Reactive arthritis is an inflammation of the joints that occurs several weeks after an infectious disease.
Since children, due to the characteristics of their immunity, are more susceptible to infections, reactive arthritis is the most common inflammatory disease of the joints among them.
They can occur especially often after an intestinal infection or inflammation of the urinary tract. Usually the disease is associated with enterobacteria (yersiniosis, salmonellosis, dysentery and others), inflammation of the urinary tract associated with chlamydia (cystitis or urethritis). Less commonly, reactive arthritis occurs after damage to the respiratory tract caused by mycoplasma or chlamydia (atypical pneumonia), parasitic diseases.
Since the frequency of infectious diseases is higher in the autumn-winter period, reactive arthritis is more common at this time.
Now many doctors understand the term reactive arthritis much more broadly, including also joint damage that occurs after viral infections, after preventive vaccinations (post-vaccination arthritis), allergic reactions and some others.
The disease is more common in teenage boys.
The reasons for the development of reactive arthritis in a child are associated with impaired immune response. The term “reactive” itself means the absence of pathogenic microorganisms in the joint environment, therefore the disease is classified as a group of seronegative spondyloarthritis. However, during illness, circulating bacterial antigens, fragments of microorganisms and other signs of ongoing immunological reactions can be detected in the blood serum and joint fluid.
Great importance in the occurrence of reactive arthritis is attributed to a hereditary factor, namely the presence of the HLA-B27 molecule. It has a similar structure to the cell wall of some microorganisms, so its own antibodies mistake it for a foreign structure. This leads to damage to the tissues of the body, as well as disruption of the normal immune response (sluggish and chronic infections are formed).
Provoking factors for the occurrence of reactive arthritis in children are also:
The main symptoms of reactive arthritis in a child include:
The duration of reactive arthritis ranges from several weeks to a year. In mild forms of the disease, improvement is noted within a few days after the start of therapy.
Often during reactive arthritis, eye damage may occur, manifested by tearing, redness, and photophobia. Possible involvement of the urinary tract. Arthritis, conjunctivitis and urethritis are classic symptoms of Reiter's disease.
Reactive arthritis may be accompanied by keratoderma, which is a painless keratinization of the skin with rashes in the form of papules and plaques, most often on the plantar part of the feet and palms. Damage to the nails (usually on the toes) is possible in the form of yellow discoloration, peeling and destruction of the nail. The mucous membranes of the oral cavity (stomatitis), the heart (pericarditis, myocarditis), the peripheral nervous system (polyneuritis), the kidneys (glomerulonephritis), and the lymph nodes (especially inguinal) may become inflamed.
In young children who cannot yet complain of joint pain, you need to pay attention to the following signs:
There are special criteria according to which reactive arthritis can be diagnosed:
If you suspect arthritis in a child or adult, you should consult a doctor. A qualified specialist will carry out the necessary diagnostic procedures to determine the cause of the disease and prescribe treatment.
Based on the examination, the doctor will identify characteristic signs of inflammation of the joint, note the connection with a previous infectious disease, and refer you to another specialist if necessary (for example, to an ophthalmologist to exclude eye damage).
Diagnosis of arthritis is carried out in a specialized department of the hospital. To confirm the reactive nature of the disease, it is necessary to identify the pathogen that caused the disease or the presence of antibodies to it.
Depending on the nature of the symptoms present, auxiliary diagnostic procedures may be prescribed.
Therapy for reactive arthritis is complex and is carried out in a specialized department of the hospital.
Medicines can be etiotropic (directed against the causative agent of the infection), pathogenetic (their action affects the mechanism of development of the disease) and symptomatic (relieves the symptoms of the disease). The following medications are prescribed:
Medicines can be given intramuscularly, intravenously, orally, or injected into a joint. The dosage of medications, the specifics of their administration, and the duration of therapy are determined by the doctor depending on the nature of the disease and the age of the child.
All medications in children are used with caution, so therapy should be carried out under the supervision of a specialist. Experimenting with treatment on your own is prohibited.
