The concept of “childhood arthritis” includes various rheumatological diseases of the joints, combined into one group. The following types of arthritis in children are distinguished: reactive, rheumatoid, rheumatic, post-vaccination, etc. The main symptoms of the disease are joint pain, stiffness of movement, limping gait, swelling and swelling.
Childhood arthritis belongs to the group of rheumatological diseases. The disease is accompanied by the development of inflammation in all elements of both large and small joints . According to medical statistics, every 1000th child suffers from this joint disease. The first symptoms of arthritis in children appear between the ages of one and four years, and it is during this period that in most cases the disease is diagnosed .
Childhood arthritis is a fairly general and collective medical term. What kind of disease is “arthritis in a child”? This concept includes a certain group of diseases with different patterns of development and nature of occurrence, but necessarily occurring with articular syndrome, inflammatory damage to the elements of the joint .
Depending on the etiology, arthritis in children is divided into the following types:
Arthritis in children can affect both the joints of the hands and the interphalangeal joints of the fingers.
In the first years of a child’s life, diagnosing arthritis is quite difficult. This is due to the fact that young children are not able to adequately assess and characterize the state of their health . They do not always complain of pain and may not talk about how they feel unwell. Babies show discomfort in different ways - they may refuse to eat, sleep poorly, be capricious, worry, cry, etc.
Important! Most often, arthritis in a child is indicated by stiffness of movement and a limping gait. It seems that the baby does not want to walk and refuses unnecessary body movements.
Children may also have the following symptoms:
Some types of arthritis have additional symptoms, for example, reactive arthritis can be accompanied by urethritis, diarrhea, the development of infectious eye diseases, scleritis, fever, muscle wasting, etc.
In mobile, active children of school age, cases of post-traumatic arthritis of the knee joint occur.
Since arthritis in children occurs with various symptoms, the diagnostic process usually involves doctors of various specializations - pediatricians, rheumatologists, infectious disease specialists, etc. The child is examined, examined, parents are interviewed, and a complete medical history is collected.
Important! To diagnose arthritis, doctors must take into account the relationship between the patient’s condition and past infectious diseases, rheumatism, hereditary predisposition, etc.
Basic diagnostic methods:
Important! If arthritis is suspected, the child does not need to undergo all of the above procedures. Often, an ultrasound, x-ray of the affected joint and a blood test are sufficient to establish a diagnosis.
Immobilization of the inflamed wrist joint in a child
Treatment of arthritis in children begins with providing complete rest to the affected joint. Sick children are prescribed bed rest, immobilization of unhealthy joints using a bandage, plaster, splint or corset .
Depending on the type and cause of arthritis, children are prescribed non-steroidal anti-inflammatory drugs, antibiotics, painkillers, glucocorticosteroids, immunomodulators, etc. If necessary, the young patient is given intra-articular hormonal drugs, lavage (washing the cavity) of the joint or flow-through drainage is performed.
The next step in treating arthritis in children is physical therapy. Ultrasound treatment, massage, electrophoresis, mud therapy, water procedures, etc. effectively fight the disease.
Surgical treatment of arthritis in children is used as a last resort - when conservative therapy does not bring positive results, or in advanced cases, for example, with ankylosis. Such patients undergo arthroplasty, joint replacement, synovectomy and other operations.
Regular examinations of a healthy baby by a pediatrician also prevent the development of arthritis
Preventing the development of arthritis in a child is the main goal of preventive measures that parents should carry out and monitor. It is necessary to monitor the health of your baby from birth, treat infectious diseases and possible complications in a timely manner. Doctors recommend undergoing medical examinations and medical examinations several times a year, and being observed by a pediatrician, neurologist, ophthalmologist, etc.
A balanced diet, adherence to a daily routine, moderate physical activity, sports and walks in the fresh air are the main components of a child’s healthy lifestyle without arthritis and other diseases.
Co-author of the material: Dmitry Ulyanov is an orthopedist-rheumatologist with 22 years of experience, a doctor of the first category. Engaged in the diagnosis, treatment and prevention of all diseases of the joints and connective tissue. He has a diploma in Rheumatology and studied at the Peoples' Friendship University of Russia.
