Rheumatology Outcomes

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Why Choose Us: Rheumatology

Our Outcomes: The Results of Our Care

Nemours pediatric rheumatologists specialize in diagnosing and treating joint, muscle and bone diseases that cause pain, swelling, stiffness and deformity, and can affect kids’ eyes, skin, internal organs and nervous system. Rheumatic diseases are often autoimmune conditions (when the body’s system for fighting infection and foreign cells sends inflammation to areas of the body when it’s not needed, causing damage or symptoms). Common diseases we treat include lupus and juvenile idiopathic arthritis.

Why Measuring Results Matters

To provide pediatric care that’s among the safest and most effective, we measure our results. Why? So we can:

  • help you make decisions about your child’s care
  • be clear about our results
  • improve so we can consistently deliver better, safer care

Here are a couple of the outcomes we track and focus on to improve the experience for both you and your child.


Preventing Infections in Children

Preventing Infections in Children

Maintaining a Low Rate of Infection After Steroid Injections

Juvenile idiopathic arthritis (JIA) is the most common type of arthritis in children. A standard treatment to help control JIA inflammation is to give injections of a corticosteroid (a natural molecule produced by the part of the brain known as the “adrenal cortex”). Corticosteroids control a wide range of processes, including immune response, regulation of inflammation, metabolism and behavior. The injection is made directly into an affected joint (this is known as an “intra-articular injection” or “IA injection”). With intra-articular injections, there’s a small risk of joint infection, called “septic arthritis.”

At Nemours, we don't just assume or take for granted that a relatively common procedure would not have problems, especially given the delicate nature of our patients. To help keep kids from having these joint infections, we:

  • Give injections under sterile conditions. We treat the injections very much as if they were surgical procedures. They’re always performed by your child’s primary rheumatologist or by an experienced physician in interventional radiology (a medical specialty that provides minimally invasive, image-guided diagnosis and treatment of disease).
  • Offer sedation (using a special medication to produce a state of calm or sleep) for the injections. Sedation helps keep kids comfortable and pain-free during injections, and also helps us keep the joint sterile. Because your child is sedated, movement is limited, so we can be very precise with the injection.


Infection Rate Following Intra-Articular Corticosteroid Injection in Patients With JIA


Nemours infections, 2016


National average (benchmark)


Data source: Nemours data collected from electronic health records of rheumatology patients at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.); Nemours Children's Specialty Care, Pensacola (in Pensacola, Fla.); and Nemours Children’s Hospital (in Orlando).
Benchmark: Less than 0.002%, or less than 1 case in 500 injected joints in JIA patients. Intra-articular corticosteroid injections in juvenile idiopathic arthritis. Cleary et al. 2003; 88: 192-196.

Helping Kids Control Pain and Stiffness

Helping Kids Control Pain and Stiffness

Reducing Inflammation Levels in Children With JIA

Children and teens with systemic JIA (sJIA) may have flare-ups of pain and stiffness when more inflammation is present in their bodies. During times of low inflammation, symptoms are much better. So, the sooner we can get inflammation under control, the sooner your child will feel more comfortable.

Blood tests called “erythrocyte sedimentation rate” (ESR) and “C-reactive protein” (CRP) help us get trackable numbers when a child has higher levels of inflammation. We can see if those numbers begin to rise before your child has a flare-up. At Nemours, we can help control your child’s inflammation by:

  • testing your child’s ESR levels every six months
  • using strong anti-inflammatory medication when ESR numbers go up


Patients With sJIA Who Show an Improvement in a Previously Elevated ESR


Nemours, 2016


National average (benchmark)


Data source: Nemours data collected from electronic health records of rheumatology patients at Nemours/Alfred I. duPont Hospital for Children (in Wilmington, Del.); Nemours Children's Specialty Care, Pensacola (in Pensacola, Fla.); and Nemours Children’s Hospital (in Orlando).
Benchmark: Outcomes and Trends of Systemic JIA in German National Pediatric Rheumatology Database 2000-2013. Arthritis Rheumatol 2016 Dec; 60(12)3023-34.

Our Differentiators: What Sets Us Apart

Our Differentiators: What Sets Us Apart

Why Choose Nemours Rheumatology

Rheumatology in children is much different than in adults. Not only are their bodies still growing and changing, but kids have different social and emotional challenges that only a pediatric team can fully address. Here are just some of the reasons families choose Nemours for their children’s rheumatology care:

  • Experienced, highly skilled pediatric rheumatologists. Our specialists are board-certified and fellowship-trained to provide the highest level of medical care for simple to the most complex conditions.
  • Comfortable, efficient visits. Managing diseases like JIA and lupus often requires frequent office visits and blood tests. We recognize that and try to make every experience with us an excellent one.
  • Options to reduce and manage pain for blood draws.
  • Award-winning electronic health records (EHR) system. Our EHR helps us keep all of our providers on the same page. And MyNemours, the parent portal of our EHR, gives you secure access to your child’s records and allows you to communicate by email with your provider(s).
  • Personalized, family-centered care. We treat every child as we would our own, and include you in every decision because we recognize that you know your child best. We work together to address your child’s physical, emotional and social needs at every step.