Susan Shenoi, MBBS, MS: New Developments in Pediatric Rheumatology

Rheumatology Network interviewed Susan Shenoi, MBBS, MS, to discuss her Rheumatology Winter Clinical Symposium presentations “New developments in Pediatric Rheumatology” and “JIA: new therapies, new guidelines.” Shenoi is Associate Professor and Clinical Director of Pediatric Rheumatology at the Seattle Children's Hospital and Research Center

Rheumatology Network: What are the highlights of your presentation on the new developments in pediatric rheumatology?

Susan Shenoi, MBBS, MS: I'm doing 2 talks. One is the new developments in pediatric rheumatology and I was asked to talk on interferonopathies. So that's this whole concept of a new set of diseases that has probably been identified in the last 10 years where there's abnormal signaling of type 1 interferon that leads to this auto inflammatory spectrum along Mendelian disorders. And this is getting more and more recognized. So there's a couple of classic diseases like STING-associated vasculopathy with onset in infancy (SAVI), which is a vasculitis that presents an infancy, another one called COPA, and then another set of diseases called CANDLE, or proteasome associated disorders. They're fairly rare. Most of them start out in very young kids, typically either newborn or infancy. But there are some newer presentations that are being recognized in adults. My entire talk is centered around that. It really is a new and exciting topic. I think it's under recognized a lot and as genetic testing is getting better and better every year, people are starting to recognize these diseases and starting to recognize how broad their presentations can be.

RN: What are some of the new therapies and guidelines regarding juvenile idiopathic arthritis?

SS: My second talk discusses the gastrointestinal (GI) guidelines that were just developed by the American College of Rheumatology (ACR). This set of guidelines is sort of a companion to the 2 ACR guidelines papers that were published in 2019. The first set of papers focused on polyarthritis, ie ids with arthritis that have several joints at the onset, enthesitis, and uveitis. And so, there was a whole subset of other GI categories that were not discussed in the first guideline. It discusses kids with fewer number of joints at the onset. We also discuss systemic arthritis, which is another one of the GI categories. And then we have special emphasis on just jaw arthritis, which is kind of unique. It's a first time for the JIA guidelines because jaw disease can be so difficult to treat sometimes that we've decided we wanted to give it special emphasis. And then the second paper around the guidelines talks about JIA overall and discusses medication monitoring, immunizations, infection, non-pharmacologic treatments, and imaging. I’m basically giving an overview of all the recommendations that were made as part of part of these new set of guidelines for these particular categories of GI.

RN: What are you most excited about in the conference?

SS: Listening to all the speakers and all the new developments. I am excited to hear the vasculitis talks. I think that'll be really fun and interesting because ACR has come up with new guidelines for vasculitis as well. And then just to listen about the updates that are happening in the adult rheumatology world because often in pediatrics things first come out in the adult world and then we start to use them in kids. And then I'm also excited to just network and have the sunshine there.