Juvenile chronic arthritis (JCA) is an autoimmune disease that causes long-term (longer than 6 weeks) joint inflammation of unknown causes in children under 16 years of age.
More than 4 joints are inflamed, so the disease is extremely dangerous. Only 5% of patients have a positive rheumatoid factor, which is associated with difficulties in diagnosing the problem in the early stages.
Particular attention should be paid to the key signs of the disease, since the speed of diagnosis, the promptness of prescribing medications and the entire further treatment process depend on the attentiveness of parents and doctors.
The characteristic features of JCA are:
The most common injuries occur to the knee, wrist, ankle, hip, and elbow joints.
Children with JCA must undergo a diagnostic examination by an ophthalmologist using a slit lamp.
Treatment of juvenile chronic arthritis is based on a combination of 4 groups of drugs with different effects.
Posted By: JustAskJulie Posted date: 09.26.2014, 10:39 in: Treatment
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Juvenile rheumatoid arthritis.
Juvenile rheumatoid arthritis (JRA) is arthritis of unknown cause, lasting more than 6 weeks, developing in children under the age of 16 years when other joint pathology is excluded. ICD-10: M08.0 Juvenile rheumatoid arthritis (RF+ and RF-); M08.1 Juvenile ankylosing arthritis; M08.2 Juvenile arthritis with systemic manifestations; M08.3 Youthful (juvenile) polyarthritis (seronegative); M08.4 Adolescent (juvenile) pauciarticular arthritis; M08.8 Other juvenile arthritis; M08.9 Juvenile arthritis, unidentified.
ABBREVIATIONS: JRA—juvenile rheumatoid arthritis; RF—rheumatoid factor; ANF—antinuclear factor; CRP - C-reactive protein; GK - glucocorticoids, NSAIDs - non-steroidal anti-inflammatory drugs; IVIG - immunoglobulin for intravenous administration; LS - drugs, COX - cyclooxygenase.
JRA is one of the most common and disabling rheumatic diseases in children. The incidence of JRA is 2-16 cases per 100,000 children under the age of 16 years. The prevalence of JRA in different countries is 0.050.6%. The prevalence of JRA in children under 18 years of age in the Russian Federation is 62.3 per 100,000, the primary incidence is 16.2 per 100,000. In adolescents, the prevalence of JRA is 116.4 per 100,000 (in children under 14 years of age - 45.8 per 100,000), primary incidence - 28.3 per 100,000 (in children under 14 years of age - 12.6 per 100,000). Girls are more likely to suffer from rheumatoid arthritis. The mortality rate is 0.5-1%.
Primary prevention of JRA is not carried out.
Screening is not carried out.
• Makes up about 50% of the total structure of juvenile arthritis.
• Develops between the ages of 1 and 5 years.
• Occurs predominantly in girls (85%).
• Articular syndrome - affects the knee, ankle, elbow, wrist joints, often asymmetrically (Fig. 1.21).
• In 25% of children, the course of articular syndrome is aggressive with the development of destruction in the joints.
• Iridocyclitis develops in 15-20% of patients. As a rule, it has a subacute and chronic course.
20% of patients develop blindness.
Clinical blood test:
• there may be no inflammatory changes in hematological parameters;
• characterized by hypochromic anemia, moderate leukocytosis and moderate increase in ESR.
ANF is positive in 80% of patients. RF - negative.
The subsection Extra-articular manifestations contains the following values:
4. Muscle damage.
5. Heart damage.
6. Damage to the serous membranes.
7. Lung damage.
10. Violation of growth and general development.
11. Local growth disorders.
14. Rheumatoid nodules.
15. Cutaneous vasculitis (ulcerative necrotizing vasculitis, nail bed infarctions, distal arteritis, livedoangiitis).
Complications section reflects information about the presence of complications caused by the disease itself or drug therapy.
In the Complication type , you must select one of the values:
1. Complications of the disease.
2. Complications of therapy.
When you select the Complications of Disease Complications indicator contains three values: /. Amyloidosis.
2. Subluxation in the atlantoaxial joint.
3. Macrophage activation syndrome. Date of diagnosis of the complication. Date the complication was resolved.
2. Dyspeptic disorders.
3. Erosions and/or ulcers.
4. Bleeding and/or perforation.
6. Urticaria, Quincke's edema.
7. Anaphylactic shock.
8. Lyell's syndrome, Stevens-Johnson syndrome.
10. Arterial hypertension.
12. Aplastic anemia.
17. Compression fractures.
18. Pituitary dwarfism.
You should not fall into the misconception that arthritis is limited only to old age. Young people are characterized by several types of arthritis, and... as statistics show, they occur most often in girls. Pauciarticular juvenile arthritis is a very serious phenomenon and difficult to treat, but with the right approach, health improvements will not be long in coming.
1. With pauciarticular arthritis, up to four joints are affected at once. The disease manifests itself through pain in the joints. This symptom can be isolated, but is sometimes accompanied by severe fatigue and deterioration in well-being. Symmetrical damage to the joints of the ankles, wrists, and knees disappears gradually, which makes timely diagnosis difficult.
