Pediatric Rheumatology Online Journal

Vol 2, No. 1 (4-6) 2004

COMMENTARY

SHOULD PEDIATRIC RHEUMATOLOGY FORM AN

INTERNATIONAL ORGANIZATION?

I’d probably say yes to that question. Certainly I may be in the minority of yes responses. Most may say no at first glance. This issue has likely come up in the past. Some may say that we have enough organizations involving pediatric rheumatology. To name a few, we have the American College of Rheumatology, the American Academy of Pediatrics, the Canadian Arthritis Society, the Pediatric Rheumatology European Society, the Pediatric Rheumatology Collaborative Study Group, the Childhood Arthritis & Rheumatology Research Alliance, the Pediatric Rheumatology International Trials Organization, the Pan American League against Rheumatism, and, finally, the Asian Pacific League against Rheumatism.

But the major international group largely in limbo, the International League against Rheumatism, may arguably not meet the international agenda of pediatric rheumatology. So why do we possibly need an international pediatric rheumatology organization? I think it’s because of the changes in the world, in pediatric rheumatology, and in medicine itself in the last decade.

The world is becoming an incredibly small place in the twenty-first century. It’s not just the instantaneous links of the media and television and movies, though these changes are at times amazing and so much a part of our daily lives that we take them for granted. It’s the computer and the internet and e-mail. It’s the pediatric rheumatology bulletin board. It’s the international travel that persists despite terrorism and the movement of families and children from country to country due to the global economy. How many times has a pediatric rheumatologist put a query on the bulletin board asking: “Does anyone know who might care for a child with arthritis in Saudi Arabia? In Pensacola, Florida? In

Peru? In the Philippines? In Athens? In Idaho? In the Sudan?” The world is a small place. So I believe that for the benefit of the children with rheumatic diseases everywhere, as well as the pediatric rheumatologists and other physicians who care for these children, it would be prudent to join together in an international organization.

It should be an organization that strengthens bonds between national organizations, provides a cooperative, collaborative atmosphere, and avoids competition and elitism. This international organization would not try to duplicate what the above ten organizations do and would not be involved directly in research, or drug trials or local and national educational and research meetings. This organization could be an umbrella organization that is not hierarchal or authoritarian, but rather collaborative and cooperative. It could be inclusive, not exclusive. It could enhance communication and education.

The niche of an international group is to complement the existing organizations and address issues that these organizations have not approached and may never be able to easily address. For example:

1) Provide a forum where national and international organizations can work together and link efforts.

2) Provide a forum where international disease classification, nomenclature, disease criteria, treatment standard of practice and other such issues can be studied, voted upon, and promulgated.

3)Develop an international directory of all physicians who care for children with rheumatic illnesses for over 50% of their practice or who are the local resource.

4) Identify the physicians in each country and locality, who care for children with rheumatic illnesses, we can invite these physicians into our other organizations and our continuing medical education efforts.

I’d anticipate a concern whether we are providing credentialing for physicians with whom we have no contact and have little idea about their training, experience, and competency. This concern might suggest that physicians will hang up a certificate of this international organization as proof of competency and certification. This is a risk, but I believe that it is putting the cart before the horse. Our first interest is linking physicians around the world who are already caring for these special children, educating everyone, bringing everyone into our pediatric rheumatology mainstream, establishing the subspecialty in each country, then we (and each country and its physician organizations) can worry about credentialing and competency.

I firmly believe that an international pediatric rheumatology organization will help us develop pediatric rheumatology in every continent and country without interfering with the existing organizations. For those of you that agree, please help us develop this proposal. For those that do not agree with this idea, please let us know why and what you would recommend instead to address the issues above. We hope to have a feasibility and organizational meeting at the PRES meeting in Slovakia in September 2004.

Charles H. Spencer, M.D.

Chicago