Inflammatory rheumatic disease

Inflammatory rheumatic diseases in children and adolescents comprise a group of rare, chronic diseases of inflammatory, autoimmune or autoinflammatory origin. They may affect the joints, muscles and bones, as well as the skin, eyes or other organs. Juvenile idiopathic arthritis is the most common form, alongside other rarer diseases such as lupus, dermatomyositis, scleroderma, vasculitis and certain autoinflammatory diseases.

The H.U.B.’s paediatric rheumatology department provides diagnosis, treatment and follow-up for children and adolescents from birth to 18 years of age who are suspected of having, or have been diagnosed with, an inflammatory rheumatic disease. A specialist consultation can be arranged at the request of the attending physician, paediatrician or another specialist physician when such a disease is suspected.
 

Care begins with a thorough clinical assessment based on a detailed medical interview (medical history) and a complete clinical examination. Inflammatory rheumatic diseases in children can present with highly varied manifestations and may sometimes resemble other, more common conditions, including mechanical, orthopaedic, infectious, neoplastic or genetic disorders. The expertise of a paediatric rheumatologist is essential for rapidly directing the diagnostic process and proposing the most appropriate additional investigations.

Depending on each child’s needs, the assessment may include laboratory tests, imaging examinations (ultrasound, X-ray or MRI), as well as more specialised investigations. All this information helps confirm the diagnosis, assess disease activity, investigate possible involvement of other organs and define a personalised treatment strategy.

Treatment is tailored to the disease, its activity, the child’s age and lifestyle, and its impact on their quality of life. It may combine anti-inflammatory treatments, joint injections, conventional disease-modifying treatments, biological therapies or newer targeted therapies. The treatments currently available have profoundly transformed the prognosis of these diseases. When prescribed in accordance with international recommendations and monitored by specialised teams, they offer an excellent benefit–risk ratio and now make it possible to achieve remission or excellent disease control in the vast majority of children.

Our care is based on a modern treatment strategy founded on international recommendations and the Treat-to-Target principle. This involves defining a precise treatment goal with the child and their family, then regularly adjusting the treatment to achieve the best possible disease control while limiting adverse effects.

 

Inflammatory rheumatic diseases in children can affect several organs and often require the involvement of different healthcare professionals. Their management is based on close collaboration between the various specialists at H.U.B., in order to ensure an accurate diagnosis, appropriate treatment and coordinated follow-up.

Depending on the disease and each child’s needs, the paediatric rheumatologist works closely with the clinical biology laboratory, the medical imaging department, ophthalmologists, dermatologists, nephrologists, paediatric orthopaedic surgeons, physical medicine and rehabilitation physicians, physiotherapists, psychologists and other paediatric specialists when necessary.
This multidisciplinary approach makes it possible to confirm the diagnosis, detect any involvement of other organs at an early stage and ensure comprehensive, coordinated and personalised care tailored to the disease, the child’s age and their individual needs.

Specific collaboration has also been established with paediatric infectious disease specialists, particularly as part of the ImmunoStart consultation, in order to optimise the prevention of infectious risks and the vaccination status of children requiring immunomodulatory or immunosuppressive treatment.


 

Each child benefits from a personalised care pathway tailored to their disease, age and needs.

1. Initial specialist consultation: A thorough clinical assessment is conducted to analyse the symptoms, examine the child and determine which additional examinations may be required.
2. Confirmation of the diagnosis: The results of the clinical examination, laboratory tests and imaging examinations are integrated to confirm the diagnosis, assess disease activity and look for any possible involvement of other organs.
3. Development of a personalised treatment plan: The diagnosis and the various therapeutic options are discussed with the child and their family. Treatment is selected on an individual basis according to the disease, its activity and the therapeutic objectives.
4. Regular follow-up: Regular consultations are used to assess the progression of the disease, the efficacy and tolerability of the treatments, and adherence to them. The therapeutic strategy is adapted where necessary, in accordance with international recommendations and the Treat-to-Target principle, in order to achieve the best possible disease control.
5. Long-term support: Throughout the follow-up period, particular attention is paid to the child’s growth, development, quality of life, schooling, physical activities, psychological well-being and gradual acquisition of autonomy.
6. Preparation for transition to adult care: As the adolescent approaches adulthood, a gradual transition is organised in collaboration with adult rheumatology to ensure continuity of care under the best possible conditions.

 

Thanks to therapeutic advances, the vast majority of children with chronic inflammatory rheumatic diseases now reach adulthood with their disease well controlled or even in remission. This development makes a structured transition to adult care essential.

Transition is a gradual process, prepared several years before the transfer to adult rheumatology. During consultations, young people are encouraged to gain a better understanding of their disease, learn about their treatments, recognise warning signs, participate in treatment decisions and progressively acquire the autonomy needed to manage their health. Parents remain fully involved in this process, while gradually supporting their child towards greater autonomy.

This period also provides an opportunity to address important topics such as studies, career plans, sports, travel, vaccinations, contraception, relationships, the desire to become pregnant and the possible consequences of long-term treatments.

For more than twenty years, the H.U.B. paediatric rheumatology department has worked closely with a rheumatologist specialising in the care of rheumatic diseases that begin in childhood. This longstanding collaboration ensures particularly smooth and personalised continuity of care, enabling young adults to be followed by a specialist familiar with the specific features of these diseases and the issues associated with this stage of life.
The aim is to ensure continuity of care without any interruption in follow-up, so that every young adult can continue their care journey with confidence and autonomy.
 

Paediatric rheumatology has undergone remarkable development over the past twenty years. Advances in research have led to a better understanding of the mechanisms responsible for inflammatory rheumatic diseases, the development of more effective diagnostic criteria, and the development of increasingly targeted and effective treatments.

As a university department, the H.U.B. Department of Paediatric Rheumatology actively participates in national and international clinical research. The team has contributed to numerous multicentre clinical trials evaluating the efficacy and safety of biological therapies and innovative treatments that are now used in the management of children with inflammatory rheumatic diseases.

The department is a founding member of the Belgian Working Group of Paediatric Rheumatology (BPR), which brings together paediatric rheumatology specialists from Belgian university centres to promote the exchange of expertise, the harmonisation of practices and the development of collaborative research projects. It also participates in the activities of the Paediatric Rheumatology European Society (PReS), PRINTO (Pediatric Rheumatology International Trials Organisation) and the Société francophone pour la rhumatologie et les maladies inflammatoires en pédiatrie (SOFREMIP), thereby contributing to the development of recommendations, the advancement of clinical research and the continuous improvement of care for children with inflammatory rheumatic diseases.

This involvement in research enables our patients to benefit from care based on the most recent scientific evidence and the most demanding international standards.
 

Within the H.U.B.’s Paediatric Rheumatology Department, we are committed to offering every child and their family:

• specialist care based on the latest scientific evidence and international recommendations;
• a personalised treatment strategy aimed at achieving the best possible disease control through the Treat-to-Target principle;
• a coordinated multidisciplinary approach bringing together the various areas of expertise required to provide comprehensive care;
• a partnership with the child and their family, promoting information, therapeutic education and the young patient’s gradual autonomy;
• continuity of care from childhood through to adulthood, facilitated by a structured and personalised transition;
• active involvement in clinical research and therapeutic innovation, ensuring that our patients have access to increasingly effective medicine.