2. Treatment for arthritis should begin with a visit to a therapist and arthrologist. Perhaps, as symptoms worsen, you will need the help of an ophthalmologist.
3. Juvenile arthritis can be treated with corticosteroids and aspirin. Depending on age, the doctor writes prescriptions and determines the daily dosage of medications. Unfortunately, in adolescence, bone growth has not yet been completed, so it is impossible to prescribe more serious medications against arthritis - by their nature, they are aimed at slowing down bone growth, which can also make a young man disabled even if arthritis is cured.
4. Prevention of arthritis is an active lifestyle, swimming, sports, tourism. Such activities strengthen muscles, prevent salts from stagnating and improve joint mobility.
Alas, even newborns and small children are not immune from arthritis. No one knows why 1 in 1,000 children suffer from arthritis or why the disease affects girls more often than boys.
There are several types of juvenile arthritis. The most common ones include:
Systemic-onset juvenile arthritis (also known as Still's disease) affects the entire body. This disease is more common in children under 5 years of age; begins with a sudden increase in body temperature, the appearance of a rash and inflammation of the joints. The illness can last for several days, or even a week, then all symptoms disappear as quickly as they appeared. After many years, such an attack may recur.
Monoarticular (monoarticular) arthritis primarily affects one joint, most often the knee, but up to four joints can be affected at the same time. In this case, they talk about pauciarticular juvenile arthritis. Sometimes joint pain is the only symptom of the disease; the child rarely complains of poor health and fatigue.
Juvenile polyarthritis affects many joints at once. It begins gradually, with inflammation of the joints of the wrist, ankles and knees, located symmetrically. The first symptoms usually appear in early adolescence (girls 9-12 years old, boys 1-13 years old). This disease is similar to adult rheumatoid arthritis and requires similar drug treatment. The prognosis is unfavorable: patients often become disabled and are forced to move in wheelchairs.
If your child suddenly begins to complain of unreasonable pain in the joint, but his health is not affected, carefully examine the sore spot. If joint swelling and inflammatory response persist for six weeks, be sure to consult your doctor. With some forms of juvenile arthritis there is a risk of eye disease, so if a diagnosis of pauci- or monoarticular arthritis is established, take your child to an ophthalmologist regularly.
[localization code see above] Included: arthritis in children that began before 16 years of age and lasting more than 3 months Excluded: Felty syndrome (M05.0) juvenile dermatomyositis (M33.0)
M08.0 Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis with or without rheumatoid factor
M08.1 Juvenile ankylosing spondylitis
Excludes: ankylosing spondylitis in adults (M45)
M08.2 Juvenile arthritis with systemic onset
Still's disease NOS Excludes: Adult-onset Still's disease (M06.1)
M08.3 Juvenile polyarthritis (seronegative)
Chronic juvenile polyarthritis
M08.4 Pauciarticular juvenile arthritis
Juvenile arthritis is an inflammatory disease of the joints in children under 18 years of age. Its main symptom is swelling of the synovial membrane. This form of arthritis is an autoimmune disease in which the immune system mistakes healthy cells for foreign cells and begins to destroy them. The disease is considered quite rare, it is found in 0.5% of children. Juvenile arthritis does not develop in children under 2 years of age; it is twice as common in girls. Some patients lose their ability to work before reaching adulthood.
There are several types of arthritis, differing in the extent of the pathological process. The systemic form affects vital organs: heart, intestines, lymph nodes. The main symptoms of this disease are skin rashes, fever, and general weakness. Pauciarticular arthritis usually affects 1-5 joints. In most cases, this is accompanied by systemic pathological processes. This form of arthritis is typical for girls; as the body develops, its symptoms may disappear spontaneously.
With polyarthritis, more than 5 parts of the musculoskeletal system are involved in the pathological process. It is most often found in girls and affects the joints of the legs, jaw, cervical spine and occipital part of the skull. Post-traumatic arthritis develops with improper treatment of fractures, dislocations and bruises. The psoriatic form occurs several years after the appearance of skin rashes. Autoimmune arthritis affects bones and connective tissues. Most often it is diagnosed in boys whose relatives had similar diseases.
Juvenile arthritis is also classified based on pathogenesis. In the articular form, bone and cartilage tissues are affected. With articular-visceral arthritis, internal organs are involved in the pathological process. Limited visceritis affects specific organs, such as the heart or lungs. You will learn more about the disease from the video:
In the early stages, the disease may be asymptomatic. In other cases, the following appears:
The patient suddenly loses weight and begins to lag behind in development; febrile convulsions often occur. With arthritis of the hip joint, the leg shortens, which contributes to a change in gait. Articular manifestations can be combined with conjunctivitis and neurological disorders.
The causes of juvenile arthritis are:
Even with proper treatment, arthritis can lead to dangerous complications. These include amyloidosis of the myocardium and digestive system, activation of macrophages, retardation in physical development, acute cardiac and respiratory failure, blindness, joint deformation, and disability.
