Physical and Rehabilitation Medicine Modalities in Pediatric Immune-Mediated Rheumatic Diseases: A Narrative Review of Current Evidence and Future Directions

Even when inflammation is controlled, impairments in strength, mobility, physical capacity, and participation may persist in children with immune-mediated rheumatic diseases. This narrative review examines therapeutic interventions relevant to physical and rehabilitation medicine (PRM) in multidisciplinary care. Literature identified through a narrative PubMed/MEDLINE search and examination of reference lists was synthesized by modality. Evidence was most extensive for land-based therapeutic exercise, particularly in juvenile idiopathic arthritis, whereas studies in juvenile dermatomyositis, childhood-onset systemic lupus erythematosus, and childhood-onset Takayasu arteritis were fewer and smaller. Aquatic therapeutic exercise has improved selected measures of pain, fitness, strength, fatigue, or function but has not demonstrated consistent superiority over well-designed land-based therapy. Digital delivery methods have shown potential to support access, feedback, and engagement within goal-directed, appropriately dosed programs. A small number of trials suggest possible adjunctive benefits of photobiomodulation, high-intensity laser therapy, and electromyographic biofeedback, whereas TECAR/CRET should remain investigational because direct evidence in pediatric rheumatic diseases is lacking. Individualized land-based therapeutic exercise should remain the core PRM modality, while aquatic therapeutic exercise may serve as an alternative or transitional option. Future trials should clarify prescription, dose, therapist involvement, adherence, adverse events, growth-plate safety, and participation outcomes.