The Multidisciplinary Team
Optimal management requires prompt diagnosis, early referral to an experienced MDT working together with families and school, community and primary healthcare providers.
The MDT will comprise various professionals and continues to evolve. Professionals involved include paediatric rheumatology and ophthalmology specialists in medicine and nursing, allied health (see below), psychologists, pharmacists, social workers and play therapists.
Many teams work closely with other specialists, particularly in orthopaedics, podiatry and complex pain, but also renal, dermatology, immunology and haematology. Colleagues in radiology, pathology and laboratory medicine are often pivotal in the diagnostic work-up.
There are many other health professionals that children and young people may see about their health care needs. Many of these are called allied health. Some of the allied health professionals that may support the child and family include:
- Occupational therapists, who can help with everyday activities that a child wants or needs to do
- Physiotherapists who can help a child with movement, or help an injury get better
- Podiatrists who can help with children’s foot problems, shoe problems or walking problems
- Psychologists who can help a child manage any feeling of sadness, anger or confusion. They can also help with learning to cope with an ongoing health issues.
Some countries provide more detailed information about allied health professionals do such as:
The paediatric rheumatology MDT will work closely with primary care and local paediatricians to ensure patient care is holistic and provided close to home where possible. Networks and shared care approaches are developing and evolving, and the advent of telemedicine has made this much more effective and accessible.
Management is focussed on reducing and suppressing inflammation, and optimising the patient’s quality of life. Generally this can be achieved though outpatient management but some patients will need inpatient care as part of their initial assessment and diagnostic journey and for induction of disease control.
The MDT may approach the patient with different goals in mind; the medical priority will focus on disease control and monitoring outcomes and medications. Patient education and support is often provided by the nursing team and they can become key confidants for the patient and their family. Patients on oral and subcutaneous medications at home need to be appropriately educated and supported on safe administration and storage of medicines, potential side effects, and when and how to seek advice if unwell.
Therapy teams will focus on improving joint range of movement, muscle strength and function alongside optimising activities of daily living and supporting the child at home and in school.
The patient journey within paediatric rheumatology may be long and complex. Good communication within the MDT and to the patient and family is of utmost importance. A holistic approach is always beneficial and patient / family education focussing on diet, exercise, maintaining optimal weight and mental health are all important issues that are the shared responsibility across the whole MDT.
The roles of the MDT include the following:
- Knowledge – making sure families and patient understand the diagnosis and treatment plan.
- Co-ordination of care – getting treatment started and then ongoing - this may be treatments given at home or on the day case unit (e.g., infusions of corticosteroids, biologics or cytotoxics or joint injections).
- Support and guidance – helping families when they are worried / concerned.
- Training – training families or local nurses to give care to child or young person at home.
- School support – contact with schools / nurseries so that the child is able to fully participate and achieve full educational potential.
- Supporting children receiving day case treatments involving cannulation or anaesthesia.
- Facilitate communication between MDT members and families.
The role of the nurse specialist in the management of rheumatic disease is further detailed in PMM for nurses.