Facilitating Adherence to Medical
Regimens for Pediatric Rheumatic
Diseases: Primary, Secondary,
and Tertiary Prevention
Michael A. Rapoff
University of Kansas Medical Center, Kansas City, KS
Pediatric rheumatic diseases (PRDs) are chronic multisystem disorders that involve acute and chronic tissue inflammation of the musculoskeletal system, blood vessels, and skin. Prevalence estimates are that between 160,000 and 190,000 children in the United States have a rheumatic disease. The most common PRD is juvenile rheumatoid arthritis (JRA), accounting for between 75% and 83% of children with a rheumatic disease ( Cassidy & Petty, 1995).
Criteria for the diagnosis of JRA include: (a) age at onset < 16 years, (b) arthritis (defined as joint swelling or two or more of the following signs: limitation of range of motion, tenderness or pain on motion, and increased warmth) in one or more joints, (c) duration of disease 6 weeks or longer, and (d) exclusion of other forms of juvenile arthritis. There are three general subtypes of JRA, which are defined by the type of disease pattern manifested during the first 6 months: pauciarticular, polyarticular, and systemic-onset. Pauciarticular JRA involves arthritis in four or fewer joints, affects 50% of children with JRA, and has the best long-term prognosis. Polyarticular JRA involves arthritis in five or more joints, affects 40% of children with JRA, and has a guarded to moderately good prognosis. Systemic-onset JRA is characterized by arthritis in a variable number of joints accompanied by fever and a rash, affects 10% of children with JRA, and has a moderate to poor prognosis ( Cassidy & Petty, 1995). Medical treatment objectives for JRA include reduction of pain and inflammation, preservation of function, and prevention of joint deformities and destruc-