With respect to pain management in pediatric rheumatology patients, Dr. Gmuca advocated for several interventions. Mounting evidence supports the integration of exercise, graded exposure and caregiver involvement in multidisciplinary treatment approaches to managing chronic pain, she said. Mobile health technologies will continue to grow as a way for patients and physicians to interface as pain is assessed and treated, she added.
Finally, Dr. Gmuca said limited evidence exists for the use of pharmacologic agents for the management of pediatric pain. Thus, a holistic approach is likely more effective than one based purely on medications.
Cuoghi Edens, MD, FAAP, assistant professor, internal medicine and pediatrics, rheumatology and pediatric rheumatology, University of Chicago, discussed reproductive health in patients with childhood-onset rheumatic diseases. Reproductive health refers to a patient’s physical, mental and social well-being in all matters related to the reproductive system’s function and processes, not merely the absence of disease, dysfunction or infirmity.
Historically, having JIA has been shown to affect the age at which patients get married and have their first child, as well as the number of children they have and even their decision to have children at all. Many patients with pediatric rheumatologic conditions worry about the long-term consequences of their disease, their ability to care for children, the effects medications will have on fertility and pregnancy, and the chance of passing their disease on to their children. Rheumatologists are ideally suited to address these issues with patients, given the long-term nature of relationships in the clinic, frequent patient contact and their ability to serve as a trusted source for information.
Dr. Edens referenced MotherToBaby, a nonprofit organization that provides evidence-based information on the safety of medications and other exposures during pregnancy and breastfeeding. This website may help guide physicians as they navigate which medications are unsafe for patients to take when trying to conceive. Certain medications, such as methotrexate, leflunomide, mycophenolate mofetil and cyclophosphamide, must be stopped well in advance of pregnancy for fetus safety. Adjunct medications contraindicated during pregnancy include warfarin, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, lenalidomide and thalidomide.
Although many rheumatologists may not know or believe their pediatric patients are sexually active, Dr. Edens said many patients are and contraception should be discussed frequently. Contraception helps prevent unplanned pregnancy and can also help alleviate specific conditions, such as polycystic ovarian syndrome, endometriosis, acne and other diseases. The selection of appropriate contraception should be tailored to the needs and comorbidities of each patient.
Transitions to Adult Care
In the final presentation, Rebecca Sadun, MD, PhD, assistant professor of medicine and pediatrics, Duke University Medical Center, Durham, N.C., spoke about effectively transitioning patients to adult rheumatologic care.