The examination of the patient begins with an examination and history taking. The rheumatologist must obtain information about the events preceding the appearance of the first symptoms, the patient’s lifestyle, and the presence of genetic diseases. During the examination, the affected areas are palpated. It is mandatory to include information about the clinical picture of the disease in the medical record. After this, the patient is referred for additional diagnostic procedures. General and biochemical blood tests reflect changes characteristic of the course of the inflammatory process in the body. Bacteriological examination helps to detect the causative agent of infection, which could provoke an autoimmune reaction.
Arthroscopy is a diagnostic procedure that allows you to examine the joint cavity and take synovial fluid for analysis. Bone marrow testing is necessary to detect leukemia. X-rays reveal fractures and other pathological changes in bone tissue. CT or MRI are used when it is necessary to examine surrounding tissue. A blood test for the presence of antinuclear antibodies is mandatory. They are produced during autoimmune processes of destruction of healthy cells.
The therapeutic regimen can be selected only after a complete examination of the patient. The type and dosage of drugs depend on the stage of the disease and its form. During the period of exacerbation, any physical activity, exposure to the sun, and consumption of fatty and salty foods are prohibited. Drug treatment involves the use of the following drugs: NSAIDs, analgesics, immunoglobulin, hormonal agents. If a bacterial or viral infection is detected, etiotropic therapy is carried out. Glucocorticosteroids are used during an exacerbation; they are usually injected into the joint cavity. These drugs quickly eliminate pain and swelling, restoring mobility to the joint. In some cases, a stem cell transplant can help achieve a positive result.
NSAIDs are effective in 30% of cases. The course of treatment lasts 1-2 months. Side effects include headaches, indigestion, and liver failure. Hormonal drugs have much more undesirable consequences, so they must be used in short courses. Glucocorticosteroid injections are often combined with sedatives. The effectiveness of methotrexate depends on the type of juvenile arthritis. Treatment begins with minimal doses, after which they are gradually increased. The most common side effects of this drug are nausea and vomiting, ulceration of the mucous membranes of the oral cavity, and diarrhea.
Sulfasalazine is the most effective treatment for juvenile arthritis. It contributes to the transition of the disease to the stage of long-term remission. Exacerbations are extremely rare even after discontinuation of the drug. It is mandatory to perform special exercises, massage and physiotherapy.
Today we offer an article on the topic: “Pauciarticular juvenile arthritis: treatment, symptoms and prevention.” We tried to describe everything clearly and in detail. If you have any questions, ask at the end of the article.
This is a rather serious illness that requires timely diagnosis and treatment, and maintaining a certain lifestyle. The problematic aspect of this disease is the difficulty of identifying all foci of inflammation and, accordingly, choosing a complex of medications.
It is characterized by damage to 1-4 joints, and inflammation of the knee joint is almost always present. Girls under 5 years of age are more susceptible to the disease. Very often this arthritis is accompanied by eye damage. The blood contains components called antinuclear factor.
Characterized by arthritis of the knee, hip and ankle joints. In children, this type is accompanied by iridoclicitis (acute inflammation of the eyes). Particularly dangerous is damage to the joints in the spine and sacrum. The specific antigen HLA B27 is found in the blood of patients.
The specificity of such arthritis is the absence of obvious signs of the disease at the initial stage. It begins to manifest itself with nightly attacks of fever, redness and itchy rash, and possibly enlarged tonsils. The disease is identified by excluding other diseases with similar symptoms.
The mortality rate for this disease is very low. The main danger for children with this diagnosis is the gradual immobilization of the joint, erosion and destruction of articular cartilage. As a result of this process, the child may remain disabled. Also, in some cases, children are at risk of losing their vision. With timely and adequate treatment, juvenile chronic arthritis goes into remission. But you should constantly monitor the patient in order to notice the appearance of a relapse in time.
Rheumatologists can make a diagnosis of juvenile chronic arthritis based on a number of instrumental and laboratory tests, including:
There are 2 main methods of treatment.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Aimed at relieving pain and inflammation of the joint, allowing you to restore its functionality
Stops joint destruction
Medication should also be taken during periods of remission, so as not to provoke an exacerbation of arthritis.
It is no less important than drug therapy. This group of methods includes:
Children with this diagnosis should be protected from:
Since the factors causing juvenile chronic arthritis in children are still unknown, only secondary prevention of the disease is possible. It is aimed at preventing recurrence of JCA. Systemic supervision by a professional rheumatologist is necessary. The main task is to recognize a possible exacerbation as early as possible through laboratory tests and symptoms. Then enhanced treatment will prevent the disease from progressing.
Juvenile rheumatoid arthritis is a childhood joint disease. It is one of the most common chronic diseases that a child can develop. The exact causes of this inflammatory disease have not yet been established. Most often, the disease develops in children under 16 years of age and lasts more than 45 days. Juvenile arthritis is usually diagnosed in girls.
As with any other disease, treatment for this disease must begin immediately after diagnosis, otherwise chronic juvenile rheumatoid arthritis may develop. The progression of the disease will result in damage to the child’s vital internal organs and eyes, fusion of joints and damage to bones. This is explained by the actions of infectious agents, which develop in a favorable environment and begin to harm the entire body.
