Rheumatic Diseases in Women & Children: Current Perspectives Shefali K Sharma, Sujata Sawhney
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fm1Rheumatic Diseases in Women and Childrenfm2
fm3Rheumatic Diseases in Women and Children Current Perspectives
Editors Shefali K Sharma MD (Medicine) MAMS Assistant Professor Internal Medicine, Rheumatology Unit Postgraduate Institute of Medical Education and Research Chandigarh, India Sujata Sawhney MD (Pediatrics) MRCP (UK) CCST (UK) Senior Consultant Pediatric and Adolescent Rheumatology Pediatric Rheumatology Division Institute of Child Health Sir Ganga Ram Hospital New Delhi, India Foreword Anand N Malaviya
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Rheumatic Diseases in Women and Children: Current Perspectives
First Edition: 2014
9789351520818
Printed at
fm5Contributors fm7Foreword
The burden of autoimmunity and systemic autoimmune diseases is several-fold higher in women. It seems unfair of nature to put this additional burden on women, over and above the responsibility of conception, pregnancy and the societal responsibility of rearing children. Also, most of the autoimmune diseases are more severe in women with poor outcome. Considering that several of the drugs used for the treatment of systemic autoimmune diseases are teratogenic while others may cause sterility, the management becomes more complicated. Some of the diseases also cause fetal loss, further increasing morbidity and mortality. Last but not the least, our country is primarily a patriarchal society where women are usually neither empowered nor have much control over their lives or health matters. They can hardly expect any social or family support for the management of their disease, especially the chronic ones, so important in systemic autoimmune diseases. Married women are sometimes abandoned by their in-laws and divorces are a common occurrence as well. Therefore, managing women with autoimmune diseases is much more difficult and problematic than in men.
Children and juveniles with systemic autoimmune diseases present with a different set of problems that make management difficult. The first and foremost is the delay in diagnosis. It is a pity that most pediatricians have little or no training in rheumatic diseases of children, especially that related to systemic autoimmune diseases. Therefore, their knowledge usually does not extend beyond rheumatic fever and tuberculosis. Secondly, the number of pediatric rheumatologists in our country can be counted on the tip of one's fingers. On top of this is the society's attitude of the neglect toward a girl child. These factors are the main stumbling blocks in optimal management of children and juveniles with systemic rheumatic diseases. It is pathetic to see such children and juveniles with undiagnosed or wrongly diagnosed neglected systemic autoimmune diseases presenting with advanced damage and disabilities at a stage where not much can be offered.
This book on systemic rheumatic diseases is written from the perspective of women and those in pediatric age group by authors who have had advanced training, extensive knowledge and vast experience in diagnosing and managing these diseases. The book promises to fill a major void in this neglected area of rheumatology.
The editors and the authors must be complemented on visualizing the unmet need for women and children and producing such a useful book for fm8pediatricians and orthopedicians in general, and for rheumatologists in particular. I extend my very best wishes for the success of this book.
Anand N Malaviya
MD FRCP (Lon) ACR ‘Master’ FACP FICP FAMS FNASc
Ex-Head
Department of Medicine
Chief of Clinical Immunology and Rheumatology Services
All India Institute of Medical Sciences
New Delhi, India
Consultant Rheumatologist, ‘A&R Clinic’
Visiting Senior Consultant Rheumatologist
ISIC Superspeciality Hospital
New Delhi, India
fm9Preface
There are many standard textbooks of Rheumatology, but none with an emphasis on the rheumatic diseases in the context of women and child bearing, and the diseases that affect children. This book aims to fill this important gap.
The birth of a baby is an experience of immense joy and pride for a woman. But, this is not always the case for a patient with a rheumatic disease who plans to have a baby.
Although miscarriages, pre-term deliveries and neonatal mortality remain a concern, successful pregnancy outcomes are an achievable goal. Good pregnancy outcomes are possible with pre-pregnancy counseling, risk assessment and stratification, early recognition of flares and complications both medical and obstetric, a multidisciplinary approach, tailored antenatal and postnatal management plan, and an on-site experienced tertiary level neonatal unit.
Of the several issues that confront the physician, the timing of the pregnancy is of utmost importance. Active disease correlates with a higher risk of adverse pregnancy outcome. Thus, it is advisable to plan the pregnancy when the disease is quiescent or when the disease activity is low. Additionally, the immunosuppressive agents should be discontinued couple of months before a planned pregnancy.
Thus, pre-pregnancy counseling, meticulous pregnancy care and the availability of a skilled neonatal team are essential cornerstones to optimize both maternal and fetal outcomes.
Children with rheumatic diseases are a neglected lot in our country. Early diagnosis and appropriate therapy are standards of care that are not available to the vast majority of these patients. This book highlights common issues that confront the pediatrician. The pediatric section of the book deals with clinically relevant topics and addresses juvenile idiopathic arthritis, PUO and pediatric rheumatology, the approach to a child with a connective tissue disease and systemic vasculitis, neonatal lupus and finally discusses the transition of care of the pediatric rheumatology patient to the adult team.
We thank the contributors for their valuable time and hope that you enjoy reading the book.
Shefali K Sharma
Sujata Sawhney
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