Arthritis is an infectious inflammation of a joint or group of joints, characterized by redness, pain, swelling and impaired (up to complete loss) mobility. The most common causes of the appearance are considered to be joint damage, previous infectious diseases, and problems with the immune system. Arthritis in children has no age restrictions. Recognition of the disease is carried out through fluoroscopy and computed tomography. A blood test is necessary to check C-reactive protein and antibodies. It will also help determine the status of rheumatoid factor. It is important that treatment can only be prescribed based on why the disease appeared.
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General signs of arthritis in infants and preschoolers are presented below in the comparative table.
In schoolchildren, the signs of various types of arthritis correspond to its manifestations in adults.
The disease occurs 2-3 weeks after treatment of infections, which often occurs due to weakened immunity.
Reactive arthritis in children is treated with anti-inflammatory non-steroids. The most important principles of treatment:
Treatment of reactive arthritis in children lasts from 2-3 weeks to a year. With a mild course, the symptoms begin to disappear within 2-3 days after the start of treatment measures. Arthritis does not cause irreversible consequences. Treatment should be carried out as effectively as possible to avoid relapse.
It is not difficult to completely restore JOINTS! The most important thing is to rub this into the sore spot 2-3 times a day.
The disease develops 2-3 weeks after treatment of an infection caused by streptococcus (sore throat, pharyngitis or scarlet fever). Most often, arthritis in children first appears at the age of 5-15 years.
Rheumatoid arthritis in children requires taking medications that relieve inflammation and strict bed rest, not only during the rise in temperature, but also after its level has normalized for another month.
The disease does not destroy the joints themselves, so after successful treatment, former mobility returns. However, childhood rheumatoid arthritis can cause the defect.
Children under three years of age are most susceptible to this disease, although every child has the possibility of being affected. Septic (as it is also called) arthritis in children develops due to fungi, viruses or bacteria entering the body. Most often this occurs due to infection of a specific area of the skin. It can also be dysentery, botulism or salmonellosis, gonorrhea (hereditary infection). This type of arthritis is considered a more serious condition than those listed above.
How is it recognized?
Infectious-allergic arthritis in children, if not properly treated, can be fatal. What is needed to avoid this?
Timely detection of infectious allergic arthritis in children and initiation of therapy will prevent complications from occurring. Most often, after recovery, the child regains normal mobility.
This is a chronic inflammation, the causes of which are unknown to science. This arthritis is also called ankylosing spondylitis.
Prolonged illness can lead to partial deformation (sometimes destruction) of the joints, resulting in disability.
Juvenile rheumatoid arthritis, like the type of arthritis described above, is chronic, and the causes of its occurrence are unknown. Although the first attacks occur in adolescents, they are more likely to occur in children 1–4 years of age.
Most often, after recovery, the child returns to normal life. Long-term illness can lead to deformation and destruction of joints, loss of mobility and disability.
As in adults, in young patients arthritis makes itself felt by the following characteristic signs:
To confirm the presence of arthritis, various laboratory tests are performed, including: ultrasound, radiographic examination methods, as well as MRI and CT.
Medicinal and physiotherapeutic techniques, massages, etc. are used for treatment.
According to average statistical data, signs of arthritis are diagnosed in every thousand children. If not detected in a timely manner and without proper treatment, the disease can rapidly progress, leading to disability in children - patients lose the ability to carry out simple self-care activities and cannot lead an independent life.
There are many types of arthritis. We will talk about the most commonly diagnosed of them. Detailed information about the most common forms of the disease is given in the table.
Table. Common forms of childhood arthritis
Let's consider the causes of arthritis in young patients in accordance with the already familiar classification.
In response to external stimuli, the child’s body begins to produce IgG. The immune system regards them as autoantigens and gives the command to produce antibodies. The interaction of these two substances provokes the formation of complexes that cause significant damage to the joint membranes and other tissues. As a result, an inadequate immune response leads to the emergence of chronic progressive pathology in the form of juvenile rheumatoid arthritis.
The following points should be noted as additional provoking factors that increase the risk of arthritis:
Following the already familiar classification, we present the signs of the disease in question in the form of several subparagraphs.
In the case of articular damage, one or several (in most situations symmetrically) joints are involved in the process. The affected areas become painful, hot and swollen. More often the disease affects large joints, for example, the wrist or knee. Much less often, pathology affects small joints.
Stiffness is noted in the morning, and gait may change. If the leg joints are involved in the process, patients under 2-3 years of age may completely lose the ability to walk. As the disease worsens, the temperature rises.
