Childhood-onset rheumatic diseases are generally chronic and are associated with significant morbidity and sometimes mortality in affected children, adolescents, and young adults. The appreciation of rheumatic diseases during childhood, aside from rheumatic fever, dates back to the late 19 century ( ). It was not until the mid-1900s that centers dedicated to the care of children with chronic arthritis were established ( ). In 1976, the American Rheumatism Association (predecessor of the American College of Rheumatology) organized a meeting on rheumatic diseases of childhood in Park City, Utah ( ). This meeting marked the first step towards developing pediatric rheumatology as a specialty, which was formally recognized by the American Board of Pediatrics in the early 1990s. It has since been increasingly appreciated that while basic disease mechanisms might be similar between children and adults for some autoimmune diseases, implications, complications, and management of these chronic disease conditions are often different in the young. In lupus for example, disease severity and the extent of major organ involvement are more pronounced in childhood-onset compared to adult-onset disease ( ). Some of these differences in disease manifestations have been attributed to higher genetic risk when complex polygenic autoimmune diseases start during childhood ( ). Monogenic forms of these conditions are usually characterized by an early disease onset ( ). Therefore, it is likely that differences in basic pathogenic mechanisms and in interactions between genetic factors and environmental triggers could explain, at least in part, clinical variability between pediatric and adult-onset rheumatic diseases.
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