Winter 2015 (Volume 25, Number 4)

Pediatric News 2015

By Deborah Levy, MD, MS, FRCPC;
Lori Tucker, MD;
Mercedes Chan, MBBS, FRCPC, MHPE;
Janet Ellsworth, MD, FRCPC

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Pediatric Committee
The Pediatric Committee of the CRA represents all Canadian pediatric rheumatologists. Current membership is approximately 55, with an additional 10 trainee members. We also welcome adult rheumatologists who see a significant number of pediatric patients in their practice. Although we are a small group, we are cohesive and have had an active and successful year! The current Executive includes Dr. Rosie Scuccimarri (Past Chair), Dr. Deborah Levy (Chair), Dr. Ronald Laxer (Vice-Chair), and Dr. Roberta Berard (Secretary). We have three active subcommittees that liaise with other CRA Committees, and an ad hoc Subcommittee that tackled Canadian management guidelines for juvenile idiopathic arthritis (JIA).

Advocacy Subcommittee
The Advocacy Subcommittee, chaired by Dr. Lori Tucker, takes on issues of importance to patient care identified by our Committee members. Over the past year, we have focused on issues of access to therapies for children with JIA. Naproxen liquid was unexpectedly discontinued in late 2013, leaving no approved nonsteroidal anti-inflammatory drugs (NSAIDs) for treatment of JIA available in liquid form. Strong advocacy efforts via an ad hoc group that included representatives of the Pediatric Committee as well as the CRA Therapeutics Committee, the Ontario Rheumatology Association (ORA) and The Arthritis Society (TAS) led to renewed availability of naproxen suspension in Canada earlier this year. See “An Advocacy Success Story", in the Winter 2014 CRAJ for more details.

Following success with naproxen we turned to triamcinolone hexacetonide (TH), the preferred steroid preparation for intra-articular use in pediatric rheumatology. This medication has been available only via the Special Access Program (SAP) for the past several years, until the recent discontinuation of supply in the late spring of 2015. Quick work by a similar ad hoc Committee has led to reinstitution of access via a new SAP supplier and together we are working on a permanent solution, outlined in greater detail in this issue of the CRAJ.

Lastly, our Committee has begun the process of identifying barriers to rheumatology care for children and youth of First Nations background. The CRA Optimal Care Committee, chaired by Dr. Henry Averns, is working with the federal Non-Insured Health Benefits (NIHB) program to bring rheumatology care issues into the open and work collaboratively to try to address them. We have begun to discuss issues such as limited biologic medication access for diagnoses other than JIA, and transition access issues for teens.

Education Subcommittee
The Education Subcommittee, chaired by Dr. Mercedes Chan, continues to strive to fulfill our mandate to equip all doctors who interact with children with rheumatic disease with resources to enhance knowledge and management of pediatric rheumatologic conditions. Some of the steps being taken include formally exploring representation at the level of the Canadian Pediatric Society (CPS), as well as encouraging and supporting rheumatology teaching at CPS annual meetings. We are also proactively reviewing the CRA's website with the aim of increasing pediatric content and linking resources between the CRA and CPS.

Human Resources Subcommittee
The Human Resources Subcommittee, chaired by Dr. Janet Ellsworth, conducts regular surveys of the pediatric members regarding manpower, clinical and academic activities, and allied health resources. These surveys are a valuable resource to our community, providing a snapshot of what is happening in pediatric rheumatology centres across the country. In 2015, we participated in the design of Stand Up and Be Counted to include relevant pediatric data. We had an excellent response, with completion of the survey by over 90% of the Pediatric Committee members, and await analyses of these data to help plan for a full pediatric survey next year.

JIA Management
An ad hoc Subcommittee, chaired by Dr. Ross Petty, has prepared a position paper on the management of JIA in the Canadian context. It builds on the guidelines of the British Society for Pediatric and Adolescent Rheumatology (BSPAR) and those of the American College of Rheumatology (ACR). Many members of the Pediatric Committee participated in subcommittees chaired by Dr. Tania Cellucci and Dr. Jaime Guzman; all members had the opportunity for input into the development of the guidelines which deal with access to care, and appropriate institution of second- and third-line pharmacologic treatment. Following approval by the Guidelines Committee of the CRA, the manuscript will be submitted for publication in the fall.

Deborah Levy, MD, MS, FRCPC
Assistant Professor of Pediatrics,
University of Toronto
Rheumatologist,
Hospital for Sick Children
Toronto, Ontario

Lori Tucker, MD
Clinical Investigator,
Child & Family Research Institute (CFRI)
Clinical Associate Professor,
Division of Rheumatology,
Department of Pediatrics,
University of British Columbia
Vancouver, British Columbia

Mercedes Chan, MBBS, FRCPC, MHPE
Assistant Professor of Pediatrics,
University of Alberta
Pediatric Rheumatologist,
Stollery Children’s Hospital
Edmonton, Alberta

Janet Ellsworth, MD, FRCPC
Professor of Pediatrics,
University of Alberta
Pediatric Rheumatologist,
Stollery Children’s Hospital and Glenrose Hospital,
Director of the Division of Pediatric Rheumatology
Edmonton, Alberta