According to the international classification of diseases, juvenile arthritis has several forms:
In the affected joint, the synovial membrane becomes inflamed and this leads to thinning of the cartilage
In principle, in terms of general medical indicators, juvenile rheumatoid arthritis is not much different from a similar joint disease in adults. Signs of this disease may begin to appear in children between the ages of 5 and 16 years. Symptoms of the disease:
The joints swell, limited movement and sharp pain in the cervical spine appear. If such symptoms appear quite often, then it is necessary to take the child to the doctor for diagnosis. You should not postpone a visit to a specialist, because juvenile chronic arthritis can cause complications in the heart, lungs, and eye membranes (a severe form leads to the development of cataracts and blindness).
The causes of rheumatoid arthritis in children are still unknown to science. Scientists put forward different theories, but there is no general consensus yet. The main reasons, which all doctors agree with, are a hereditary predisposition to rheumatic diseases and complications resulting from various infectious diseases, after which the child is vaccinated (measles, rubella, hepatitis B). Various joint injuries can lead to the development of the disease.
Rheumatoid arthritis in children can only be diagnosed in a medical facility. A rheumatologist examines the child and prescribes the necessary examination. When examining a patient, a specialist can detect swelling of the joints and the presence of pain when flexing and extending the limbs.
In the blood of patients there is an increased content of red blood cells, hemoglobin, ESR, and platelets. A urine test shows increased amounts of protein and other substances. Particular attention is paid to patients whose doctor has diagnosed chronic juvenile arthritis. To confirm the diagnosis, x-rays and ultrasound of internal organs are prescribed. To rule out eye damage, an ophthalmologist examines the pupils. It should be noted that in most cases the disease causes complications in the eyes of girls.
It is very important to diagnose juvenile idiopathic arthritis in a timely manner. This chronic disease is quite rare in children and is characterized by severe inflammation of the joints. Modern experts explain the appearance of JIA by the child’s weak immune system. The severity of the disease is that, like any chronic disease, it is difficult to cure. Modern medicine can only improve the patient's condition. The signs and symptoms of this type of joint damage are much the same as those of other types of juvenile arthritis.
Systemic juvenile arthritis is a severe form that requires very careful comprehensive treatment. In this case, the disease affects not only the joints, but also many vital systems of the body. The heart, lungs, and eyes begin to ache.
The peculiarity of the disease is that several joints are affected at once. Treatment of juvenile arthritis of the systemic type is carried out under the strict supervision of a physician. Patients are prescribed corticosteroids and aspirin. Injections of hormonal drugs are made directly into the damaged joints. Treatment of juvenile idiopathic arthritis in children should be comprehensive.
It is strictly forbidden to use potent drugs prescribed to adults. Medicines that slow down bone growth are especially dangerous. Their use may result in disability for the child. Young patients are taught by a rehabilitation doctor who prescribes special physical exercises.
To prevent juvenile rheumatoid arthritis, it is first recommended to lead an active lifestyle. Sports, physical education, hiking and cycling develop joints and do not allow fluid to stagnate in them. Children should be protected from hypothermia and various limb injuries. Regular preventive examination is very important, especially if you have joint pain.
Childhood arthritis is a disease in which the joints become inflamed. When arthritis occurs in children, symptoms usually become noticeable before the child is 16 years old. Although this is contrary to what most people think, the pathology is not exclusively a disease of old age. In fact, arthritis can affect not only an elderly person, but also a small child (even infants are at risk). Arthritis in children typically affects the feet, ankles, hips, knuckles, or wrists. In addition, areas of the knees, shoulders, elbows and lower back are affected. In the modern world, cases of childhood arthritis are common and continue to increase in frequency. Most likely, the reason for this spread is that the disease can occur some time after the child has an infection in the urinary tract or digestive tract. In addition, despite the fact that arthritis in children is a widespread phenomenon, the study of the causes of this disease began only at the end of the last century.
For what reasons can such a disease occur?
To correctly identify the disease and prescribe the correct treatment, it is necessary to have knowledge of the causes of arthritis in children. It is not difficult to make a mistake when making a diagnosis, because this disease sometimes appears after some other illness that the child has had for a long time. To eliminate the negative impact of pathology on the baby’s health, it is necessary, if possible, to avoid all possible causes that provoke its appearance. Such reasons include, for example, infection with various infections. Weak immunity also does not allow the child’s body to resist the disease with all its might. Metabolic disorders are another reason for the appearance of an unpleasant disease in children.
In addition, various injuries, bruises and other injuries play a bad role in the fight against arthritis in children. Sometimes the appearance of pathology is explained by the child’s genetic predisposition to this disease. Hypothermia has a bad effect on children's bodies and is one of the causes of arthritis. Thus, it is necessary to try to avoid each of these factors so as not to harm the child’s fragile body and do everything possible, because the disease should not be able to affect the health of children.