When the inflammatory process in the joint subsides, physical therapy, massage, and possibly sanatorium treatment are prescribed.
In most patients, the disease ends in complete recovery. As a rule, reactive arthritis goes away without a trace, leaving no pathological changes in the joint. However, with repeated infectious disease, arthritis may recur.
After an illness, follow-up with a rheumatologist is necessary.
The likely outcome of chronic and often relapsing reactive arthritis is juvenile spondyloarthritis. It occurs in patients who carry the HLA-B27 molecule, most often in teenage boys. The articular syndrome in this disease is similar to reactive arthritis, but radiography can detect unilateral or bilateral sacroiliitis.
Unfavorable outcomes of the disease are possible in patients with concomitant heart damage (myocarditis, pericarditis, endocarditis and their combinations).
The only possible measures to prevent reactive arthritis are timely detection and treatment of infectious diseases, compliance with specialist recommendations and refusal of self-medication, and maintaining a healthy lifestyle. This is especially true for persons with a hereditary predisposition to rheumatic processes.
The number of cases of reactive arthritis in children has increased sharply in recent years. Joint inflammation is considered to be reactive if it does not develop independently, but due to some infection of the body caused by microbes or viruses. In first place is chlamydial infection of the genitourinary tract, in second place - intestinal diseases. In response to microorganisms, the child produces protective complexes - antibodies, and they damage the body's own cells. Infectious diseases are contagious; a child can receive the pathogen through airborne droplets, airborne dust, or contact. The state of the macroorganism, such as decreased immunity and concomitant pathologies, plays a major role in the occurrence of arthritis. Children with the presence of the HLA B27 gene in the genotype are at risk, i.e. this disease is hereditary. Reactive arthritis is dangerous due to its complications affecting the joints (loss of their mobility) and damage to the heart. Signs of reactive joint inflammation can easily be mistaken for the onset of a severe systemic disease, and vice versa.
At home, one can suspect reactive arthritis if inflammation of the joint was preceded by any infectious disease, and also judging by the characteristic clinical picture described above. Next, you should show the child to the doctor without starting any treatment on your own, because an accurate diagnosis of reactive arthritis is made only after tests and instrumental studies. All children with suspected reactive arthritis should be referred to a rheumatologist.
You should consult a doctor immediately if:
There is no specific prevention for reactive arthritis. Disease prevention measures include:
If signs of reactive arthritis appear, you should not self-medicate; you should consult a doctor early.
If swelling and pain appear in the joint, the child should be shown to a rheumatologist, since such symptoms can be observed in various diseases. If the eyes and urethra are simultaneously affected, you should consult an ophthalmologist and urologist.
In recent years, rheumatologists have increasingly encountered reactive arthritis in children. This problem is gradually coming to the fore, since inflammatory processes in the joints, manifested against the background of an infection in the digestive tract and urinary tract, are diagnosed by pediatricians quite often.
The second name of the disease is reactive arthropathy. Note that this is a whole group of diseases that combine inflammatory lesions of the joints (non-purulent), which progress due to immune disorders resulting from urogenital or intestinal infections.
Reactive arthritis is a very common disease. Out of 100 thousand children, almost 87 people will suffer from it. Young men and teenage boys are at risk. Sometimes the lesion is based on a genetic predisposition. For example, the likelihood of psoriatic arthropathy is much higher in children whose relatives are susceptible to psoriasis.
It is important to understand that we are talking about a secondary lesion, since the disease develops against the background of other pathologies. The infection affects the elbow and knee joints, ankles, hands and various parts of the spine. We list some types of reactive arthritis found in children:
The list of ailments can be continued, but this is the topic of a separate article.
We have already found out that this group of diseases is based on infectious lesions. On numerous forums they write about pathogens such as:
Scientists explain the frequency of reactive arthritis by the fact that some patients have increased sensitivity (due to a genetic factor) to individual fragments of pathogen cells.
