The Division of Rheumatology is based at the Children’s Hospital of Eastern Ontario (CHEO) which serves Eastern Ontario, Western Quebec, Nunavut and parts of Northern Ontario.

This division evaluates, treats and advocates for children with rheumatic symptoms, such as joint pain and swelling. The division also treats rheumatic diseases including inflammatory arthritides such as juvenile idiopathic arthritis (JIA), connective tissue diseases such as systemic lupus erythematosus (SLE), and systemic vasculitides such as ANCA-associated vasculitis. 

Our mission is to help children with these diseases reach their full potential. We practice family-centred care using a team approach which is supported by scholarship in education and research through the University of Ottawa’s Faculty of Medicine. 

Our team consists of four staff rheumatologists and several allied health personnel including two nurses, a physiotherapist and a social worker, as well as administrative support and research personnel.

Related links

• Canadian Bioethics Society
• Canadian Paediatric Society
• Canadian Tri-council core skills tutorial for research ethics

Inpatient care 

The major inpatient activity for the rheumatology team is the provision of a consultation service to the inpatient wards, the intensive care units and the emergency department. Consultation requests vary in number from week to week, totaling approximately 100 per year. Conditions typically include the evaluation of children with fever, polyarthritis, systemic symptoms and vasculitis. Occasionally, the division’s rheumatology patients are admitted to the hospital but this is an infrequent occurrence with usually not more than 50 admissions annually. 

Outpatient care 

The main component of clinical care occurs in the ambulatory domain with a total of approximately 2,500 patient visits annually, including 350 new consultations. 

Patients are seen predominantly in two different areas: 

• Ambulatory clinics – new consultations and return visits are seen in 10 weekly, half-day clinics 
• Medical day unit – patients requiring intravenous infusions of biologic agents or immunosuppressive drugs  

In addition, patients may undergo technical procedures such as musculoskeletal ultrasound or intra-articular injection, usually undertaken in the ambulatory setting but occasionally also in the operating room. 

Clinical problems and diseases evaluated and followed 

Inflammatory arthritides

• Juvenile idiopathic arthritis (JIA)
• Reactive arthritides including post infectious arthritis
• Arthritis associated with inflammatory bowel disease (IBD)
• Other arthritides

Connective tissue diseases

• Systemic lupus erythematosus
• Juvenile dermatomyositis (JDMS)
• Scleroderma – localized and diffused
• Mixed connective tissue disease and overlap syndromes
• Raynaud’s phenomenon
• Neonatal lupus 

Vasculitis

• Henoch-Schonlein purpura
• Kawasaki disease
• Polyarteritis nodosa
• ANCA-associated vasculitides
• CNS vasculitis

Autoinflammatory diseases

• Familial Mediterranean fever
• Hyperimmunoglobulinemia D with recurrent fever
• TNF receptor associated periodic syndrome (TRAPS)
• CIAS-I associated disease
• Other
• Familial cold urticaria
• Neonatal onset multisystem inflammatory disease
• Periodic fever - aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome, Blau syndrome, pyogenic sterile arthritis - pyoderma gangrenosum - acne (PAPA syndrome)

• Musculoskeletal ultrasound – usually undertaken in the ambulatory clinic setting 
• Intra-articular injection – usually undertaken in the ambulatory clinic setting 

There are no specific laboratory or other diagnostic programs associated with this division.

The Division of Rheumatology at The Children’s Hospital of Eastern Ontario (CHEO) has a very active and productive research program, with studies conducted in a variety of areas. These studies are funded by both federal and provincial organizations such as The Canadian Institutes of Health Research (CIHR) and The Canadian Initiative for Outcomes in Rheumatology Care (CIORA), as well as private and public partnerships. The studies are multi-disciplinary in nature with collaboration locally, nationally and internationally, resulting in several presentations at national and international meetings, as well as several annual publications. Specific areas of research include, but are not limited to: 

• Long-term Outcomes and Qualify of Life
• Physical Activity
• Pain
• Imaging Studies
• Transition to Adult Care
• Peer Mentoring
• Knowledge Translation
• Incidence and Outcomes in JIA - Associated Uveitis

Undergraduate training opportunities 

Rheumatology welcomes medical students for rotations of a two to four week duration. Exposure includes teaching in relation to the full array of inpatient and outpatient clinical activities with one-on-one case reviews. For types of diseases seen and followed, please consult the Clinical Programssection.

Emphasis during rotations is placed on: 

• Comprehensive history taking
• Physical examination and musculoskeletal anatomy
• Case management, including appropriate use and interpretation of laboratory investigations and diagnostic imaging
• Anti-rheumatic drugs
• Infusion surveillance in the medical day unit. 

Some exposure to musculoskeletal ultrasound and joint injection techniques will also occur. 

Postgraduate training program 

There is no certified postgraduate program in the Division of Rheumatology at this time. 

Additional postgraduate training 

Rheumatology welcomes residents for rotations of a four-week duration. For a full depiction of exposures, see the Clinical Programs section and the Undergraduate Training Opportunities section. 

While the opportunities for rotating residents are similar to those described for undergraduate trainees, the level of responsibility afforded to rotating residents is considerably greater. Additionally, expectations are higher with residents taking ‘first call’ for consultation requests and for inpatients during the regular work day.