What types of pathology in children can be identified and what are their features? Rheumatoid and reactive types of pathology
In pediatric patients, the most common form of arthritis is called reactive arthritis. This is a type of childhood arthritis in which an inflammatory, but not purulent, process occurs in the affected joints. The causes of its occurrence are usually reduced immunity and an infection suffered 2-3 weeks ago (genitourinary, intestinal, nasopharyngeal). With this type, the joints swell, acute sharp pain appears, and the skin over the damaged joint begins to turn red. If the sick child suffered from a juvenile form of arthritis, but did not have any infectious diseases, then an autoimmune joint disease may be suspected.
Rheumatoid arthritis occurs when, for unknown reasons, immune cells begin to perceive the child's joint tissue as enemies and begin to destroy them.
As a result, severe inflammation occurs, the joints become deformed and destroyed.
Temperature of 40° C, hellish pain and gradual exhaustion - this is how the disease affects children.
Rheumatoid arthritis is much less common (about 2 times). This type of disease is much more terrible and much more difficult to treat. During the treatment of this type of disease, a small patient will have to undergo a large number of procedures; it is necessary to take various medications, including strong antibiotics. Of course, the effect of antibiotics, especially strong ones, on a child’s fragile body is not positive, despite the fact that their effectiveness is not always one hundred percent. Such a remedy can only suppress the causative agent of this type of disease, the symptoms of reactive arthritis will no longer be noticeable, the patient will feel better, but when the causative agent returns to the child’s body, the disease will resume. Then he will feel bad again, as before.
Juvenile idiopathic and septic arthritis
A type called juvenile idiopathic arthritis is a chronic inflammation of the joints in a child. The reasons for the appearance of this form of the disease are unknown. The onset of attacks occurs not only in infancy or early childhood, but also in adolescence (up to 16 years). In juvenile arthritis, large joints become inflamed. A small patient complains of pain when he makes active movements (however, in 25% of sick children this symptom is not observed). Inflammation in this type of disease, such as juvenile arthritis, lasts 30 days or more. At the same time, the child’s body temperature is elevated, the lymph nodes enlarge, and a rash appears on the skin.
Another type, called septic, is a serious and dangerous disease in which one (or sometimes a whole group) of joints becomes inflamed. The reason for the appearance of such a disease is that infections such as viruses, bacteria or fungi enter the joint. This type of disease can occur in children from early to adolescence, but children under 3 years of age most often suffer from infectious arthritis. A common cause of septic childhood arthritis is infection of the skin (these are dermatitis, which are caused by infections such as fungi, Staphylococcus aureus, etc.), as well as infections that the child received due to heredity (gonorrhea). In addition, these infections also include the intestinal type (salmonellosis). The bacteria travel through the blood to the joints, which is why the child develops a form of septic (infectious) arthritis. If you have a high fever and accompanying severe joint pain, you should immediately seek medical help from a qualified doctor.
The next type of arthritis in children is very similar to rheumatoid. This type of disease is called chronic juvenile arthritis. The causes of the disease are the same as in the case of rheumatoid juvenile arthritis.
In a disease such as juvenile chronic arthritis, there may be three options for the development of inflammation. In the first (oligoarthritis) 1-4 joints are affected, in the second (polyarthritis) more than four joints are affected, and in the third (generalized) arthritis all groups of joints are affected.
At the same time, the peculiarity of juvenile chronic arthritis is that it constantly progresses and is prone to persistent deformities. There are several functional classes in juvenile chronic childhood arthritis. In the first class, all joint functions are preserved. In the second class, the functions of the joints are limited, but the ability to self-service remains. In the third grade, the ability to independently care for oneself begins to become limited, and in the fourth grade, a small patient cannot do without the help of others to move or care for himself.
The types of childhood arthritis also include the so-called pauciarticular juvenile arthritis. This disease is quite dangerous and difficult to treat even in a hospital setting, however, if you approach the issue of its treatment correctly, recovery is quite possible.
With a form such as pauciarticular arthritis, up to 4 joints are affected simultaneously. You can guess the appearance of this type of disease by severe pain around the joints. Basically, this is a single symptom, but in some cases there is a feeling of severe fatigue and a deterioration in the patient’s general well-being. With symmetrical damage to the joints of the ankle, wrist, and knee, the disease develops gradually, making it difficult to make a timely diagnosis.
What symptoms can be used to identify childhood arthritis in a child in order to begin treatment in a timely manner?
There are many symptoms of childhood arthritis. Children often complain of symptoms such as pain when moving joints, and the affected area of the baby's body may become red or swollen. This is especially noticeable after any physical activity, when the pain becomes stronger.
The first symptom of childhood rheumatoid arthritis is pain in the legs. If at the same time the baby’s body temperature rises, loss of appetite, weight decreases, pain increases in the morning, he limps a little when he walks, and the area of the affected tissues and joints swells, then these are additional signs confirming the presence of a pathology in the child.
