Prospects in pediatric rheumatology.

Although pediatric rheumatology became a specialty during the mid 1970s, a number of clinical, research and therapeutic issues still need to be addressed. New entities need to be clearly defined and definite diagnostic criteria established. Research has identified the involvement of cytokines and genetic factors in juvenile chronic arthritis (JCA), while synthetic histone peptides will allow more thorough research into antinuclear antibodies. No satisfactory drug therapy exists for the treatment of chronic rheumatic disease, though the use of local injections of triamcinolone hexacetonide has modified the prognosis of pauciarticular JCA. Joint replacement requires special consideration, as prostheses need to be constructed according to individual requirement. Finally, the psychological impact of JCA must not be underestimated.