A Closer Look at Pediatric Rheumatology Care

The Center for Pediatric Rheumatology at Cleveland Clinic Children’s is internationally recognized for its expertise in evaluation of rheumatologic conditions, rare and complex, as well as common. In 2018, the center added staff physicians to become the largest pediatric rheumatology practice in Northeast Ohio. Andrew Zeft, MD, MPH, Director of Pediatric Rheumatology at Cleveland Clinic, talked to CQD to share more about his team.

What do you see as the latest challenges in Pediatric Rheumatology?

Dr. Zeft: The accurate, timely diagnosis of children with pediatric rheumatologic disorders is key. Accurate diagnosis early in a child’s autoimmune disease course provides the best chance for a good outcome. This takes experience and often a specialized team approach. For example, juvenile idiopathic arthritis (JIA), the most common chronic rheumatic disease condition we diagnose and care for, can present like lupus, chronic recurrent osteomyelitis, or even as a vasculitis-type disorder. These illnesses are complex in that they may have varied presentations and indicators. Patients with arthritis may have specialized forms of ocular inflammation, such as iritis or uveitis, and they also present with features of other autoimmune diseases, including thyroiditis or inflammatory bowel disease.

What is your team’s area of focus?

Dr. Zeft: We provide comprehensive care for inflammatory and autoimmune disorders that affect the joints, muscles, skin, blood vessels and selective organ systems. We are a regional, national and international referral center for families seeking second opinion services for their child’s pediatric rheumatologic condition. Our team has expertise in a number of pediatric rheumatology conditions, including JIA, lupus, dermatomyositis, scleroderma, vasculitis and unique childhood autoinflammatory diseases. We have a combined clinic with pediatric dermatology, focusing on autoimmune skin conditions, such as psoriasis, which also may affect a patient’s musculoskeletal system.

How do you use technology?

Dr. Zeft: We utilize state-of-the-art musculoskeletal ultrasound in the clinic at the bedside to diagnosis and guide treatment for patients with pediatric arthritis and tendon inflammatory conditions. We also can provide telehealth follow-up visits for patients seen initially at Cleveland Clinic. This allows for continuity of care for complex pediatric rheumatology conditions and for patients who travel distances from areas underserved of pediatric rheumatology expertise.

What is your involvement with research?

Dr. Zeft: Our facility has offered patients the opportunity to participate in state-of-the-art clinical trials for juvenile arthritis and vasculitis. Our research has been involved with collaborative studies with the National Institutes of Health to identify genetic markers associated with JIA, as well as cutting-edge therapeutic trials for new biologics in JIA, vasculitis and autoinflammatory disease.

What is your approach to care?

Dr. Zeft: We use a multidisciplinary approach. Our team of doctors may feel it is important to coordinate efforts with a variety of pediatric colleagues to provide comprehensive care to patients and families. We work in close collaboration with many subspecialists at Cleveland Clinic Children’s Hospital, such as with dermatology in our combined pediatric rheumatology / dermatology clinic, with ophthalmology specialists at Cleveland Clinic’s Cole Eye Institute, and with pediatric epilepsy and neurology for patients with neurology inflammatory-based conditions.

We utilize musculoskeletal ultrasound in our Cleveland Clinic main campus clinic to provide further insight into the patient’s arthritis diagnosis and disease activity. It’s also important that we provide seamless transition of care for young adults with childhood-onset rheumatic conditions. We have a transition program unique to this young adult population with dually-trained pediatric and adult rheumatology staff.

Any final thoughts?

Dr. Zeft: It is a very exciting time to practice rheumatology. At this stage in the evolution of our field, we have treatment approaches and medication options for many pediatric rheumatologic conditions. I am proud that our center is able to provide comprehensive care for pediatric patients and their families.