Paediatrics Rheumatology Clinic Population in Singapore: The KKH Experience

Abstract

Introduction: The subspecialty of paediatric rheumatology (PR) is the newest discipline established at KK Women's and Children's Hospital, in 2009. The service provides tertiary care for children with rheumatic diseases in Singapore. Referral population to this subspecialty has not been described in this region. Methods: Using the Registry for Childhood Onset Rheumatic Diseases (RECORD), a dedicated web-based data entering system, case descriptions and diagnoses were captured. Standardised descriptions of diagnoses were used. Results: Data from January 1, 2009 to March 31, 2012 included 1158 referrals which were analysed. Almost half (42.2%) were diagnosed as non-rheumatic conditions. Systemic vasculitides (28.4%) with Henoch-schonlein purpura (HSP) and Kawasaki disease (KD) were the most common rheumatic diseases. Enthesitis related juvenile idiopathic arthritis (JIA) was common but JIA associated uveitis was rare, so as to antinuclear antibody (ANA) positivity (25.4%). The remaining 36.4% of patients with rheumatic disease had a variety of other conditions. Primary angiitis of the central nervous system (CNS) and recurrent aphthous stomatitis were seen more commonly in local patient than in patients from the west. Of the patients with non-rheumatic disease, 66.3% had orthopaedic/mechanical related conditions, 7.4% had a fever of unknown causes and 4.9% had infections. Mechanical joint pain (67.6%) and hypermobility syndrome (18.5%) were the most frequent referrals. Conclusion: Our report described, for the first time, a large single centre cohort of a PR clinic population. Local frequencies or burden of paediatric rheumatic diseases and unique findings were delineated. Targeted education and awareness to both healthcare professionals and members of the public were made possible. However, continuous prospective longitudinal data collection is on-going in order to confirm our initial observation.