The most common chlamydial infection. Children can become infected with chlamydia through contact with animals (birds, dogs, cats) and strangers.
Main routes of infection:
The second position in the frequency of damage to a healthy child's body is occupied by intestinal microorganisms (Salmonella, Yersinia, Campylobacter, Shigella).
There are the following symptoms to identify reactive arthritis:
Usually the illness is short-lived. However, there are exceptions in the form of chronic arthritis, which requires long-term and not always effective treatment.
If you have the above symptoms and suspect an infection, you should immediately consult a doctor and get laboratory confirmation of the diagnosis. The doctor must identify the cause of the development of oligo- and monoarthritis. There are certain exclusion criteria:
Etiological diagnosis is also used, including the following set of methods:
When diagnosed with “reactive arthropathy”, complex treatment is used, which can be divided into three components:
Treatment with folk remedies has recently become widespread. These are mainly compresses and ointments that do not eliminate the cause of the disease, but alleviate the patient’s suffering. Let's go over the most popular medications that do not require a doctor's prescription.
Health to your child!
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One of the pressing problems of modern pediatrics is the diagnosis and treatment of inflammatory joint diseases. The most common rheumatic disease of childhood is reactive arthritis (ReA), which occurs
One of the pressing problems of modern pediatrics is the diagnosis and treatment of inflammatory joint diseases. The most common rheumatic disease of childhood is reactive arthritis (ReA), which occurs in 86.9 per 100,000 children [1].
The term “ reactive arthritis ” was introduced into the literature in the early 70s of the twentieth century. Finnish scientists K. Aho and R. Ahvonen to designate arthritis that developed after a yersinia infection. At the same time, the “reactive”, sterile nature of arthritis was emphasized. As diagnostic methods improved, the concept of “sterility” of synovitis in ReA became relative. The discovery of circulating bacterial antigens and microbial DNA and RNA fragments in the serum and synovial fluid of patients with ReA gave impetus to the formation of fundamentally new views on ReA [2, 3, 4, 5]. Until recently, ReA meant any inflammatory disease of the joints associated with a current or past infection.
Currently, ReA includes inflammatory non-purulent diseases of the joints that develop as a result of immune disorders, after an intestinal or urogenital infection. In the vast majority of cases, ReA is associated with acute or persistent intestinal infection caused by enterobacteria ( Yersinia enterocolitica, Yersinia pseudotuberculosis, Salmonella enteritidis, Salmonella typhimurium, Shigella flexneri, Shigella sonnei, Shigella Newcastle, Campylobacter jejuni ), and with acute or persistent urogenital infection caused by oh Chlamydia trachomatis . Respiratory tract infections associated with Mycoplasma pneumoniae, and especially Chlamydophila pneumonia , can also cause the development of ReA. There is also evidence of an association between ReA and intestinal infections caused by Clostridium difficile and some parasitic infections.
ReA, associated with intestinal infection and infection caused by Chlamydia trachomatis , develops predominantly in genetically predisposed individuals (HLA-B27 carriers) and belongs to the group of seronegative spondyloarthritis [2, 3, 6]. Antibodies to a number of microorganisms have been found to cross-react with HLA-B27. This is explained by the phenomenon of molecular mimicry, according to which the cell wall proteins of a number of intestinal bacteria and chlamydia are structurally similar to certain parts of the HLA-B27 molecule. It is assumed that cross-reacting antibodies can have a damaging effect on the body's own cells, which most express HLA-B27 molecules. However, it is believed that such cross-reaction may interfere with the implementation of an adequate immune response, contributing to the persistence and chronicity of the infection. There is evidence that carriers of HLA-B27, after an intestinal and urogenital infection, develop ReA 50 times more often than in individuals who do not have this histocompatibility antigen.
The diagnosis of ReA is made in accordance with the following diagnostic criteria adopted at the III International Meeting on ReA in Berlin in 1996 [7].
– Oligoarthritis (affects up to 4 joints).
– Predominant damage to the joints of the legs.
