, MD  more...
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Answer

Referral to a pediatric rheumatologist may be indicated when the diagnosis is unclear, when information on diagnostic evaluation and long-term management is needed, or because the family requires information from a subspecialist to cope with the patient's disease process, to accept the treatment plan, to allay anxiety, and/or to receive education. [45]

In addition to a pediatric rheumatologist (when available), the subspecialty team may include a nurse, physical and occupational therapists, social worker, ophthalmologist, and orthopedic surgeon. A nurse may provide patient education through nursing care.

Although at presentation, arthritis may be so active as to preclude the use of an aggressive program of muscle strengthening, physical and occupational therapists are an important part of treatment. The use of pain modalities during this period may permit the gradual introduction of an active program of exercises and stretching.

Social work evaluation helps to determine how well each family is coping with their child's disease in terms of emotional and financial resources. Social workers can offer invaluable guidance that helps children maintain healthy relationships within their families and at school. Transition programs for adolescents with arthritis can help to prepare them for higher education and vocation.

A pediatric ophthalmologist provides slit-lamp examinations to exclude uveitis, and a pediatric orthopedic surgeon is essential when orthopedic diagnoses are being considered.

The spectrum of specialists may be required such as pediatric hematologist for evaluation for malignancy or a pediatric gastroenterologist if inflammatory bowel disease is suspected.


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