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Reactive arthritis symptoms in a child

06 Jul 18

Causes and symptoms of reactive arthritis in children, methods of treatment and prevention

Joint disease in adolescence is suffered by 80-100 people out of every 100 thousand, the bulk of which are boys. In adults, reactive arthropathy occurs several times less frequently.

Causes of reactive arthritis in children

Children get sick often, and when the immune system weakens, the young body is open to all sorts of pathologies, including arthritis. The source of the disease is a pathological reaction that appears at the moment the microbe enters the body. Most often, infection occurs due to chlamydia infection or bacteria that cause enterocolitis.

The source of infection for adults in most cases is sexual relations. For children, the carriers of infection are pets, birds or sick people. Infection occurs mainly not from peers, but from adults. But you should be careful in kindergartens and schools.

Harmful microorganisms enter the body through:

The infection that causes reactive arthritis enters the body through dirty food, unwashed hands, toys and other objects. Another carrier may be the mother herself, who passed the disease on through inheritance.

It is important to understand that the disease does not appear immediately after infection, but waits for an opportune moment when the immune system loses strength, so it is important to know all the symptoms of arthropathy. The causes of the height of the disease may even be a common cold.

Arthropathy in children manifests itself as Reiter's syndrome, which includes conjunctivitis, arthritis and urethritis. It is less dangerous for children than for adults. Conjunctivitis in the eyes can also occur due to allergies, but even in this case it is necessary to conduct a proper examination. An examination will not hurt, even if there are no other symptoms of arthropathy.

The organs of the genitourinary system may become inflamed, and in children this is more difficult, but with joints it will be almost painless. With urethritis, the child's genitals become inflamed. In boys, the onset of the disease consists of signs of balanitis, synechiae, and phimosis. Girls are characterized by vulvitis, urethritis, microhematuria, vulvovaginitis. The urinary tract may show signs of arthritis up to six months before other symptoms are noticed.

Treatment may cause complications in the visual system. Therefore, you need to pay special attention to antibacterial therapy and its correctness, having studied all the side effects. If the treatment is not correct, iridocyclitis may occur, the consequences of which lead to the development of blindness, and it is almost impossible to stop it.

All symptoms consist of a general deterioration in the patient’s well-being. This is a high temperature that lasts up to 7-8 days, intoxication, keratitis, scleritis. These symptoms can appear either one at a time or simultaneously.

When joints are damaged, nearby tissues swell and effusion forms in the joint cavity, as a result of which defiguration is activated. Constant pain can be observed in a calm state; when attempting active movements, sharp redness on the skin and an increase in body temperature occur. The joints in the knees, ankles, big toes and cruciate iliac ligaments become inflamed. These symptoms are the most pronounced and very difficult to tolerate, have serious consequences, and require urgent treatment.

Arthropathy is characterized by pain where the tendon attaches to the bones. In this case, enthesopathy and enthesitis develop. Reactive arthritis can be diagnosed by pain in the heel, and this is typical for any age. If these symptoms have been observed in your child, you should immediately undergo a full examination and diagnosis.

Diagnosis and treatment

Paying attention to the huge number of clinical diseases in children, as well as the absence of pronounced symptoms, the only option for correct diagnosis is a complete immunological examination. To confirm reactive arthritis, it is necessary to detect antibodies to chlamydia and other pathogens in the blood. It is also important to consider that arthropathy can only begin if the child suffered another immune-suppressing acute illness no more than 4 weeks ago.

Chlamydia is a microorganism that, upon penetration, destroys adjacent tissue cells. To combat this infection, a suitable drug is selected that helps the immune system. Its task is to destroy the pathogen, stop the infection and rid the body of it. This fight against a simple microbe forms immune complexes, which in turn provoke the occurrence of arthropathy.

To exclude this possibility, the main tasks in the treatment of chlamydia infection are:

  • elimination of the pathogen from the body;
  • preventing symptoms;
  • preserving the adequacy of immune reactions.
  • Since the infection is located intracellularly, antibiotics in most cases become powerless because they cannot penetrate the cell. Therefore, there are drugs to remove chlamydia directly from the cell. These medications are very toxic and cause great harm to the body, especially to young children. At this stage, many refuse such treatment, risking the appearance of arthritis.

    Reactive arthropathy in children develops quite quickly, because in order to preserve their health, a complex of drugs is prescribed:

  • Etiotropic treatment. This method involves the presence in the program of antibiotics that can affect pathogens inside the cell. The dosage is prescribed according to age, but the cycle lasts at least 10 days. In difficult cases, 15-20 days.
  • Pathogenetic treatment. Immunomodulatory and immunostimulating drugs are prescribed to stimulate the activity of the immune system. These medications are used together with antibiotics according to the regimen prescribed by the doctor.
  • Symptomatic treatment. Either non-steroidal anti-inflammatory drugs or steroid hormones are used, but in a shorter course. If the clinical and laboratory activity of inflammation is too high, immunosuppressive drugs are prescribed. Due to the harm to the body, this is done only in extreme cases.
  • Children whose arthropathy is acute should undergo inpatient treatment under the close supervision of a rheumatologist. He also prescribes therapy depending on the symptoms and the state of the immune system, considering all the causes of the disease.