With the reactive form, other symptoms appear. This type of childhood disease usually affects the lower extremities, affecting these joints. In this case, concomitant cystitis, diarrhea, and urethritis appear (such symptoms usually appear two weeks before the picture of the disease becomes clear). Another sign of reactive arthritis is an infection in the urinary tract or inflamed joints in a child, which provoke this type of childhood disease.
If a disease is detected in a child’s knee joint, if both lower limbs are affected, the body must be examined to check for infection. If there is no infection, additional examination is necessary to rule out autoimmune inflammation. If the lesion affects both the joints and the eyes, the presence of rheumatoid arthritis cannot be ruled out.
At the onset of a childhood disease such as reactive arthritis, there are several noticeable symptoms. For example, the patient’s general condition worsens, the temperature rises greatly, signs of intoxication appear, conjunctivitis, scleritis and keratitis may appear (these three diseases appear during intoxication, and their appearance can occur either simultaneously or alternately).
Swelling of the affected joint occurs, a change in the shape of the joint can be noted, in addition, with arthritis, children experience very strong pain when they move, but they do not go away with the cessation of physical activity. Redness of the skin can also be noted, and an increased temperature is observed in the affected area.
Typically, in a child, reactive arthritis affects the joints in the lower extremities, and the disease itself is more likely to be asymmetrical. Boys most often, if they have arthritis, experience signs of inflammation such as balanitis, phimosis and synechiae, while girls may have vulvitis or urethritis.
Arthritis in children: treatment
When arthritis appears, the correct, effective and, if possible, safe treatment must be chosen, because the child’s health must be preserved.
To treat such a disease in any form in modern medicine, there are many methods that are very effective and based on the rich experience of previous generations of doctors, but new means and methods of treating childhood arthritis are being invented.
Treatment of arthritis in children must be carried out in a complex, which includes physiotherapy, physical therapy and a special type of massage. During the period when the disease worsens, the small patient is sent to a hospital for treatment. Sometimes the child is given a splint on the affected area to temporarily immobilize the inflamed joints. In addition, there are special shoes with insoles that will support the child’s feet while moving. During temporary recovery (remission period), it is recommended to travel with the child to the resort for sanitary treatment.
Juvenile rheumatoid arthritis is an arthritis that affects children under 16 years of age. The disease is characterized by inflammation and restriction of joint movement. It lasts longer than six weeks. This disease is also known as Still's disease, childhood chronic arthritis, and juvenile chronic polyarthritis.
Typical signs of juvenile rheumatoid arthritis are joint pain, swelling, and stiffness. These symptoms are worse in the morning or after a short sleep. At the same time, children, even small ones, do not complain of pain.
This disease may be accompanied by fever, loss of appetite and weight loss. In some cases, a rash appears on the arms and legs. Sometimes the lymph nodes become enlarged.
Juvenile rheumatoid arthritis may cause growth retardation. In some cases, the affected joints develop at different rates, and because of this, the length of a child's arms or legs may vary.
Juvenile rheumatoid arthritis is an autoimmune disease, which means the immune system mistakenly perceives its own body tissues as foreign and tries to destroy them. However, experts still do not know why such a malfunction of the immune system occurs. It is assumed that infectious diseases and preventive vaccinations, especially against measles, mumps or rubella, can trigger the disease. Moreover, after vaccination, girls are more likely to develop rheumatoid arthritis. However, infection is not the only cause of juvenile rheumatoid arthritis. It can also develop after joint injuries, hypothermia, or overheating in the sun.
In juvenile rheumatoid arthritis, non-purulent inflammation of the synovial membranes occurs. In this case, joint fluid is released in increased quantities and accumulates in the joint cavity. The synovial membrane thickens, adheres to the articular cartilage and after some time fuses with it. Cartilage erosion occurs. And after some time the cartilage is destroyed. Moreover, the time during which these changes occur varies for all patients.
Based on the number of affected joints, they are classified into:
Oligoarthritis can be of two types – first and second. 80% of children suffering from type 1 oligoarthritis are girls. The disease begins at a young age, usually affecting the ankle, knee and elbow joints. The disease is accompanied by chronic iridocyclitis. Rheumatoid factor (autoantibodies to immunoglobulin G) is absent. In 10% of cases, children remain with vision problems for the rest of their lives, and in 20% of cases – with joints.
Oligoarthritis of the second type mainly affects boys. It develops later than type 1 oligoarthritis. In this case, large joints are affected, most often the hip. The disease is often accompanied by sacroiliitis (inflammation of the sacroiliac joint), in 10-20% of cases it is accompanied by acute iridocyclitis. Rheumatoid factor is absent. Often, children who have had type 2 oligoarthritis still have spondyloarthropathy (a disease of the joints and the places where tendons attach to the bones).
Polyarthritis is divided into rheumatoid factor positive and negative. It is mostly girls who suffer from both. Polyarthritis negative for rheumatoid factor can develop in children at any age, and it affects any joints. Occasionally, the disease is accompanied by iridocyclitis (inflammation of the choroid of the anterior part of the eyeball). In 10-45% of cases, the outcome of the disease is severe arthritis.