– Time of onset: 2–4 weeks before arthritis develops.
– Not necessary, but recommended if there are clinical signs of infection.
– Mandatory, in the absence of obvious clinical manifestations of infection.
However, in real practice, the term ReA is mistakenly used by rheumatologists much more widely and includes arthritis after a viral infection, post-vaccination arthritis, post-streptococcal arthritis and some others.
Currently, one of the most common causes of ReA development is chlamydial infection.
In the structure of ReA, chlamydial arthritis accounts for up to 80% [8, 9, 10]. This is due to the chlamydia pandemic in the world, the characteristics of the transmission routes of chlamydial infection, the development cycle of chlamydia and the response to therapy. Susceptibility to chlamydia is universal; there are many ways of transmission of infection, including contact and household routes (in relation to Chlamydia pneumonia). The trigger role of intestinal infection in the development of ReA also remains relevant.
The classic manifestation of ReA is Reiter's disease or urethro-oculo-synovial syndrome, first described by Benjamin Brody and then by Hans Reiter, under whose name the syndrome entered medicine. Reiter's disease is currently considered a special form of ReA and is characterized by a classic triad of clinical symptoms: urethritis, conjunctivitis, arthritis. In the presence of keratoderma, they speak of tetralogy of Reiter's disease. Reiter's syndrome most often begins with symptoms of damage to the urogenital tract 2-4 weeks after an infection or suspected infection with chlamydia or intestinal bacteria. In Reiter's syndrome, trigger infectious factors are most often Chlamydia trachomatis, Shigella flexneri 2a, or a combination thereof.
Reiter's syndrome, associated with intestinal infections, begins acutely, with an increase in body temperature to febrile levels, a disturbance in the general condition, and intoxication. The classic symptoms of the triad - conjunctivitis (keratoconjunctivitis), urethritis (cervicitis) - most often precede the development of arthritis. Conjunctivitis is observed in 30–60% of patients and is acute (photophobia, blepharospasm), clinical signs of scleritis (“cat's eye symptom”), keratoconjunctivitis may occur, and in some patients, corneal ulcers form. 12–37% of patients develop uveitis [11]. Urethritis can occur acutely, subacutely; asymptomatic urethritis is often noted, manifested only by sterile pyuria. Articular syndrome in Reiter's disease of shigellosis and yersinia etiology is also characterized by an acute onset [12]. Asymmetric oligoarthritis is characteristic, less often - a polyarticular variant of arthritis. Arthritis occurs with a pronounced pain reaction, joint defiguration (mainly due to exudation into the joint cavity and periarticular swelling of soft tissues), increased local temperature, and hyperemia of the skin over the joint. Often there is severe hyperesthesia of the skin over the affected joint, painful contracture, the patient cannot lean on the leg due to pain. Reiter's disease mainly affects the knee, ankle, and first toe joints, and less commonly, the sacroiliac joint and lumbar spine. The wrist and elbow joints may be involved. Characterized by asymmetrical damage to small joints and periarticular tissues of the hands and feet with severe swelling of the fingers, pain, hyperemia of the skin and the formation of the so-called “sausage-shaped deformity”, which is noted in 5–10% of children. In approximately 50% of patients, asymmetric oligoarthritis is combined with the development of enthesitis and enthesopathies (pain and tenderness on palpation at the sites of attachment of tendons to bones). Most often, enthesopathies are determined along the spinous processes of the vertebrae, the iliac crests, in the places of projection of the sacroiliac joints, in the places of attachment of the Achilles tendon to the tubercle of the calcaneus, as well as in the place of attachment of the plantar aponeurosis to the tubercle of the calcaneus. Patients with ReA experience pain in the heel area (talalgia); pain, stiffness, limited mobility in the cervical and lumbar spine and sacroiliac joints. These clinical symptoms are characteristic of adolescent boys with the presence of HLA-B27. These children have a high risk of developing juvenile spondyloarthritis.
