Growth and Development in Children with Rheumatic Diseases: Maintaining a Balance between Drugs and Disease Activity

Rheumatic diseases are autoimmune disorders that affect the bones, skin, and muscles, and they contribute to a significant burden of chronic illnesses in children throughout the world, the most common of them being juvenile idiopathic arthritis (JIA). Symptoms begin at a young age and last throughout maximum growth potential in these children. Long-term consequences usually follow delayed diagnosis and contribute to increasing disease burden, joint damage, deformity, and delayed growth and development. Children with systemic arthritis with uncontrolled disease, and/or prolonged use of corticosteroids have an increased risk of growth impairment. Uveitis associated with JIA has a significant impact on academic competence and social development. On the other hand, newer diseases such as autoinflammatory diseases not only pose a challenge in diagnosis but also in management due to the lack of easy availability of targeted therapy. Rheumatic disease in adolescents has more pronounced effects on the development of self-identity, self-confidence, and sexual development. Therefore, there is a need to establish psychosocial and educational interventions targeted at improving social support, resolving insecurities, and building confidence among these adolescents. Drugs used in the treatment of rheumatic illnesses such as glucocorticoids, disease modifying anti-rheumatic drugs (DMARDs), and biologics have both short-term and long-term effects on growth and overall development. A treat-to-target approach and use of various disease activity monitoring tools are efforts in the direction of standardizing treatment and achieving and maintaining prolonged disease remission. Finally in order to provide a holistic care, we need to ease the access to pediatric rheumatologists, increase the awareness of these diseases among the medical fraternity and community, build financial and social systems to support both patients and their families. In this article, we highlight the various aspects of rheumatic diseases in childhood and their possible effects on the overall growth and development in children.