Often the patient’s condition is complicated by skin rashes, abnormalities in the size of the spleen and liver, uveitis and other pathologies.
In the case of the systemic form, the following symptoms appear:
Anemia may develop, as well as myocarditis, pleurisy, etc.
As the disease progresses, deformation processes in the area of the affected joints with limitation of their mobility are diagnosed. In accordance with average statistical data, juvenile rheumatoid arthritis leads to disability in approximately a quarter of all cases.
Accompanied by articular syndrome in combination with signs of the general and extra-articular type. The process most often involves the knee joints, as well as the joints of the toes. Significantly less often, pathology is diagnosed in the area of the ankle and hip joints, as well as the sternocostal, pubic and joints of the upper extremities.
The process is often accompanied by spinal rigidity, enthesopathy and other complications.
As for extra-articular symptoms, in most situations it includes the following manifestations:
The presence of ankylosis of the intervertebral joints and pathologies of the hip joints in many situations leads to disability of the patient.
Signs of such arthritis make themselves felt during the first month after infections affecting the genitourinary system and/or gastrointestinal tract. The joints become painful and swollen. The skin over the affected areas turns red and becomes hot to the touch. Bursitis, enthesopathies and other complications may develop.
In combination with articular lesions, various extra-articular signs may develop, namely:
Common manifestations of the reactive form of the pathology include, first of all, fever, as well as anemia and muscle wasting.
Typically, reactive arthritis, subject to timely and proper treatment, can be completely eliminated. If appropriate therapeutic measures are not taken, complications may develop in the form of polyneuritis, amyloidosis, etc.
Arthritis of a bacterial nature is characterized by acute development of symptoms. The patient's general condition is rapidly deteriorating.
The following symptoms are associated:
The patient has to hold the affected areas in a position in which the severity of pain decreases.
Viral arthritis is mostly reversible. The characteristics of their manifestation depend on the causative agent of the disease. For example, in the presence of tuberculous arthritis, the patient develops a fever, the skin becomes pale and swollen, and fistulas may form.
Children's arthritis is characterized by a complex course with many accompanying symptoms, which forces the involvement of several specialists in the diagnostic process, namely: a pediatrician, rheumatologist, cardiologist, as well as a nephrologist, dermatologist, ophthalmologist, etc. When studying the patient’s condition, doctors always pay attention to the previous the diseases he suffered and the order of their course.
The main methods of instrumental diagnostics are ultrasound, as well as CT and MRI. Among the most characteristic signs of childhood arthritis, one can note, first of all, a decrease in joint spaces and bone erosion, as well as manifestations of osteoporosis and ankylosis of the affected joint.
The list of laboratory tests includes the following checks:
An important component of the diagnostic process is puncture of the joint in order to subsequently study the state of its internal fluid.
The presence of a tuberculous form of the disease will be indicated by X-ray examinations of the chest, the results of the Mantoux reaction and other related techniques.
In order to exclude or confirm the presence of cardiac pathologies, a specialist may refer the child for examinations such as echocardiography and ECG.
Treatment is carried out comprehensively and includes drug therapy, appropriate physiotherapy, mechanotherapy, massages, etc. During exacerbations, medications are prescribed to suppress the manifestations of the disease.
The most commonly used means of local treatment are intra-articular injections, the use of corsets and devices to limit joint mobility.
Arthritis of the infectious and reactive groups is treated with symptomatic, pathogenetic, and etiotropic therapy. The treating specialist selects medications for a particular patient, taking into account the individual characteristics of the course of the disease.
To improve the patient's physical condition, visits to the pool, cycling, and regular spa treatment may be recommended.
Respond in a timely manner to unfavorable changes in your children’s health, follow medical recommendations and everything will be fine!
Most often, the cause of childhood gonarthritis is pathological conditions of infectious origin, in other words, children get sick after an infection. Moreover, the difficulty of diagnosis lies in the vagueness of clinical manifestations. External symptoms may be absent for a long time, although a biochemical blood test can easily reveal the presence of inflammatory processes.
There are other factors that predispose to the development of gonarthritis in children:
The clinical picture of childhood gonarthritis is determined by the etiology of the inflammatory process, and also depends on the form of the disease. Chronic forms of knee arthritis develop gradually and occur with mild symptoms. And acute ones begin suddenly and develop rapidly, characterized by a more severe course of the disease. Experts have identified a group of symptoms characteristic of all pathological forms and varieties:
Pain and swelling are especially noticeable in the morning.