Reiter's disease, associated with chlamydial infection, is characterized by a less severe clinical picture [8, 10]. Damage to the urogenital tract is characterized by blurred clinical picture. Boys may develop balanitis, infected synechiae, and phimosis. In girls, damage to the urogenital tract may be limited to vulvitis, vulvovaginitis, leukocyturia and/or microhematuria, as well as clinical cystitis. Damage to the urogenital tract may precede the development of articular syndrome by several months.
Eye damage is characterized by the development of conjunctivitis: often catarrhal, unexpressed, short-lived, but prone to recurrence. One third of patients may develop acute iridocyclitis, which can lead to blindness. Eye damage may also precede the development of articular syndrome by several months or years.
Exudative arthritis (mono- or oligoarthritis) in Reiter's disease of chlamydial etiology can occur without pain, stiffness, or severe dysfunction, but with a large amount of synovial fluid and continuously relapsing. In this case, joint damage is characterized by a long-term absence of destructive changes, despite recurrent synovitis.
Often ReA occurs without distinct extra-articular manifestations related to the symptom complex of Reiter's syndrome (conjunctivitis, urethritis, keratoderma). In such cases, the leading one is articular syndrome, which is also characterized by predominant damage to the joints of the lower extremities, of an asymmetrical nature. Despite the absence of extra-articular manifestations, these children also have a high risk of developing juvenile spondyloarthritis. The presence of a characteristic articular syndrome, accompanied by severe exudation and associated with a previous intestinal or urogenital infection or with the presence of serological markers of an intestinal or urogenital infection, makes it possible to classify the disease as reactive arthritis with a high degree of probability.
Diagnosis of ReA is based on clinical and anamnestic data, including the presence of a characteristic articular syndrome associated with an infectious process. Due to the fact that the infection preceding the development of ReA is not always pronounced, data from additional laboratory tests become especially important in the diagnostic process. To make an accurate diagnosis, it is necessary to isolate the pathogen that caused the infection and/or detect high titers of antibodies to it in the blood serum. To identify trigger infections, various microbiological, immunological and molecular biological methods are used. Etiological diagnosis includes the following.
1.1. Detection of chlamydia antigen in epithelial cells obtained as a result of scrapings from the urethra and conjunctiva, as well as in synovial fluid (direct immunofluorescence analysis, etc.).
1.2. Detection of antibodies to chlamydia antigens in blood serum and synovial fluid (complement fixation reaction, direct and indirect immunofluorescence):
1.3. Detection of antibodies to intestinal bacteria in blood serum (using direct hemagglutination reaction and complement fixation reaction).
The most conclusive evidence is the isolation of trigger microorganisms using classical microbiological methods (stool culture, transfer of scrapings from the urethral epithelium and/or conjunctiva to cell culture). More often it is possible to isolate chlamydia from the urogenital tract, much less often - enterobacteria from feces.
Difficulties in diagnosing ReA are often due to the erased subclinical course of the primary infectious process. Arthritis develops more often with mild forms of intestinal or urogenital infections, and by the time arthritis develops, the signs of the trigger infection in most cases disappear. In addition, in conditions of an impaired immune response, the development of chronic persistent forms of infection is possible. Therefore, at the onset of articular syndrome, it is necessary first of all to exclude hidden intestinal and chlamydial infections. In addition, the diagnosis of ReA is complicated by the combination of previous infectious processes of different localizations. It has also been established that damage to the intestines and urinary tract can be either primary in relation to ReA or develop simultaneously with it and even later, which often makes it difficult to determine cause-and-effect relationships.
Differential diagnosis of ReA from other types of juvenile arthritis is often difficult. The most common pathology requiring differential diagnosis with ReA is infectious arthritis, infection-related diseases accompanied by arthritis, as well as orthopedic pathology and various forms of juvenile idiopathic arthritis.
