One hundred and seventy cases of childhood-onset rheumatological disease in Singapore.

One hundred and seventy patients with rheumatological disease diagnosed before their 16th birthday and still on follow up were studied retrospectively. They were seen within the last 3 years at KK Women's and Children's Hospital, Tan Tock Seng Hospital, National Skin Centre or Singapore General Hospital. Of these, 89 were still less than 16 years old at the time of study. The majority had systemic lupus erythematosus (51.8%). Many were on long-term follow-up for persistent disease, including renal manifestations (47.7%), neurological manifestations (26.1%) and haemolytic anaemia (15.9%). Photosensitivity and malar rash were more common than in Western studies while arthritis was less common. Anti-phospholipid antibodies were found in children complicated by myocardial infarction, pulmonary hypertension, Raynaud's phenomenon, cerebral and gut lupus. Children with juvenile chronic arthritis comprised 28.8% and juvenile dermatomyositis 10%. The male predominance and lack of uveitis in children with pauciarticular JCA were striking. Rarer conditions included polyarteritis nodosa, scleroderma, rheumatic fever with arthritis, polychondritis and Behcet's disease. Many diseases may first present with a rheumatological complaint. This review of features of local children highlights similarities and differences with Western data. It also provides information for planning long-term care, multidisciplinary clinics, group physiotherapy sessions, educational programmes and support groups.