Center for Childhood Arthritis and Rheumatic Diseases

Curriculum

Arthrocentesis
Synovial fluid analysis
Interpretation of results of disease-specific laboratory tests
Plain radiographs
Joint ultrasound including ultrasound guided joint aspiration and injection
Interpretation of results from the following tests:
- Diagnostic imaging techniques
- Radionuclide scanning techniques
- Arteriograms in the vasculitides
- Electromyograms and nerve conduction studies
- Biopsy specimens including histochemistry and immunofluorescence of tissues
Others: nailfold capillary examination, ischemic forearm muscle test, Schirmer’s and rose bengal tests, closed needle synovial biopsy and arthroscopy
Demonstrate the ability to construct a differential diagnosis in children presenting with signs and symptoms related to rheumatologic diseases and to outline further testing necessary to establish the correct diagnosis
Using the basic principles of decision analysis, understand the indications for and costs of ordering laboratory tests and procedures to establish a diagnosis of a rheumatologic disease

Multidisciplinary team concept
Methods of rehabilitation
- Exercise: range of motion, strengthening and stretching
- Rest and splinting
- Aids and appliances
- Shoes and orthotics
- Nutritional issues
Specific rehabilitative techniques and modalities:
- Psychosocial aspects – psychologic and emotional factors
- Economic, educational and vocational issues
- Compliance issues
Rehabilitation of the rheumatic disease patient after a surgical or orthopaedic procedure

Understand indications for surgical and orthopaedic consultation in acute and chronic rheumatic diseases
For each procedure, the fellow should possess a working knowledge of indications, preoperative evaluation and medical adjustments, contraindications, complications, postoperative management and expected outcome:
- Arthroscopy
- Synovectomy of tendons and joints
- Spine surgery: radiculopathy, stenosis and instability
- Reconstructive surgery of hand and foot
- Total joint replacement: hip, knee, shoulder, other
Infected joint
- Infected joint management principles
- Infected prosthetic joint
Non-allopathic medical practices: diet, nutritional supplements, antimicrobials, acupuncture, topicals, homeopathic remedies, venoms and others
Using the basic principles of decision analysis, understand the indications for and cost of different therapies used in the management of pediatric rheumatic diseases.

Understand the biology and principles/methodology of the laboratory techniques:
- Erythrocyte sedimentation rate, C-reactive protein and acute phase reactants
- Rheumatoid factors
- Antinuclear/Anticytoplasmic antibodies: screening test, specific autoantibody tests, and LE cell preparation
- Antineutrophil antibodies: membrane and cytoplasmic
- Antiphospholipid antibodies including RPR, lupus anticoagulant and anticardiolipin antibodies
- Others: total serum complement activity, complement proteins, histocompatibility markers, cryoglobulins, immunoglobulin levels
Synovial fluid analysis
Radiographic imaging and other diagnostic procedures:
- Plain radiographs of bone and joints
- Bone densitometry
- Nuclear medicine scintigraphy
- Ultrasonography
- Computed tomography
- Magnetic resonance imaging
- Electromyography and nerve conduction velocities
Test-performance characteristics: principles of sensitivity, specificity and predictive value
Biomechanics of joints

Main Number: 215-590-1000
Physician Referral Service: 1-800-879-2467
Coordinates: 39.9486937, -75.1929596
An Equal Opportunity Employer
The Children's Hospital of Philadelphia is an equal opportunity employer. We do not discriminate on the basis of race, color, gender, sexual orientation, age, religion, national or ethnic origin, disability or veteran status.