and Young Adult Rheumatology
Adolescence is a particularly difficult time to have a rheumatological condition. It is a time where normal tasks include education, state examinations, deciding on career paths, risk taking, evolving relationships with friends and partners, and changing dynamics within family as the young person moves towards independence. In addition the young person is physically growing and developing. Biologists tell us that the human brain continues to change until a young person’s early to mid 20s. To add to all of these normal tasks, young people with chronic rheumatological conditions may have to contend with pain, reduced mobility, fatigue, missing time at school, hospital appointments, blood tests and having to take medications that may have side effects.
With all of this in mind, adolescent rheumatology is an accepted subspecialty of rheumatology, where doctors with an appreciation and experience of dealing with these complexities undertake dedicated adolescent clinics to try to meet the young person’s needs. Dr Ambrose was the clinical lead for the adolescent rheumatology department at UCLH, London before taking up her current post at the Blackrock Clinic (https://www.uclh.nhs.uk/OurServices/ServiceA-Z/CYPS/ADRHEUM)
Juvenile Idiopathic Arthritis (JIA)
JIA describes people of any age whose arthritis developed before adulthood. There are many types of JIA and management differs somewhat depending on the type. Arthritis means that there is inflammation in one or more joint, caused by the person’s immune system mounting an immune response against themselves (‘auto-immunity’). Symptoms in young people can differ significantly from that of adults.
refers to pain that is related to the way a young person uses their joints. For example shoulder pain may result from the use of heavy school bags, or back pain from leaving over a desk when exams are fast approaching.
refers to pain that persists for months, where tests including imaging and blood tests are normal. This pain can be severe and also distressing when tests are being reported as normal. Risk factors for the development of chronic pain are quite broad and include recurrent injuries, being double jointed, or having a particularly stressful injury. The condition is manageable with the right help and advice.
describes being double jointed. It is common to be double jointed in some joints, about 20% of the entire population are double jointed. A small amount of these people will have related health problems and are diagnosed with Hypermobility Spectrum Disorder. A smaller subset of these patients will have Ehlers-Danlos syndrome. Dr Ambrose undertook a weekly hypermobility clinic to diagnose and treat this group of patients at UCLH in London.
that the adolescent rheumatologist may look after include juvenile onset lupus (JSLE), Juvenile onset dermatomyositis (JDM), Chronic recurrent multifocal osteomyelitis (CRMO), osteoporosis, juvenile onset systemic sclerosis, vasculitis and behçet’s syndrome.
Young Adult Clinics
It is increasingly being recognised that young adults have specific challenges and health requirements. This is a time where trajectories are set for future success, both for education and careers, as well as for social goals such family planning. Juggling demands in the context of living with a chronic illness and transitioning to adult hospitals and teams is stressful and complex. Young Adult care describes providing dedicated care for 18-26 year olds, both those transitioning from the paediatric setting, but also for those who present for the first time with joint problems during this period.
Rheumatology conditions affecting adolescents include arthritis, lupus, muscle inflammation and non-inflammatory conditions such as mechanical pains, chronic pain and hypermobility.