Viral arthritis. It is currently known that about 30 viruses can cause the development of acute arthritis. These include: rubella viruses, parvovirus, adenovirus, hepatitis B virus, herpes viruses of various types, mumps virus, enteroviruses, Coxsackie viruses, etc. Diagnosis is based on the connection with a viral infection or vaccination. The clinical picture is more often represented by arthralgia than arthritis. Clinical symptoms are observed within 1–2 weeks and disappear without residual effects.
Diagnostic criteria for poststreptococcal arthritis include:
Tick-borne borreliosis (Lyme disease) . Diagnosis of borreliosis is based on medical history: the patient’s stay in an endemic area, a history of a tick bite, as well as a characteristic clinical picture. The diagnosis is confirmed by serological methods that detect antibodies to Borrelia burgdorferi .
The diagnosis of septic arthritis is made on the basis of the clinical picture of the infectious process, determination of the nature of the synovial fluid, the results of culture of the synovial fluid for flora with determination of sensitivity to antibiotics, as well as radiological data (in the case of osteomyelitis).
The clinical picture of tuberculous arthritis is represented by general symptoms of tuberculosis infection: intoxication, low-grade fever, autonomic disorders and local symptoms - joint pain, mainly at night, arthritis. To confirm the diagnosis, X-ray data, analysis of synovial fluid, and biopsy of the synovial membrane are necessary.
The greatest difficulty is in the differential diagnosis of ReA with juvenile rheumatoid arthritis (JRA), a variant of “little” girls, since the clinical picture shows similar symptoms: oligoarthritis, mainly of the lower extremities, eye damage in the form of conjunctivitis, uveitis. The diagnosis of JRA is made based on the progressive course of arthritis, the presence of immunological changes (positive antinuclear factor), characteristic immunogenetic markers (HLA-A2, -DR5, -DR8), and the appearance of radiological changes characteristic of JRA in the joints.
Juvenile spondyloarthritis. This disease is a possible outcome of the chronic course of ReA in predisposed individuals (HLA-B27 carriers). Articular syndrome, as with ReA, is represented by asymmetric mono- or oligoarthritis with predominant damage to the joints of the legs. The cardinal signs that make it possible to make a diagnosis of juvenile spondyloarthritis are radiological data indicating the presence of sacroiliitis (unilateral or bilateral).
There are three types of therapy: etiotropic, pathogenetic, symptomatic.
Etiotropic treatment of ReA associated with chlamydial infection. Since chlamydia are intracellular parasites, the choice of antibacterial drugs is limited only to those that can accumulate intracellularly. These drugs include macrolides, tetracyclines and fluoroquinolones. However, tetracyclines and fluoroquinolones are quite toxic, their use is limited in pediatric practice. In this regard, macrolides are used to treat chlamydial arthritis in children. Azithromycin - for children, on the first day of administration, the dose of the drug is 10 mg/kg, and in the next 5-7 days - 5 mg/kg in one dose. The best effect is achieved when using the antibiotic for 7–10 days. Roxithromycin - for children, the daily dose is 5-8 mg/kg body weight. Josamycin (vilprafen) daily dose of the drug is 30–50 mg/kg body weight, divided into three doses. Clarithromycin is used in children over 6 months - 15 mg/kg/day in 2 doses, spiramycin - in children weighing more than 20 kg at the rate of 1.5 million IU/10 kg body weight per day. The frequency of administration is 2–3 times.
In adolescents, tetracyclines and fluoroquinolones may be used.
For ReA associated with intestinal infection, there are no clear recommendations for antibiotic therapy. The presence of antibodies to intestinal bacteria and especially bacteriological confirmation of intestinal infection is the basis for prescribing antibiotics. Aminoglycosides are used - amikacin IM or IV - up to 15 mg/kg/day in one or two injections, 7 days, gentamicin IM or IV 5-7 mg/kg/day in two injections, 7 days , fluoroquinolone drugs (for children over 12 years of age).
Pathogenetic therapy. Monotherapy with antibiotics has insufficient effect in case of protracted and chronic course of ReA and inadequate immune response. It is advisable to use various immunomodulatory agents (tactivin, lycopid, polyoxidonium) in combination with antibiotics for the treatment of chronic chlamydial arthritis.