There are several types of gonarthritis that occur in childhood:
This type of joint inflammation is caused by bacterial origin as a result of a previous illness and can develop as a complication against the background of frequent colds. Symptomatic manifestations such as local hyperemia and swelling occur only as the disease progresses. And the characteristic pain symptoms are disturbing at first only in the morning hours. The child has a deterioration in his general condition, with fever, weakness and headaches.
Acute infectious gonarthritis occurs rapidly in children, is reversible and ends in 7-14 days.
This arthritic form is often found in school-age patients, which is caused by their maximum physical activity. The disease develops as a result of joint injuries, which have a destructive effect on cartilage tissue, which leads to limited range of motion and severe pain.
This form of pathology is systemic in nature and is accompanied by joint pain, high fever, allergic rashes, enlarged lymph nodes, etc.
This type of arthritis develops due to autoimmune disorders and exposure to staphylococcal pathogens. For pediatric patients, a similar form of pathology often develops after a sore throat, in the presence of thyroid pathologies or a tendency to allergies. This pathological form is characterized by a symmetrical lesion.
It is often diagnosed in children, representing joint inflammation caused by immune disorders caused by damage to the gastrointestinal tract or genitourinary system. The lesions are asymmetrical and are often accompanied by unusual symptoms such as cystitis or diarrhea. The complex of therapeutic measures requires additional antibiotic therapy with broad-spectrum drugs, as well as the use of immunomodulators.
For childhood gonarthritis, the basis of treatment is NSAIDs, but since their long-term use leads to gastric pathologies, they are prescribed in relatively short courses. To more quickly eliminate pain symptoms, injections of corticosteroid drugs are prescribed.
In severe forms of gonarthritis, the application of a special splint is indicated to immobilize the joint, thus preventing pain.
In addition to drug treatment, exercise therapy and massage are indicated. Ointment preparations are used for local treatment, and the use of chondroprotectors prevents subsequent cartilage destruction. To ease the course of the pathology, it is recommended to wear special insoles and orthopedic shoes, which will help support the legs and prevent the development of joint fusion.
Doctors call arthritis a disease of inflammatory nature, during which the inner membranes of the joints are affected. It can occur in acute and chronic form, is characterized by a slow progressive course and without appropriate treatment can lead to disability of the patient.
The exact causes of the development of this disease are not reliably known, but most scientists are inclined to the immunogenetic theory of its occurrence, according to which arthritis develops against the background of a genetic disorder of the immune system. In addition, the following factors can lead to inflammatory damage to joint tissue:
The following types of arthritis occur in children:
It is also worth mentioning that there is polyarthritis, characterized by inflammation of two or more joints at once, and monoarthritis, in which the knee or hip joint is most often affected.
Almost nothing can be said about the pathogenesis of the disease, due to the lack of information about the exact causes of its development, but the mechanism of development of juvenile rheumatoid arthritis in children is based on autoimmune disorders. When conducting research in the body of a child with this diagnosis, an increased content of autoantibodies was discovered, which are capable of forming immunocomplexes that damage the synovial membrane of the joints.
Symptoms of the development of arthritis in a child depend on its type, but it is worth saying that the main signs of the development of the disease include:
Scientists noted that rheumatoid arthritis in children is characterized by symmetrical damage to articular tissue on the right and left sides of the body. This is the main symptom of the disease and is used to make a primary diagnosis.
Separately, it is worth mentioning that in children there is a disease such as neuro-arthritic diathesis, which is also sometimes called gouty arthritis. In fact, diathesis is not a disease, but a condition of the child’s body, which is transmitted by heredity and is characterized by a predisposition to the development of certain diseases of an allergic, infectious, inflammatory or nervous nature.
A neuro-arthritic diathesis is a condition of the body in which a child has a genetic metabolic disorder, which manifests itself against the background of excessive excitability of the nervous system. It would be more logical to classify a diathesis of a neuro-arthritic nature as a group of metabolic diseases, but the difficulty lies in the fact that the main symptoms of its manifestation include damage to the joints (in most cases, the hip).
This type of diathesis occurs in only 2% of patients, but it is very difficult to begin its timely treatment. In infants, its diagnosis is very difficult, because the full clinical picture of the disease appears only at school age. The main symptoms of its development (except for joint pain) include:
Doctors say that neuro-arthritic diathesis, which occurs in children under 18 years of age, is a collective concept that includes various undiagnosed (often hereditary) metabolic disorders. For this reason, it is almost impossible to cure such a diathesis, so doctors treat those diseases that arise against its background.
