Advancements and Challenges in Pediatric Rheumatology, with Susan Shenoi, MD, MS

In an interview with HCPLive, Susan Shenoi, MD, MS, associate professor of pediatrics and clinical director at Seattle Children’s Hospital, discusses her upcoming Rheumatology Winter Clinical Symposium (RWCS) presentations related to the field of pediatric rheumatology.

Her first presentation provides an overview of significant developments in pediatric rheumatology over the past year, including a study on emapalumab, a new interferon-gamma monoclonal antibody used in refractory macrophage activation syndrome.

In her second presentation, Shenoi focuses on myositis in both adult and pediatric patients. She discusses the evolution of myositis classification, the role of myositis antibodies, and the latest therapies, including biologics, Janus kinase (JAK) inhibitors, and the promising use of CAR T cell therapy in adults with dramatic myositis.

Additionally, she touches on the importance of mental health in children with arthritis, especially in the aftermath of the COVID-19 pandemic, by discussing recent studies from Sweden and Canada.

“It is becoming clear that maybe there's a higher risk and children with chronic disease such as arthritis, she said. “So, it seems like we, in pediatric rheumatology, need to start paying close attention to this and start screening our children for this, recognizing it, and treating them or referring them appropriately to either mental health counselors, or psychiatrists.”

When it comes to transitioning patients from pediatric to adult care, Shenoi believes key aspects involve conveying comprehensive medical history, including medication trials and complications, and addressing the patient's comfort with the transition. She emphasized support and facilitating the transition are crucial.

“I think the most significant advancements these last few years have been increasing availability of medications that are approved for pediatric arthritis,” Shenoi stated. “That has been really through advocacy done through the pediatric rheumatology community in conjunction with the US Food and Drug Administration (FDA). We now have more biologic agents, and we now have small molecule, such as tofacitinib, available. [It] is an oral drug, which is exciting because the kids hate the shots.”

Additional advancements include the growing recognition of mental health's impact, which underscores the importance of pediatric rheumatologists actively addressing and treating mental health concerns in their patients.

Shenoi receives funding from Cure JM Foundation for Seattle Juvenile Myositis COE and consults for Pfizer and Novartis. She is a member of the Childhood Arthritis Rheumatology and Research Alliance (CARRA) and Pediatric Rheumatology Collaborative Study Group (PRCSG).