PE21.1 | Rheumatologic Referral Approach — Summary & Reflection

KEY TAKEAWAYS

Paediatric rheumatological diseases form a spectrum from self-limiting reactive arthritis to chronic, potentially blinding or organ-threatening conditions such as JIA, SLE, Kawasaki disease, and HSP. The key clinical skill is structured recognition: duration >6 weeks + inflammatory pattern + systemic features = refer, not reassure. JIA is diagnosed clinically (arthritis <16 yr, >6 wk, ILAR criteria) — the subtype determines the uveitis risk, erosion risk, and treatment escalation. Red-flag features requiring urgent referral include Kawasaki criteria, renal involvement (proteinuria/haematuria), MAS indicators (ferritin >10,000), ANA+ with eye risk, and dermatomyositis. Investigations (ANA, anti-dsDNA, complement, urinalysis) guide classification but do not replace clinical reasoning. While awaiting referral, NSAIDs provide symptomatic relief; steroids and IVIG are deferred to confirmed diagnoses. The referral letter should include joint map, lab results, medications, and vaccination status.

REFLECT

Consider a child you have seen in the paediatric ward or OPD with joint symptoms or a systemic rash. In retrospect, which red-flag features were present, and what was the initial clinical impression? How long did it take before a rheumatological diagnosis was considered? What barriers (parental beliefs about 'growing pains', investigations not available, subspecialty referral delay) may have contributed? How would you approach the same child differently now, and what system-level change could reduce the diagnostic delay in your future practice setting?