Polyarthritis, positive for rheumatoid factor, usually develops in older childhood and affects any joints. Occasionally it is accompanied by sacroiliitis. In 50% of cases, children who have had this disease continue to have severe arthritis for the rest of their lives.
60% of children suffering from systemic rheumatoid arthritis are boys. The disease can develop in a child at any age. Any joints can be affected. Rheumatoid factor is absent. In 25% of cases, those who have been ill have severe arthritis for the rest of their lives.
According to the nature of the course, juvenile rheumatoid arthritis can be acute, subacute, chronic and chronic with exacerbations.
To make a correct diagnosis, consultation with a pediatrician, rheumatologist, or orthopedic traumatologist is required. It is necessary to undergo general and biochemical blood tests. They also do:
The main goals in the treatment of juvenile rheumatoid arthritis are to relieve inflammation, remove joint manifestations, restore normal function of the affected joints, and prevent their destruction.
To relieve inflammation, non-steroidal anti-inflammatory drugs or glucocorticoids are prescribed.
Immunosuppressants (drugs that suppress the immune system) are often prescribed to treat juvenile rheumatoid arthritis. These drugs must be taken continuously and for a long time. And their cancellation often causes an exacerbation of the disease.
If the joint is severely deformed, surgery is performed to restore it.
Physiotherapy has a good effect in the treatment of rheumatoid arthritis. It helps relieve inflammation and prevent deformation of the compounds. Electrophoresis, ultrasound, ultraviolet irradiation of affected joints, magnetic therapy and mud therapy are often used.
Preventive vaccinations are contraindicated for children suffering from juvenile rheumatoid arthritis. But MANTU, despite the fact that tuberculin is a killed culture of mycobacterium tuberculosis, does not pose a danger to those suffering from this disease. They should not take drugs that stimulate the immune system.
Specific prevention of juvenile rheumatoid arthritis has not been developed, since doctors do not yet know the exact cause of its occurrence. But to prevent this disease, you need to reduce risk factors. That is, it is necessary to avoid hypothermia, prolonged exposure to the sun, and protect against infections.
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21 Jan 2018 22:35
I'm Inna. My Nadya is 11 years old, I had my pregnancy monitored at a regular antenatal clinic, everything was fine. Suddenly, at 27 weeks, contractions began and rapid labor occurred. My girl looked at me and passed out. It was eggplant in color. She was resuscitated, then there was a month and a half of artificial ventilation, intraventricular hemorrhage of 3-4 degrees, as a result - hydrocephalus, bronchopulmonary dysplasia, encephalitis. And a bunch of little things that the brain already refused to perceive, such as jaundice, cholestasis, etc., etc. Despite assurances that these adversities were incompatible with life, my Nadezhda pulled through. Then there were operations to remove hernias and bypass surgery. Then shunt dysfunction. Everything more or less settled down after the shunt system was reinstalled in Germany. Cerebral palsy has been present since one year. We have been walking by the hand and with a stick since we were 9 years old, we study according to a simplified program at school, and we have been talking since we were 9 years old. We think well, especially where she needs it. And if you don’t need it, do everything for her.
And about a year ago, the pupil in my right eye narrowed. It is very difficult for her to check her vision, since our character is very harmful, she is specifically intimidated by doctors and, at their request, specifically pretends that she is in a tank and does not answer questions. She generally kicked the German ophthalmologist in the groin, so that he turned white. In a word, for sure nothing was clear, they concluded that it was from shunting (the shunt is on the right side of the head). And this summer my right knee became swollen.
First I went to an orthopedist, he took an X-ray of my hips, everything was more or less there, and he sent me to a rheumatologist. I found a rheumatologist from the nearest available one by appointment at the Research Institute of Rheumatology. ( we are in Moscow). They did an ultrasound there and found fluid. Nise was appointed. Nothing improved, only morning stiffness appeared and began to grow, then after driving in a traffic jam I could not straighten my leg when getting out of the car - throughout the whole day, not only in the morning. At the same time, we went to the ophthalmologist. There was uveitis in the right eye, a bunch of drops, dropped 13 times a day. The rheumatologist only observed, in response to complaints about deterioration, he prescribed Voltaren tablets; according to ultrasound, the fluid seemed to have decreased. My stomach started hurting from Voltaren. Here I found information about Ekaterina Iosifovna Alekseeva from the NCCH, and began to wait first for the registration to open, then for the reception itself. Meanwhile, on Voltaren, the swelling decreased and the stiffness went away. The ophthalmologist also noted improvements and reduced the number of drops instilled.
