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When It May Be an Autoimmune Disease

Nathan Wei is a board-certifed
rheumatologist with more than
30 years of practice and clinical
research experience. But when his
10-year-old son, Benji, developed
symptoms suggestive of juvenile
ankylosing spondylitis (arthritis),
he felt powerless. “I’m an adult
rheumatologist, but pediatric diseases
are very different,” Wei said.
Juvenile ankylosing spondylitis,
explained Dr. Wei, is one of many
autoimmune diseases that children may
develop. Unless treated aggressively,
it may lead to blindness and crippling
What exactly is an autoimmune
condition? It’s a situation in which the
body’s healthy immune system, which
is designed to protect against invaders
such as microorganisms, goes awry.
“In autoimmune disease, the immune
system attacks your body tissues
instead of foreign proteins like viruses

and bacteria,” said Nancy Pan, MD, a
pediatric rheumatologist practicing in
New York.
Often diffcult to diagnose,
autoimmune diseases can attack all
organ systems, including skin, lungs,
kidneys, joints, brain and spinal cord.
Although relatively uncommon, some
of the more often seen childhood
autoimmune conditions are type 1
diabetes, celiac disease, arthritis,
lupus, infammatory bowel diseases
such as Crohn’s and ulcerative colitis,
and juvenile dermatomyositis. Less
frequently, kids develop multiple
sclerosis and Addison’s (adrenal)
The cause of autoimmune diseases
is still a mystery, although research is
beginning to make it less so. “Genetics
certainly come into play,” said Dr. Pan.
“If a child’s parent or grandparent
has an autoimmune disease, there’s
a higher likelihood of the child having
that condition or another autoimmune
Many health researchers think that


if you have a genetic tendency to
develop an autoimmune condition, it
still takes a “triggering event,” such as
a virus, to activate the immune system
to attack the body. And still others
believe in the “leaky gut” theory.
In this theory, the intestinal lining,
which is the frst line of defense in
the immune system, develops “holes”
that allow invaders such as toxins and
waste to enter your bloodstream. This
results in the immune system going
into overdrive, attacking everything in
sight – including your healthy tissue.
The cause of leaky gut is widely
debated, but most researchers point
to a diet high in refned and processed
food and preservatives, chronic stress,
bowel infections and medications such
as aspirin or acetaminophen that can
irritate and compromise the intestinal
“The exact cause of autoimmune
conditions is a topic of intense
research,” said Dr. Pan. “It’s a hot topic
right now, but nobody knows for sure.”
When should you be concerned

that your child’s symptoms may be
something more serious than a minor
illness? Red fags, according to Dr. Wei,
are “unexplained weight loss, fevers,
rashes, joint pains, eye infammation,
mouth sores, or bowel or bladder
More subtle observations, said Dr.
Pan, are “when you see that your child
isn’t enjoying sports or activities as
they used to, or when they’re limping,
or stiff and sore in the morning.”
Parents are valuable resources
in helping to pinpoint the cause of
symptoms. You can help the doctor
make a diagnosis by monitoring
details, such as when symptoms
frst occurred, if they are constant or
intermittent, and the time of day they
are better or worse. It’s also good to
be able to describe the exact location
of the symptoms and what they feel
like, such as whether pain is stabbing
versus throbbing.
As for what kind of doctor
you should consult to diagnose

an autoimmune condition, “The
best person to start with is your
pediatrician,” said Dr. Pan. “There are
many other illnesses to rule out before
diagnosing an autoimmune condition.”
And because autoimmune diseases
affect so many body systems,
many types of specialists are
involved in diagnosing and treating
these diseases. For example, an
endocrinologist is involved in diabetes
type 1, a gastroenterologist with
celiac disease, and a rheumatologist
with arthritis. If your pediatrician is
concerned that your child may have
an autoimmune disease, he or she
can then refer you to the appropriate
As for Benji Wei, “He is 24 now,”
said his dad, “and working in Boston.
He was able to play soccer in high
school and rugby in college.”
“Autoimmune diseases, when caught
early, and treated aggressively,” added
Dr. Wei, “can often be managed and
put into remission.” MS&F

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When PANDAS Is Dangerous

One autoimmune condition that has been the subject of much research over the
past decade is Pediatric Autoimmune Neuropsychiatric Disease Associated with
Strep Infection, or PANDAS. It is a cluster of symptoms following a childhood strep
infection. It’s thought that the bacteria triggers an overactive immune response that
results in infammation in the brain. Symptoms may include the abrupt onset of
anxiety, obsessive-compulsive disorder, tics, personality changes, decline in math
and handwriting abilities, sensory sensitivities, and restrictive eating.
PANDAS is thought to be a genetic condition, triggered by the strep bacteria. It is
related to rheumatic fever, which is another post-strep condition. Some pediatricians
are unfamiliar with this condition, so if your child has a sudden onset of symptoms
following a strep infection, it’s important to consult with a specialist familiar with the
disorder, such as a pediatric rheumatologist. PANDAS is treatable with a prolonged
course of antibiotics. Learn more about this condition at

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