Spectrum of Rheumatological Disorders in Children from a Tertiary Care Hospital in Bhubaneswar, Odisha

Epidemiological data from India is lacking about prevalence of childhood rheumatological diseases, but India with 1.15 billion people(2010 Census data), “we could estimate approximatel ˜ 1.3 million children with Juvenile Idiopathic Arthritis(JIA) and 2, 00, 000 with Systemic Lupus Erythematosus (SLE) alone, basing on world prevalence data. But due to many factors these cases are not diagnosed and treated early; children with JIA can be misdiagnosed as Tuberculosis or Acute Rheumatic Fever (ARF), because of the lack of awareness about rheumatic diseases. On many occasions parents move here and there without proper approach, guidance and management leading to increased morbidity and mortality.

To assess the prevalence and distribution of pediatric rheumatic diseases in a tertiary level hospital in Bhubaneswar, Odisha.

This retrospective study was carried out during Sep 2015 to Aug 2016. Diagnosis was reached by using classification criteria supplemented by necessary investigations.

Total number of cases was 115 with female predominance (F: M ratio of 1.4: 1) and mean age 8.7 yrs (range 7 months to 18 yrs). JIA (34.8%) was most common followed by Vasculitis Syndrome (15.6%), Benign Hypermobility Joint Sndrome(13%), Pain Amplification Syndrome/Fibromyalgia(13%). Juvenile Dermatomyositis (JDM), ARF, SLE, Juvenile Scleroderma, restless leg syndrome(RLS), Juvenile SjÖgren syndrome, Inflammatory Bowel Disease(IBD) and Mixed connective tissue disease (MCTD)were found in 5.2%, 4.35%, 4.35%, 2.6%, 2.6%, 1.7%, 1.7% and 0.87%cases respectively. Common medications were nonsteroidal anti-inflammatory drugs(NSAIDs), prednisolone/deflazacort, disease modifying antirheumatic drugs(DMARD) and biologic agents; methotrexate being the anchor drug in many disorders. Physiotherapy was necessitated in 21% cases and intra-articular injections(steroids) in 26% cases. In 77% cases various combinations of treatment were required. Supplementation with folic acid, calcium, vitamin-D, proton-pump inhibitors(PPI)/H2-Blocker was done in 94% cases.

Rheumatological disorders in children are not uncommon in our country; prevalence of diseases varies from place to place across the world. Better awareness of parents and improved clinical acumen of pediatric practitioners will definitely allay the sufferings of affected children avoiding increased morbidity and mortality. Further, large available pool of patients in our country is an untapped clinical source that could provide the platform for further research studies.