WASHINGTON, D.C.—The teen years are turbulent, especially for adolescents with rheumatic diseases. When treating teenage patients, rheumatologists must assess unique health risks and talk openly about risky behaviors, said experts during a session titled, “Puberty, Adolescence and Rheumatologic Disease,” at the 2012 ACR/ARHP Annual Meeting, held here November 9–14. [Editor’s Note: This session was recorded and is available via ACR SessionSelect at www.rheumatology.org.]
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Adolescents go through dramatic psychosocial, psychosexual, and physical changes, said Frank M. Biro, MD, professor of clinical pediatrics at Cincinnati Children’s Hospital. These changes affect how these patients interact with healthcare professionals and how they view their disease, said Dr. Biro. In puberty, reactivation of the hypothalamic–pituitary–gonadal axis spurs intense growth and development, so teens see dramatic changes in body mass index and body composition.
Discussing Risky Behaviors
In teens with rheumatic diseases, however, pubertal changes like adrenarche, thelarche, gonadarche, and menarche may be delayed, he said, causing emotional reactions like poor self-image that may have serious ramifications. “Youths with chronic conditions are as likely or more likely to engage in risky behaviors with greater consequences,” Dr. Biro said. Teens may use drugs, tobacco, or alcohol or engage in sexual activity to fit in with peers, Dr. Biro said.
These behaviors can be more devastating in adolescents with already compromised immune systems, he noted. “Tobacco use can accelerate the development of cardiovascular disease in dermatomyositis and systemic lupus erythematosus. Alcohol use increases the hepatotoxicity of methotrexate,” he stressed. Rheumatologists must communicate carefully with teen patients to assess risky behaviors and psychosocial problems, he concluded.
Such dialogue is important but challenging, said Margaret Blythe, MD, professor of pediatrics and clinical gynecology at Indiana University and Riley Hospital for Children in Indianapolis. Teen patients assert their independence by questioning everything, even asking rheumatologists why they need to take their medications. In response, build rapport through dialogue to help this patient understand why compliance is important for achieving long-term career or life goals, Dr. Blythe suggested.
Earlier adolescence is marked by a strong desire for privacy. Ask these patients to journal, writing down their thoughts about their disease, body changes, or medications, Dr. Blythe said. “There are times when they will come out with very impulsive thoughts, and these can be hurtful to parents, but they tell you a great deal” about their potential behavior risks.
Eating disorders and drug and alcohol use often are seen in middle adolescence, from ages 14 to 17, Dr. Blythe said. “Talk about use of marijuana or alcohol in a safe space. Teens will often have tried things, but it doesn’t mean they’ll become dependent on a drug just because they’ve tried it,” she said. Spend more time alone with these patients without their parents present to facilitate honest dialogue, she said.