According to the results of long-term controlled studies, the most effective regimen was using lycopid [8, 10, 13].
The scheme of combination therapy with lycopid and antibiotics in patients with chronic ReA associated with chlamydial infection is as follows.
The use of immunomodulators is contraindicated in cases of ReA transformation into spondyloarthritis and high immunological activity.
Symptomatic therapy. NSAIDs are used to treat articular syndrome in ReA. Diclofenac orally 2–3 mg/kg/day in 2–3 divided doses or naproxen orally 15–20 mg/kg/day in 2 divided doses or ibuprofen orally 35–40 mg/kg in 2–4 divided doses or nimesulide orally 5 mg/kg in 2–3 doses or meloxicam orally 0.3–0.5 mg/kg in 1 dose.
Glucocorticosteroids, as the most powerful anti-inflammatory drugs, are used during exacerbation of articular syndrome. Their use is limited primarily to the intra-articular route of administration. If necessary, you can use a short course of methylprednisolone pulse therapy, which involves rapid (over 30–60 minutes) intravenous administration of large doses of methylprednisolone (5–15 mg/kg for 3 days).
In case of severe and torpid course of the disease, the appearance of signs of spondyloarthritis, high clinical and laboratory, including immunological, activity, the use of immunosuppressive drugs is possible. The most commonly used is sulfasalazine (at a dose of 30–40 mg/kg per day), less commonly methotrexate (at a dose of 10 mg/m2 per week).
In most children, ReA ends in complete recovery. In some patients, episodes of ReA recur and subsequently signs of spondyloarthritis appear, especially in HLA-B27 positive patients. Prevention measures include timely detection of chlamydial infection in a child and his family members, adequate treatment of urogenital infection.
E. S. Zholobova , Doctor of Medical Sciences, Professor
E. G. Chistyakova , Candidate of Medical Sciences, Associate Professor
Joint diseases in children are not uncommon, and reactive arthritis is quite common among them. According to statistics, 80–90 minors out of 100 thousand suffer from it. For comparison, in adults it occurs 2–3 times less often. Mostly boys are affected. Treatment of the disease in childhood has a number of features associated, first of all, with the side effects of drugs on the growing body.
In the photo there is damage to the knees due to the disease
As in adults, in children this pathology develops after illnesses, mainly of an inflammatory nature. Most often, reactive arthritis is provoked by chlamydial infection, and a little less often by bacteria that cause enterocolitis (inflammation of the gastrointestinal tract). The disease occurs due to a pathological reaction of the immune system to a microbe entering the body, hence the name - reactive.
Unlike adults, who become infected mainly through sexual contact, the infection enters the children's body in other ways: from domestic animals (cats and dogs), birds and sick people. Children are more likely to become infected from adults than from their peers, but the spread of infection in children's groups also occurs. The pathogen can enter the body through dirty hands, objects, food and even air. Babies often get chlamydia in utero - “as a reward” from their mother. The disease can lie dormant in the body for a long time and make itself felt years after infection, when the immune system weakens (for example, after a cold).
Manifestations of reactive arthritis in children have their own characteristics. The development of Reiter's syndrome (one of the forms of the clinical course of the disease, manifested by a triad of symptoms: conjunctivitis, urethritis and arthritis) is less pronounced than in adults. Eye damage in the form of conjunctivitis is often chronic and can occur several years earlier than arthritis itself. Often, both parents and children's doctors mistake conjunctivitis for a manifestation of an allergy and do not conduct a proper examination of the child, especially if there are no other symptoms.
Symptoms of damage to the genitourinary system may be more pronounced than in adults, and inflammation of the joints, on the contrary, may occur without severe pain. Despite the fact that children, as a rule, are not infected through sexual contact, urethritis (one of the most important symptoms of Reiter's triad) is often accompanied by inflammation of the genital organs: balanitis in boys and vulvovaginitis in girls.
