UNC to expand its pediatric rheumatology program

At a time when only a quarter of children with arthritis see a specialist due to their scarcity, UNC Children’s expands its rheumatology services.

UNC to expand its pediatric rheumatology program click to enlarge Dr. Keisha Gibson, a pediatric nephrologist, checks research samples in a super-cold (-81C) storage unit.

One in 250 children is living with a form of arthritis, yet only one-fourth see a pediatric rheumatologist due to their scarcity. In fact, there are 11 states in the U.S. without a single pediatric rheumatologist.

“Children with rheumatic disorders often have to travel long distances to receive care,” says Eveline Wu, MD, a pediatric rheumatologist and allergy/immunologist at UNC Children’s. “There has to be a better way to treat patients. That’s the reason we are expanding the clinical services for rheumatology and clinical immunology.”

The effort to which Dr. Wu refers is the creation of a pediatric systemic lupus erythematosus clinic that combines the services of pediatric rheumatology and pediatric nephrology. This clinic, though not limited to children with lupus, will offer help to any child with a pediatric rheumatic disorder that involves the kidneys.

The goal of the new clinic, says Dr. Wu, is to provide a streamlined approach to care.

“Joint clinics like this promote a coordinated and comprehensive approach to a child’s care and make it easier for families to see multiple caregivers in one visit,” says Wu.

The expansion of services will also include CHAPEL, which stand for “Chapel Hill Alliance Promoting Excellence in Lupus,” a research group which includes Dr. Wu, Keisha Gibson, MD (pediatric nephrology), William Pendergraft, MD (adult nephrology), Jennifer Rogers, MD (adult rheumatology), and Saira Sheikh, MD (adult rheumatology).

“Though research in lupus should not have an age restriction, I have a particular interest in pediatric patients,” says Dr. Wu. “Compared to their adult counterparts, children with systemic lupus erythematosus tend to have more severe, widespread disease with more major organ involvement and greater, irreversible organ damage in a short period of time.”

While some might only see a dire situation in such cases, Dr. Wu sees opportunity, a chance to intervene and improve her patients' quality of life.

“Though children and adolescents with lupus pose a significant challenge, they also represent a special, ideal opportunity,” she explains. “Their developing immune systems, hormonal influences, and cumulative burden of disease can potentially provide us insight into the cause and mechanisms of the disease.”

Education is also part of Dr. Wu’s vocation.

“Since there are so many medical schools without pediatric rheumatology programs, many physicians have had limited exposure to the specialty,” says Wu. “My colleague, Dr. Leonard Stein [also a pediatric rheumatologist], and I engage in teaching medical students, residents in training, physicians in other specialties, and general practitioners in the community.”

Dr. Wu sees advocacy as an important part of the educational process and is active in area JIA Days, a series of educational events ponsored by the Arthritis Foundation that focuses on health, wellness, and fun for families that have children affected by juvenile idiopathic arthritis.

“There was a JIA Day in the Triangle in June and one in Wilmington in October,” she notes.

Wu considers advocacy a catalyst to raising the support necessary for research—for while approximately 300,000 children in the U.S. suffer from juvenile arthritis, the disease remains relatively unknown. Most people consider arthritis an “old person’s disease,” unaware of the challenges the disease presents.

This lack of awareness is reflected in funding for research, says Wu. While disorders like leukemia can receive as much as $270 million a year in private funding, the Juvenile Arthritis Foundation estimates that private funding for juvenile arthritis research can dip as low as $4.5 million a year despite CDC estimates that put the costs of juvenile arthritis around $285 million annually.

Funding research is key to potentially finding a cause and cure for arthritis and other childhood rheumatic diseases. Still, Wu is optimistic about advances in the treatment of pediatric rheumatic conditions despite limited funding.

“We have overcome some barriers to conduct needed investigations in children,” says Dr. Wu. “Part of the problem with pediatric rheumatic disorders is that so much of the data is extrapolated from adults. We hope that our new services will not only benefit patients who need long-term care, but that they will participate in research, which will benefit both patients and researchers. We are certainly conducting better research now than ever before.”

 

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