[The chronically ill child with rheumatoid arthritis]

Juvenile chronic arthritis (JCA) and other pediatric chronic rheumatic diseases such as the more rare juvenile collagenoses and the systemic vasculitides represent illnesses with a substantial potential of long-term problems and are additionally associated with a significant degree of mortality. Seen among the long-term problems associated with JCA are functional loss, deformities and the destruction of afflicted joints, a visual loss which may extend as far as blindness as a consequence of rheumatic iridocyclitis, irreversible organ damage caused by AA-amyloidosis as well as growth failure. Apart from cutaneous manifestations, on the other hand, the collagenoses and systemic vasculitides also demonstrate an involvement of specific organ systems, particularly of the kidneys, the lungs, the brain or the gastrointestinal tract. There is no causal therapy available. However, the application of a multidimensional therapeutic regimen primarily involving antirheumatic drugs, physiotherapeutic and ergotherapeutic methods as well as the application of a psychosocial treatment and the aid of governmental support, has resulted in good long-term results for most children suffering from JCA. The collagenoses and systemic vasculitides, however, have proven to be more problematic although the full utilization of the possibilities which are available today has provided encouraging results for most of these afflicted children. The complex therapeutic scheme, however, requires interdisciplinary cooperation. The pediatrician and/or family physician must fulfill crucial responsibilities which are relevant for the continuing prognosis of the illness. The pediatrician/general practitioner must thereby maintain a situation of close cooperation with the patient and their family as well as with the various colleagues active in the therapeutic team, especially with the pediatric rheumatologists. Moreover, these physicians also play a central role in establishing an early diagnosis in monitoring the disease progress and the therapy as well as in providing the mandatory assistance in the event of acute problems.