Diagnosing arthritis in children under 16 years of age is very difficult because it can manifest differently in each patient. The main thing is that at the very first symptoms of its manifestation it is necessary to consult a doctor, since the sooner he makes a diagnosis and prescribes appropriate treatment, the greater the chance that the prognosis of therapy will be favorable.
The main diagnostic methods include:
Arthritis is classified depending on the etiological reasons that triggered the onset of the disease. The most common types of arthropathy observed in children are:
The most common type of inflammatory arthropathy, recorded in 87 patients out of 100,000 children. This non-purulent inflammatory form develops in the vast majority of cases as a result of acute or persistent (latent) infections entering the child’s body.
The bulk are intestinal or urogenital bacterial infections caused by the Enterobacteriaceae family of bacilli and obligate intracellular parasites of the Chlamydia class. In isolated cases, the cause of reactive arthritis is infection of the respiratory tract.
At risk are children who have a genetic predisposition to chronic infection due to an insufficient immune response, the so-called carriers of the histocompatibility antigen HLA-B 27.
It develops against the background of penetration of pathogenic agents into the joint cavity during open trauma to the joint, during surgery or puncture. Most often, the culprits of the disease in young children under 5 years of age are gram-negative bacteria, staphylococci and Haemophilus influenzae. The causative agents of infectious arthritis in school-age children are streptococci, gonococci, and staphylococci.
Symptoms of the disease appear in children after a short period of time after a viral attack on the body of the parvovirus family, the causative agents of rubella, mumps, and hepatitis B.
The chronic form of infectious arthritis is characteristic of exposure to pathogenic fungi and Koch's bacillus (the causative agent of tuberculosis).
A clear cause of juvenile arthritis has not been established. Most doctors attribute this pathology to autoimmune malfunctions, due to which the child’s immune system begins to attack the body’s own cells.
Juvenile rheumatoid arthritis manifests itself in the age group up to 16 years with an average frequency of five patients per thousand inhabitants. According to statistics, this progressive disease occurs more often in girls. Moreover, the later the symptoms of arthropathy appear, the more complex the course of the disease and the more difficult the treatment.
If treatment is untimely, incorrectly carried out, inconsistent or not comprehensive, juvenile rheumatoid arthritis can cause disability in a child.
Several classifications of pathology are used in the medical environment:
A dangerous type of juvenile rheumatoid type of inflammatory arthropathy is juvenile systemic rheumatoid arthritis (Still's disease).
The inflammatory process in the joints in children can be provoked by a variety of allergens, to the action of which an abnormal reaction of the body occurs. Among the provocateurs:
Very often, the cause of allergic arthritis in a child under one year of age or older is a reaction to the administration of vaccination medications according to the vaccination schedule.
In children, due to an imperfect immune system, symptoms of chronic inflammatory joint damage may intensify when exposed to conditioned allergens, for example: critically low ambient temperatures.
This type can develop in children due to the special sensitivity of the incompletely formed musculoskeletal system to mechanical influences. Arthritis occurs several weeks or months after bone fractures, soft tissue bruises, joint dislocations, damage to the ligamentous-capsular apparatus, sprains and ruptures of ligaments.
The reason for the development of the inflammatory process: rupture of capillaries and veins in the injured area, which provokes an intense response of the body to the violation of the integrity of its own tissues. If inflammation develops without the presence of a microbial agent, then post-traumatic arthritis is called aseptic. With open injuries, tissue infection and the development of acute septic (purulent) arthritis are possible.
Childhood arthritis manifests itself in a variety of clinical symptoms, different for a specific type of disease, but there are also general manifestations of the disease.
The main symptom of arthritis in a child is pain in the affected joint. The pain can be of a different nature, manifesting itself as a pulling, aching sensation, often radiating in the form of tingling into the muscles of the nearest anatomical parts of the body. In the chronic form, the pain is not intense, but with the acute development of the disease, arthralgia can be very strong and does not stop with rest.
Quite often, in children in the first years of life, the only symptom of discomfort is a change in the baby’s behavior. The baby becomes restless and capricious, cannot stay in one place, and communicates pain by crying loudly. Older children can point out to their parents the area where arthralgia occurs.