Conjunctivitis. Affected eye - left
The inflammatory process often involves the knees, ankle joints, the sacrolumbar spine and the metatarsophalangeal joint of the big toe (the “bone” in the area of the big toe may attract attention).
Small joints of the hands are less commonly affected. At the same time, the fingers swell and turn red, as experts say - they take on the appearance of sausages.
Pain in joint damage in children often occurs not with movement, but with pressure on the joint itself and the area around it, especially on the attachment points of the muscle tendons. Thus, reactive arthritis is characterized by pain in the area where the Achilles tendon attaches to the heel bone. Often young children retain normal mobility and activity and complain only of pain when pressed.
Arthritis in children is characterized by severe swelling, which is more likely to attract the attention of parents than complaints of poor health. If arthritis is mild, the child may not have any complaints at all.
Children prone to pronounced allergic reactions, on the contrary, can be very seriously ill: with high fever and multiple joint damage, accompanied by severe pain and swelling. Such children often have diarrhea and vomiting due to involvement of the gastrointestinal tract. And if arthritis is complicated by damage to the heart, which often happens in severe cases, a life-threatening condition can arise. Fortunately, such severe forms in children are rare.
Joint damage is often asymmetrical (unlike rheumatoid arthritis). Sometimes only one joint is involved in the painful process (oligoarthritis), but more often – several.
Older teenagers sometimes complain of limited mobility in the spine: in the lumbosacral or cervical region. In them, the disease can take the form of juvenile spondyloarthritis, leading to the destruction of joints and fusion of the vertebrae. This course of the disease occurs only in boys and is genetically determined.
In most cases, with proper treatment, reactive arthritis can be completely defeated, but sometimes it still develops into chronic forms, which then haunt the person throughout his life. Disability rarely develops. Fatal outcomes of reactive arthritis are now extremely rare.
Swelling of the right foot
Due to the variety of clinical forms of the disease in childhood, as well as many cases of chronic course with mild symptoms, only the results of an immunological examination can be considered a reliable diagnostic sign. Confirmation of the diagnosis of “reactive arthritis” is the presence in the blood of antibodies to chlamydia or other pathogens. Antibodies are special proteins that appear in the blood serum only when a specific type of microbe is present in the body.
Another important criterion is the onset of reactive arthritis 2–4 weeks after an acute illness.
In the treatment of children with chlamydial infection, the correct choice of drug is particularly difficult. Chlamydia is a microorganism with special properties that penetrates cells and causes them to be damaged by its metabolic products. The affected cells stimulate the immune system, which, in an attempt to rid the body of the infection, destroys them and “deactivates” the pathogen. As a result, immune complexes are formed that provoke the development of reactive arthritis.
Treatment of chlamydial infection has three goals:
removal of the pathogen from the body,
preventing the development of an inadequate immune response,
Since the microbe is inside the cell, it cannot be destroyed by conventional antibiotics - they simply cannot penetrate the cell membrane (membrane). Therefore, in the treatment of chlamydia, special drugs are used that can “fish out” the pathogen from the cell. But all these drugs are highly toxic and are used in pediatric practice extremely rarely and only for special indications. Therefore, it is very important to entrust the treatment of your son or daughter to a highly qualified pediatric rheumatologist and strictly follow his recommendations.
To eliminate symptoms of damage to joints and other organs, therapy is used depending on the clinic and complaints.
Children with acute arthritis are examined and treated in a hospital, after which they are observed by a rheumatologist in the clinic.
Chlamydia under a microscope
Whether a child gets sick or not largely depends on his parents and environment. Of course, we should protect him from infections, but we all understand that placing a child in a completely germ-free environment is impossible and even harmful. Harmful for the proper development of the immune system. Therefore, to effectively prevent reactive arthritis, it is enough to observe the following:
These measures are not only preventive, but also educational in nature - teaching a healthy lifestyle. And they should be observed not occasionally or when the child is already sick, but constantly. After all, prevention can only be particularly beneficial when health has not yet been lost.