CHEERS (Paediatric Rheumatology)

Child and adolescent East of England Rheumatology Service (CHEERS). The paediatric rheumatology team provide the best possible evidence based care for all children and young people with rheumatological conditions.

Urgent advice: Group A Streptococcus advice for parents from the paediatric rheumatology team

We know that some parents are worried about the recent reports of higher than usual numbers of children becoming unwell with Group A Streptococcal infection, and will have questions about what this means for their child.

There are lots of viruses circulating that cause fevers, sore throats, coughs, colds and rashes; especially during the winter months. The majority of these illnesses will get better without needing any special medical assessment or treatment. However, some illnesses are caused by bacteria, of which Group A Strep (GAS) is one. You will have heard about this infection in the news as it has been found in some children who have become very sick, very quickly. Fortunately, this is still a rare occurrence.

What is GAS?

GAS usually causes a mild illness with a fever and sore throat (“strep throat”), often without a significant cough or runny nose. This usually lasts a few days before getting better and does not always require antibiotics. As always, we would advise that you call 111 or see your GP for advice if you are concerned about your child. Children on immune-modulating medications should continue to follow our guidance to omit their medication if they develop a temperature of 38 or above with symptoms of being generally unwell. Please update the rheumatology team by telephone call or email if this is the case.

GAS can also cause an illness called Scarlet Fever. Children usually have a fever, sore throat and a rash. The rash typically has small pimples that begin on the chest and tummy before spreading elsewhere. It often feels rough or sandpapery when you run your finger over it. The rash is often harder to see in darker skin tones, but still feels bumpy to the touch. If you are concerned your child has Scarlet Fever, you should contact your GP or 111 for assessment as Scarlet Fever requires antibiotics. You should keep your child at home for at least 24 hours after starting antibiotics to monitor them and reduce the risk of spreading infection to others. More information is available here: Scarlet fever - NHS (www.nhs.uk)

The reports in the news recently have described cases when GAS causes a more serious infection called ‘Invasive GAS’. Thankfully, this is still a rare occurrence. The NHS website has very useful guidance on signs to look out for that might signal your child is unwell: High temperature (fever) in children - NHS (www.nhs.uk).

Advice from the paediatric rheumatology team

Ultimately, the advice from the paediatric rheumatology team has not changed: if you are worried about your child you should seek medical advice and then update the rheumatology team. We are not advising that children on medication that affects their immune system isolate from school or seeing their friends and family. If your child has been in contact with GAS you do not need to do anything other than keep an eye on their symptoms. If there is any requirement for ‘preventative antibiotics’ due to close contact, this would be organised by the Public Health team and only include those they decide are at high risk.

We would like to take this opportunity to remind parents with children on methotrexate that you should always ask whether there are any interactions between prescribed medications, including antibiotics.

Other resources you may find useful

Our goal is for the child and young person to be able to fulfill their potential in all areas of growth and development, without any restriction associated with their condition. Care is therefore tailored to the individual needs of the child and family and delivered as close to home as is practical and safe.

We will see children and young people up to the age of 16 years with all the conditions listed in the National Service Specification for paediatric rheumatology. Young people from 16 to 18 years who need ongoing rheumatology care will be transitioned to the adult service at a time which is best for them.

Please follow this link for further information about our service and referral information.

Covid-19 information

For our statement & advice on Covid-19, please visit this page before attending your appointment.

Conditions we treat

Our Paediatric Rheumatology service is involved in the diagnosis and management of the following conditions (as stipulated within the NHS England service specification for Paediatric Rheumatology).

Meet the team

Paediatric rheumatology physiotherapy

The paediatric rheumatology physiotherapy and occupational therapy team at Addenbrooke’s Hospital treats patients with inflammatory musculoskeletal conditions.

What Rheumatology Occupational Therapy services are provided?

The role of the OT in treating young people with inflammatory and non-inflammatory conditions is very diverse, ranging from:

Assessing the child’s ability to perform day-to-day tasks and routines and suggesting alternative ways to carry out tasks
Offering practical support and advice on assistive gadgets/aids for example pencil grips, writing slopes, bath boards
Offering advice on pain management and techniques to improve sleep and energy levels
Acting as a liaison between the family, health and social care teams and school about current needs
Setting patient centred goals to maintain their engagement in therapy and to motivate them to return to full function.

How will Occupational therapy help?

The OT can help by suggesting:

Hand/wrist exercises to strengthen or stretch specific muscles
Activity modification by suggesting different ways to do an activity for example, adopting a more supported seating posture, taking regular rest breaks and getting the correct pen grip with or without the help of a pencil/pen grip aid
Splinting - splints are sometimes used:

When joints are very painful and the pain and stiffness are having an effect on their ability to carry out certain tasks

To stabilise a joint if there is deviation or subluxation (i.e. misalignment/dislocation)

To stretch out soft tissues which have tightened and caused loss of movement to e.g. a finger joint

Teaching relaxation techniques and techniques to increase sleep and energy levels
Pain management advice techniques to help to reduce pain and stiffness in their hands and wrists
Providing information to school to support a child attending and participating in lessons and extracurricular activities during their school day
Pacing/energy conservation: when a child is working towards a specific goal or trying to increase their muscle strength and endurance it’s important they pace themselves

Paediatric rheumatology research

We are dedicated to high quality medical research in the knowledge that this is the principle way that improvements in care and in outcomes can be achieved. Children and young people who come into our service will be given the opportunity, where eligible, to take part in open research studies (in Norwich and/or Cambridge).