[The treatment organization of rheumatic children and adolescents in West Germany]

Pediatric rheumatology represents a specialized subject which overlaps with important fields of pediatrics, as well as with adult rheumatology. As a speciality it includes age-specific rheumatologic diseases, an age-dependent differential diagnosis, special growth disturbances and joint deformities that are also influenced by age, and a subgroup of juvenile chronic arthritis. Socio-medical problems arise from a child's impaired physical and psychosocial development and their impact on education, the individual's choice of career, and effects on the patient's family. For pediatricians who are trained in this field and who treat only or predominantly children with rheumatic diseases the subspeciality of pediatric rheumatology should be introduced. In the future, precise figures on incidence and prevalence of juvenile rheumatic diseases in Germany must be obtained. Therapy of children with chronic arthritis affords improvement and further development by comprehensive training and further education of physicians and physiotherapists. Thus, it is important to take advantage of possibilities of inpatient and outpatient care, as well as the co-ordination of existing institutions. Arthralgias and acute rheumatic disorders in children present in a relatively high frequency. Chronic arthritis, however, is rare and treatment requires a supra-regional center for pediatric rheumatology. Quality of therapy for children with chronic rheumatic diseases must be considered prior to a locally oriented care. More intensive research is needed, with more clinical studies and basic research. More effort must be made to integrate analyse of musculoskeletal function and the importance of joint-deformity development into the research program. Further cooperation between pediatric rheumatology centers and universities would offer significant advantages in the future.