At the first stage of the disease, the child complains of a feeling of stiffness and says that it is difficult for him to perform certain movements. As arthropathy progresses, the baby refuses to carry out active movements of the affected limb, preferring to place the arm or leg in a position in which the discomfort will be less intense.
In the flowering phase of the disease or in the acute form of inflammation, the pathological process is indicated by the following symptoms:
A small child becomes lethargic and apathetic. He refuses to play the usual active games. The little one does not want to jump or run, and often asks his parents to pick him up. If the joints of the legs are damaged, it is difficult for the baby to sit on the potty independently, when the joints of the upper limbs are affected - the baby has difficulty lifting and holding a spoon or cup.
He may have problems sleeping: difficulty falling asleep, frequent awakenings at night. In some cases, the baby does not allow you to touch his body or change his underwear, because even a very gentle touch brings excruciating discomfort.
If the joints of the lower extremities are damaged, the first morning steps are difficult for the baby. Lameness when walking is also visually noticeable. With some types of arthritis, a characteristic rash appears on the skin: unlike other skin rashes, it does not itch and disappears on its own.
Symptoms of intoxication of the body caused by the activity of harmful bacteria are:
In the last stages of the disease, symptoms of skeletal muscle atrophy are observed: the muscles on the damaged limb lose their volume, they feel flabby rather than elastic to the touch.
The clinic of childhood arthritis can be divided into three aspects:
In the case of acute arthritis, it is necessary to treat the child in an inpatient department, where there are conditions for conducting detailed diagnostic studies.
The primary task after determining the diagnosis is to ensure immobilization of the injured joint, giving the joint the correct physiological position using special orthopedic devices. Carrying out this medical manipulation presents some difficulty in children of the first years of life due to their natural age-related activity and lack of ability to consciously limit their movements.
For information! The right way out in this situation is to offer him exciting activities that do not involve physical activity during the baby’s waking hours. Parents staying in the hospital with a child, staff psychologists should help the baby adapt to forced immobility and prevent a deterioration in the psychological state.
An equally difficult and important task for arthrologists is to choose a program of drug therapy, since most of the drugs traditionally used in the arthritis clinic cannot be used until a certain age is reached. Therefore, if the condition of a tiny patient allows, preference should be given to homeopathic medicines that have a minimum of side effects.
Etiotropic treatment of reactive and infectious arthritis involves the use of antibacterial drugs to which the causative agent of inflammation is sensitive.
Attention! The choice of antibiotics is the prerogative of the attending physician after a thorough study of the medical history, comparing the benefits and threats of the prescribed medication.
It is advisable to include immunomodulatory drugs in the treatment of chronic forms of arthritis (with the exception of rheumatoid types of disease). In pediatric practice, agents of a polypeptide nature, for example: tactivin (Tactivinum), are often used between the ages of 6 months and 14 years.
In order to get rid of pain, non-steroidal anti-inflammatory drugs can be used in children. Most pediatricians do not prescribe drugs from this group to children under 1 year of age. In case of severe pain, children after 1 year of age are prescribed, under the supervision of a doctor, to take propionic acid derivatives, for example: naproxen (Naproxenum) in a dose calculated depending on the child’s body weight.
In critical situations, the Ministry of Health has authorized the use of glucocorticosteroids mainly by intra-articular injection. If necessary, children over 12 years of age are given methylprednisolone (Methylprednisolonum).
For rheumatoid arthritis, a different treatment regimen is used, including non-steroidal anti-inflammatory drugs and immunosuppressive drugs.
The following steps will help ease the condition of a child suffering from arthritis.
Step 1. We create the right diet for the child. The daily menu includes fresh fruits and vegetables, sea fish, and cereal porridges. We limit deli meats and culinary sweets. We exclude carbonated drinks and products containing preservatives.
Step 2. We introduce the child to an active lifestyle. During the period of remission, we take walks in the fresh air every day.
Step 3. Together with your baby, we perform specially selected exercises for joint health every day.
Step 4. Water procedures can improve the functions of the immune system: contrast showers, swimming in the pool, swimming in open water in the summer.
Step 5. Dress the baby according to weather conditions. We do not allow the baby's body to become hypothermic.
Step 6. If allergic arthritis is suspected, we exclude the possibility of exposure to allergens.
Step 7. At the first symptoms of illness, we seek qualified medical help.