Management

Key themes relevant to the management of rheumatic diseases in children and young people are described. Key points include:

• Early diagnosis and starting the appropriate treatment improves clinical outcomes. Evidence has shown that joint damage can occur early in Juvenile Idiopathic Arthritis (JIA). Children can rapidly become functionally impaired if there is delay. 
• Management is multidisciplinary. The team includes doctors, nurses, and therapists with ready access to ophthalmologists, dentists, psychologists and orthotists. Families and local healthcare services require advice and support from specialist teams.
• Education and support - The nurse specialist is central to providing education and support, often extending to include local community nursing teams and school health nurses. This nursing support is essential for families unable to give treatment themselves at home.
• Treatments - The emergence of potent and effective immunosuppressive agents have dramatically improved clinical outcomes. Disease Modifying AntiRheumatic Drugs (DMARDS) and Biologic therapies need careful supervision. Corticosteroids are used in joint injections and systemically to achieve rapid disease control.
• Pain assessment informs the approaches to management.  
• Monitoring - Medical management includes controlling disease activity, screening for complications of disease (especially uveitis), monitoring effectiveness and safety of medications, physical growth and pubertal status, as well as evaluation of psychosocial functioning. The aim is good disease control, minimising side effects of treatment with the goal of optimising school attendance and quality of family life.
• Nursing Notes - These provide essentials of knowledge and skills for the nurse involved in clinical care - both general notes and also points for specific conditions. 
• Transition - As young people mature and grow-up they will require preparation to move into an adult healthcare setting, a process known as transition. 
• Practical Skills - Nurses play an important role to support children and families with procedures and delivery of treatments.