Rheumatic diseases refer to a group of conditions that primarily affect the joints, muscles, or connective tissues.

While these diseases can occur in both children and adults, there are certain differences in their presentation, diagnosis, and management. This article aims to highlight the key distinctions between rheumatic diseases in children and adults, helping healthcare professionals and individuals better understand and differentiate these conditions.

1. Prevalence and Age of Onset

One primary difference between rheumatic diseases in children and adults is the prevalence and age of onset.

Certain rheumatic diseases, such as juvenile idiopathic arthritis (JIA), predominantly affect children, with symptoms often appearing before the age of 16. On the other hand, adult-onset rheumatic diseases, like rheumatoid arthritis (RA), typically manifest after the age of 16 in individuals with fully developed skeletal systems.

2. Disease Subtypes

Rheumatic diseases have various subtypes that may occur exclusively in children or adults.

For instance, childhood-onset systemic lupus erythematosus (SLE) is a rheumatic disease that commonly affects children and adolescents, whereas adult-onset SLE typically manifests in individuals aged 15 to 45. Similarly, conditions such as dermatomyositis and juvenile dermatomyositis primarily occur in children, while polymyositis is more prevalent in adults.

3. Clinical Presentations

The clinical presentations of rheumatic diseases may significantly differ depending on the age group. In children, joint pain, swelling, stiffness, and reluctance to use affected joints are commonly observed.

Children may also exhibit systemic symptoms such as fever, rash, fatigue, and irritability. In contrast, adults with rheumatic diseases may experience joint pain, stiffness, and swelling, along with other age-related musculoskeletal issues like osteoarthritis.

4. Diagnostic Challenges

Diagnosing rheumatic diseases in children can often be challenging due to several factors.

Some symptoms may overlap with normal developmental processes, making it difficult to differentiate between transient musculoskeletal issues and chronic rheumatic conditions. Additionally, children may struggle to accurately communicate their pain and discomfort, further complicating the diagnostic process.

In contrast, adults are usually able to articulate their symptoms and medical history more effectively, aiding in the diagnosis of rheumatic diseases.

5. Laboratory Findings

Laboratory tests play a crucial role in diagnosing rheumatic diseases in both children and adults. However, the types and patterns of abnormal lab findings may vary between the two age groups.

For example, children with JIA often show high levels of inflammatory markers like erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). In adults, these inflammatory markers are also relevant but may be elevated due to other underlying diseases or conditions, making interpretation more complex.

6. Imaging Studies

Imaging studies, such as X-rays and magnetic resonance imaging (MRI), are valuable tools in assessing joint and tissue damage caused by rheumatic diseases.

In children, imaging findings often reveal soft tissue swelling, growth disturbances, and abnormalities in bone development. On the other hand, imaging studies in adults may demonstrate joint erosions, synovial hypertrophy, and signs of degenerative changes commonly associated with aging.

7. Treatment Approaches

The treatment approaches for rheumatic diseases differ significantly between children and adults. In children, the focus is on disease control, pain management, physical therapy, and promoting optimal growth and development.

Nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and occasionally biologic agents are commonly used. Adult treatment, on the other hand, may involve a wider range of medications, including NSAIDs, DMARDs, biologics, and corticosteroids, tailored to the specific disease and individual patient.

8. Long-Term Prognosis

Rheumatic diseases can have long-term implications on both children and adults. Early diagnosis and appropriate treatment can significantly improve outcomes for patients.

However, children may experience unique challenges due to their ongoing growth and development, which may lead to skeletal deformities and functional limitations if not adequately managed. In adults, the focus may be on preventing joint damage, managing pain, and preserving functional independence as they age.

9. Disease Course and Remission

The disease course of rheumatic conditions can vary greatly between children and adults. Some childhood-onset rheumatic diseases, such as JIA, may have periods of remission, where symptoms temporarily subside or disappear altogether.

However, these diseases can also persist into adulthood, requiring ongoing treatment. In contrast, adult-onset rheumatic diseases like RA often exhibit a chronic and progressive course, with periods of disease activity and remission.

Rheumatic diseases can have a significant psychological and social impact on individuals, regardless of age. However, children may face additional challenges related to their education, peer relationships, and overall quality of life.

Chronic pain and physical limitations may affect participation in recreational activities and school attendance. Similarly, adults may experience disruptions in their occupational and personal lives due to the impact of rheumatic diseases on their functional abilities and overall well-being.