McGowan Institute for Regenerative Medicine affiliated faculty member Raphael Hirsch, MD, the Aldo V. Londino Jr., MD, Professor of Pediatrics and chief of the Division of Pediatric Rheumatology at Children's Hospital of Pittsburgh of UPMC and the University of Pittsburgh School of Medicine, directs Children's pediatric rheumatology program which has grown from a one-physician division to one of the largest and most comprehensive programs in the United States, with six full-time faculty, an experienced clinical staff, and a National Institutes of Health (NIH)-funded research laboratory. The program treats hundreds of young patients from as far away as Altoona, western New York, eastern Ohio, and West Virginia with new diagnostic tools and potential regenerative medicine therapies.
The NIH-funded research program focuses on answering fundamental questions about arthritis. Dr. Hirsch’s areas of expertise include gene transfer, gene expression in arthritis, modulation of T-cell immune responses, and therapy of autoimmune diseases. Currently, the rheumatology division has in progress two NIH-funded studies on new proteins it discovered, which in turn could lead to new therapies. Assistant professor Margalit Rosenkranz, MD, is credited with one discovery and Dr. Hirsch with the other.
Another study in progress at Children's is on a new diagnostic tool called an arthritis imager developed in conjunction with Carnegie Mellon University software engineers and the University of Pittsburgh. "It takes two kinds of pictures; there are two cameras in it," Dr. Hirsch said. "One takes a thermal image showing heat in the joint. The other takes a three-dimensional picture of the hand to show the contours for a search for swelling."
It quantifies the diagnoses rheumatologists now have to make by observation. "It's hard to get agreement among doctors," Dr. Hirsch said.
Dr. Hirsch said 100 children and 100 adults are being recruited for the imaging trial. "We think we can conclude the study in about a year."
Also, Dr. Hirsch and his division are actively training fellows to treat young patients under a NIH grant. Taking 2 new fellows a year for 3-year fellowships, Children's has produced 10 U.S. fellows and 2 international fellows since the program began in 2003. Dr. Hirsch said that's between 10 percent and 15 percent of all fellows being trained nationally.
In addition, Children's is working on a telemedicine program that would allow its farflung patients to go to local hospitals for checkups by their Children's rheumatologists. The goal is to start the system later this year or in 2011.
Juvenile rheumatoid arthritis (JRA) is a type of arthritis that happens in children age 16 or younger. It causes joint swelling, stiffness, and sometimes reduced motion. It can affect any joint, and in some cases it can affect internal organs as well. One early sign of JRA may be limping in the morning. Symptoms can come and go. Some children have just one or two flare-ups. Others have symptoms that never go away. JRA causes growth problems in some children. No one knows exactly what causes JRA. Scientists do know it is an autoimmune disorder, which means your immune system, which normally helps your body fight infection, attacks your body's own tissues. Per Children’s Hospital of Pittsburgh of UPMC treatment may include:
- nonsteroidal anti-inflammatory medications, NSAIDs, (to relieve symptoms)
- disease-modifying anti-rheumatic medications (to slow the progress of the disease, such as methotrexate)
- corticosteroids (to reduce inflammation and control severe symptoms)
- physical therapy (to improve and maintain muscle and joint function)
- occupational therapy (to improve ability to perform activities of daily living)
- assessment of nutritional status by a nutritionist and ongoing, if necessary, nutritional guidance (to ensure adequate nutritional intake for your child whose appetite may be adversely affected by the disease process itself or some medications used for treatment)
- regular eye exams to detect early changes of eye inflammations
- patient education (to help decrease the frequency and severity of flare-ups and prevent complications), including educational topics such as:
- exercise and weight control
- adequate rest
- how to use large joints rather than small joints to move or carry things
The American Academy of Family Physicians offers these coping suggestions for children with juvenile rheumatoid arthritis:
- Soothe painful joints with a warm shower, a hot pack, or sleeping in a warm bed.
- Exercises, including stretches and activities that help improve range-of-motion, can help ease stiffness.
- Take any medication at the same time each day. To help your child remember, associate it with another activity, such as eating a meal.
- Get regular exercise. Associate this with a favorite activity, such as watching TV.
Abstract (Synovial fluid proteins differentiate between the subtypes of juvenile idiopathic arthritis. Rosenkranz ME, Wilson DC, Marinov AD, Decewicz A, Grof-Tisza P, Kirchner D, Giles B, Reynolds PR, Kolli K, Thompson SD, Hirsch R. Arthritis and Rheumatism. On-line 2010 Mar 10.)