Anatomy
- Normal growth and development, including puberty
- Structure and function of:
- blood vessels
- bone
- connective tissue
- joints
- muscle
- nerves
- tendons
Associated therapies
- Complementary or non-evidence-based medicine
- Dietician support
- Occupational therapy:
- adaptive equipment and assistive devices
- home, school, and workplace assessment
- Pain management strategies
- Patient education and self-management
- Physiotherapy:
- exercise therapy:
- conditioning
- hydrotherapy
- joint protection and energy conservation techniques
- range of motion
- rest and splinting
- strengthening
- stretching
- Psychology
Immunology
- Basic structure and function of:
- cellular and molecular components of the immune system
- central and peripheral lymphoid organs
Pathophysiology
- Classification of rheumatic diseases of childhood
- Pathophysiology of pain
- Relevant adult musculoskeletal and connective tissue conditions and problems
- Rheumatological emergencies
Pharmacology
- Clinical use of medications, including:
- analgesics for pain
- antibiotic regimens for the prophylaxis and treatment of infectious complications in immune-suppressed children
- anticoagulants in the prophylaxis and management of thrombotic diseases
- bisphosphonates for chronic non-infectious osteomyelitis, and primary or iatrogenic osteoporosis
- corticosteroids, including the role of calcium and vitamin D supplementation:
- intra-articular
- intramuscular
- intravenous
- oral
- Combination drug therapy
- Cytotoxic drugs as used for organ- or life-threatening disease, such as cyclophosphamide
- Disease-modifying antirheumatic drugs (DMARDs):
- biologic DMARDs (bDMARDs), including, but not limited to, inhibitors of:
- B cells
- co-stimulatory effects
- interferon
- interleukin-1 (IL-1)
- interleukin-6 (IL-6)
- interleukin-17 (IL-17)
- tumour-necrosis factor α
- conventional DMARDs (cDMARDs), including, but not limited to:
- azathioprine
- cyclosporine
- leflunomide
- methotrexate
- mycophenolate mofetil
- small-molecule DMARDs (tsDMARDs), including, but not limited to:
- C5a inhibitors
- Janus kinase inhibitors
- Interactions with other medications
- Intravenous and oral therapies for severe Raynaud phenomenon and pulmonary arterial hypertension
- Monitoring and management of drug toxicity
- Non-immune-suppressing immunomodulatory drugs, such as:
- colchicine
- hydroxychloroquine
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Pharmacology of agents used in rheumatic disease
- Prescribing for children with kidney and hepatic insufficiency
- Risks of pregnancy with medications
- Sedation and pain management techniques for children and young people
- Use of medications under special circumstances, such as off-label
Physiology
- As applicable to the understanding of the mechanisms and the treatment of musculoskeletal conditions, such as:
- biomechanics
- cellular and molecular biology
- genetics
- growth development and puberty
- immune mechanisms:
- autoimmunity
- autoinflammation
- immune complexes
- infectious agents
Clinical assessment tools
- Measures of disease activity, functional status, cumulative damage, and quality of life appropriate to the child’s condition. These include:
- 36-Item Short Form Survey (SF-36)
- American College of Rheumatology Pediatric 30 (ACR-Pedi 30)
- BAS Disease Activity Index (BASDAI)
- BAS Metrology Index (BASMI) for juvenile ankylosing spondylitis
- Bath Ankylosing Spondylitis Functional Index (BASFI)
- Child Health Questionnaire (CHQ-50)
- Childhood Health Assessment Questionnaire (CHAQ)
- Systemic Lupus Erythematosus Disease Activity Index (SLEDAI)
- Systemic Lupus International Collaborating Clinics (SLICC) Damage Index
- Screening tools, including, but not limited to:
- paediatric gait, arms, legs and spine (pGALS)
- patient-reported experience measures (PREMS)
Diagnostic imaging techniques
- Angiography:
- conventional
- imaging-based
- Bone densitometry dual-energy x-ray absorptiometry (DEXA)
- CT
- MRI
- PET
- Plain x-ray
- Radionucleotide scans, such as bone scan
- Ultrasound
Investigations (optional)
- Clinician-performed musculoskeletal ultrasound
Investigations (required)
- Capillaroscopy
- Interpretation of joint fluid results:
- Interpretation of relevant laboratory and imaging results
- Tissue biopsy (awareness of when it is required)
Laboratory investigations
- Autoantibodies:
- antibodies to form blood elements, such as:
- antiplatelet antibodies
- Coombs testing:
- antineutrophil cytoplasmic antibodies (ANCA), including specificities for neutrophil granule constituents, such as myeloperoxidase (MPO) and proteinase-3 (PR-3)
- antinuclear antibody (ANA)
- antiphospholipid antibodies, such as:
- anti-beta-2-glycoprotein I antibodies
- anti-cardiolipin
- lupus anticoagulant
- anti-double-stranded DNA (dsDNA)
- anti-histone
- extractable nuclear antigen (ENA), including:
- rheumatoid factor and anticyclic citrullinated peptide (CCP)
- Clinical chemistry:
- creatinine kinase and lactate dehydrogenase
- liver function tests
- serum electrolytes
- thyroid function tests
- urea and creatinine
- Genetic testing:
- monogenic auto-inflammatory diseases
- storage disorders and other inborn errors of metabolism
- whole exome and parental studies, and applicability to rheumatic diseases
- Haematology:
- coagulation studies
- full blood count, including white-cell differential
- Inflammatory markers:
- C-reactive protein
- erythrocyte sedimentation rate
- ferritin
- serum amyloid A
- Other immunology:
- complement studies C1q, C3, C4, CH50, and components of the complement cascade
- flow cytometry studies for analysis of lymphocyte subsets and function
- human leukocyte antigens (HLA) typing
- immunofixation electrophoresis, serum immunoglobulin levels, and serum protein electrophoresis
- Serologic and polymerase chain reaction (PCR) tests for common infections
Neuroelectrophysiological tests
- Electromyography
- Nerve conduction
Procedures
- Arthrocentesis of large and small joints
- Intra-articular steroid injection on small and large joints
Synovial fluid analysis
- Cell count and differentia
- Culture and sensitivity
- Assistance for families and patients, such as:
- cultural
- emotional
- psychological
- Disability determination, such as:
- career advice and planning
- carer allowance and payments
- disability pension – adolescents
- educational supports
- Factors affecting adherence to treatment regimens:
- access to advice and support systems
- distance from specialist help
- educational
- emotional and psychosocial
- socioeconomic
- Pharmaceutical Benefits Scheme requirements for commencing certain medications, such as bDMARDs
- Transitional care of adolescents, and transfer to adult services:
- adolescent-specific issues:
- body image
- emotional development and independence
- risk-taking behaviours
- social media
- local resources for transition of care to adult services
- medication-specific issues
- specific counselling regarding contraception and pregnancy
- transfer of adolescents taking off-label or compassionate-access medication
- transition guidelines for paediatric and adult rheumatology services
