Why should pediatric rheumatology be recognized as a separate subspecialty: an open letter to medical councils and government agencies

I am writing to you in support of an application of new pediatric rheumatologists in your country to have their subspecialty accredited by your governmental agency or medical council and to receive governmental and university support. I suggest to you that their application should be approved in your country for the sake of children with rheumatic disease.I have five reasons for supporting their application for recognition as a pediatric subspecialty distinct from pediatrics and adult rheumatology:1) Contrary to common belief, there are substantial numbers of children with rheumatic disease in your country and around the world. The best prevalence figures are that 1–4/1000 children and adolescents have chronic arthritis due to juvenile idiopathic arthritis. [1] For example, in a country of 10 million, there are approximately 3 million children; that translates into 5000 to 10,000 children with chronic arthritis diseases including juvenile idiopathic arthritis, lupus, dermatomyositis, sarcoidosis, and others. Where are they? They are there but they are often invisible, flying beneath the radar. They are often misdiagnosed and/or slow to be diagnosed and treated. These diseases do not often kill but they can cause much suffering and disability, especially when not properly diagnosed and treated. The cost to your society and gross national product can be considerable. Yes, there are many competing medical costs for children with malnutrition, diarrhea illnesses, HIV, tuberculosis, severe poverty, and other health challenges. But children with arthritis illnesses also deserve your help.2) There are an inadequate number of pediatric rheumatologists in your country and most countries for patient care. By a recent guideline developed in the United Kingdom, a country such as yours needs one pediatric rheumatologist per 300,000–500,000 population of children just for clinical care. At a current population of 10 million, from all available evidence, your country needs a minim