Ekaterina Iosifovna immediately recommended that I go to the hospital and be fully examined. While waiting for this, I replaced Voltaren with Movalis syrup. For me, going to the hospital is something beyond the bounds, I’d rather pay for all possible paid appointments, but the child will be at home and won’t catch anything, and in general, what about work, non-home conditions? Well, that’s okay, we both pulled ourselves together, collected tests and On January 9 of this year we went to bed. We must pay tribute to E.I., she promised us a separate ward in view of our underlying illness, and so it happened, it was a great relief. They took blood, did a CT scan of the knees and lungs, and an ultrasound of the abdominal cavity. At the same time, we went to appointments with a neurologist, psychologist, gynecologist, and exercise therapy. But it was blowing from the windows and in the corridors, and a runny nose began. In this regard, the department did not try the prescribed methotrexate. On January 19, we were discharged to treat a runny nose at home, and after that it would have been very difficult for us to start taking methotrexate tablets; it would have been very difficult for us to cope with injections. They recommended buying Methotrexate Ebeve, or any other foreign, non-Russian one. And folic. Diagnosis - M08.4 Pauciarticular juvenile arthritis, activity grade 1, radiological stage 1. NF 2.
By the way, in terms of blood, everything seems to be uncritical, and if it weren’t for the eye, then it would be possible to do without methotrexate, as far as I understand. But E.I. She said that we need to drink, otherwise we will lose our eyes. Maybe the drops don’t help in the end, I don’t understand? They relieved our inflammation, the dose was reduced. Although, on the advice of E.I. We changed the ophthalmologist, who again prescribed large volumes of drops, then reduced them. This week we are going for an examination again.
I want to ask you - I was prescribed 18 mg/week. I found tablets of 10, 5, 2.5 mg on the Internet. Should I buy all three types and give 0.5 mg less? Or 10+5+somehow divide 5 mg to make 3?
On the websites they write that it is only by prescription. We do not have a prescription, only an extract. Will they sell? Or do I need to go to the clinic first to get a prescription?
We have a disability, due to cerebral palsy. I think I refused medication, I don’t remember now.
Is it better to give after lunch and dinner? Or right after dinner? Different doctors said differently, E.I. there was no time to ask.
Do you experience nausea on the pills? Complications in the gastrointestinal tract?
Maybe I should immediately apply Linex or something similar? I didn't have time to ask
And for further treatment. E.I. She said that she would be re-hospitalized in six months. It was like a knife to my heart, I asked about the possibility of an examination at a paid diagnostic center - she said that of course it was possible. And in general, I would prefer to do all these studies for a fee, but on an outpatient basis. Is anyone treated like this, without hospitalization? It seems to me that the majority of people just want to do everything for free, so they automatically offer to do everything. In the department, everyone was just like old men, I don’t want it like that
although I understand that this will all last for a long time
21 Jan 2018 23:07
Let's start in order. NF is a functional deficiency, it is a characteristic of the ability to perform job duties, do not take it into account.
It may make you feel sick, but it doesn't have to be. The dose can be taken at one time, or divided into 2-3 doses. It would be good to cover the stomach with omez. You can drink it in courses.
In general, all these issues have already been discussed, and more than once. Use the Guide and Search. Get comfortable on the forum. Good luck.
22 Jan 2018 11:15
As for the dosage, you can actually buy all the options and take your dose with different tablets. It seems to me that 17.5 or 18 is not a big difference.
Thank you, I’m just getting settled in and studying. Thanks for the advice, there’s a lot of information, and the medications are so serious, it’s a little scary, but that’s okay, we’ll get through it
25 Jan 2018 22:42
The NCDH said that there is no need to buy domestic methotrexate. Better imported. Better methotrexate Ebeve. 0I tried to order online. Ebewe is available in different dosages. I asked the doctor if I could give 10+5+2.5 tablets instead of 18 mg. I added these dosages to my cart. They call from online delivery - do you have a recipe? No, I say, just an extract from a medical institution. Then, they say, we won’t be able to sell it. I realized that I had to go to the clinic to get a prescription. There they calmly prescribed me folic acid, but it’s already inexpensive, around 55 rubles, but prescription methotrexate is only available domestically. So I just took a prescription; they can’t prescribe a different dosage, so I prescribed 10 mg. I ordered it online again, tried different dosages, let's see what happens.
25 Jan 2018 23:29
31 Jan 2018 00:58
Only we haven’t started the appointment yet, the runny nose won’t go away, which blossomed magnificently at the NCCH, however, they have already lost us at school, so we went on Monday evening, we have a five-day period there, attendance is monitored quite strictly, because... This is money for food, etc. Tomorrow I’ll call and find out how you’re feeling, but I’m in the mood to pick it up on Thursday, and not on Friday, as usual, so that I can still start the appointment on Friday.
By the way, I asked the doctor, I really like that two doctors at the National Center for Health Care gave their phone numbers, you can calmly ask everything! - what to do with the dosages. She said that 17.5 mg is also normal. In general, you should first start with 15 mg, take it for a month, and if you can tolerate it normally, increase it to 17.5.
I’ve already read a lot of things here, but I still see that even if I have a little runny nose at times, they still give methotrexate. Otherwise, we need to start, but we still can’t fully recover.
And next week we also start classes with a super-exclusive speech therapist, which caused us speech despite the recommendations of all the teachers to teach our daughter to communicate with gestures. We decided to go all the way and now I can’t stop my chatter at times. But my speech is not clear yet, and we are far from ideal, so we still have to study and practice. I really hope you don’t miss that course due to illness. And that methotrexate will not cause weakness, etc.