    It is impossible to know when and what a child might get sick with, so you should protect him as much as possible from surrounding infections. But preventing bacteria from entering the body completely is not an easy task. There are several ways to eliminate possible causes of the disease:

  • Before becoming pregnant, the mother needs to be tested for the presence of chlamydia in her body. If they are detected, the woman needs to undergo a course of therapy. This is done in order to prevent infection of the child in utero.
  • Parents should be promptly checked and treated for chronic infections so as not to infect their heirs.
  • It is important to teach children hygiene from childhood.
  • Vaccinate pets.
  • In adolescence, teach proper sexual hygiene.
  • Temper them, feed them properly, accustom them to a routine - do everything to strengthen the children’s immunity.
  • Teaching a healthy lifestyle is the responsibility of every parent, which will have a positive impact on the health of young people in the future. Prevention should be carried out not only after an illness, but throughout life - this will protect not only from arthritis, but also from other diseases.

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    Reactive arthritis in a child: symptoms and treatment of the disease

    Reactive arthritis is not the most common disease in children, but in recent years statistics show that children have begun to encounter it more and more often. Out of one hundred thousand children, only eighty are diagnosed with reactive arthritis, most of them are boys.

    Treatment of this disease in children has a number of differences from medical procedures that are used for adults. The main difference is that children experience many forms of reactive arthritis more acutely.

    Reactive arthritis as a joint disease

    Reactive arthritis most often develops as a result of viral or bacterial infections. During the immune response to infection, histocompatibility antigens appear in the body, which in a number of parameters resemble articular tissue.

    Having dealt with the infection, immunity can switch to the joints. Such inflammation is not purulent, but aseptic in nature.

    According to the international classification (ICD-10), this disease has code M02.3 - Reiter's disease.

    Reactive arthritis in children

    In children, the disease does not always manifest itself. Doctors suggest that a hereditary factor plays a decisive role in the occurrence of the disease.

    The course of the infection also matters - the disease develops if the infection spreads quickly, which leads to massive formation of antibodies. The immune system weakens under such pressure, which leads to inflammatory damage to the joints.

    Sometimes the disease can develop in a child even before birth. In this case, it is not only hereditary, but also congenital. It is important to note that even congenital reactive arthritis may not appear until several years after birth. Most often this occurs when immunity decreases.

    Causes of reactive arthritis in children

    To distinguish between the reactive and infectious forms of the disease, it is generally accepted that the reactive form is the one that develops mainly after urogenital and intestinal infections.

    Reactive arthritis is usually caused by:

  • Infections of the genitourinary system – ureaplasma, chlamydia.
  • Intestinal infections - salmonella, shigella, etc.
  • Respiratory infections - chlamydia and microplasma.
  • The most common cause is chlamydial infection. It can be transmitted by contact or airborne transmission.

    Diagnosis of reactive arthritis in children can be complicated by the fact that the infection often occurs latently. The rheumatologist collects anamnesis and visually examines the child.

    If joint inflammation is suspected, it is necessary to check for the presence of trigger microbes:

  • Analysis of feces and urine for the presence of pathogenic bacteria.
  • Checking blood for antibodies to microbial antigens and rheumatoid factor.
  • Immunofluorescence analysis.
  • Microbiological blood test for the presence of microbial DNA.
  • Culture analysis for the detection of chlamydia.
  • Ultrasound or MRI of the joint to identify foci of inflammation in the soft tissues around the joint.
  • The most common sign of reactive arthritis in a child is Reiter's syndrome.

    It represents a whole complex of symptoms, usually as follows:

  • pain when emptying the bladder;
  • fear of bright light;
  • blepharospasms of the eyes;
  • the appearance of ulcers on the cornea of ​​the eyes.
  • Symptoms of reactive arthritis in the early stages can easily be confused with an allergic reaction or a cold.

    Viral reactive arthritis

    Viral arthritis is characterized by a rapid course - it develops in just one to two weeks. Also, with viral arthritis, a rash may appear on the child’s skin and the lymph nodes may become enlarged. The joints swell and there is pain when moving. Small joints are primarily affected.

    Acute arthritis is characterized by severe damage to the joint:

  • The skin around it becomes redder and the tissues swell.
  • The child's general condition worsens.
  • Body temperature rises in combination with local hyperthermia.
  • Inflammation of the joints of the lower extremities may be accompanied by pain in the spine.
  • Relapsing arthritis

    The recurrent form of arthritis appears a year after the acute stage or later. Remission before the disease becomes relapsing can last six months or more.

    Symptoms of relapse may include:

  • temperature increase;
  • swelling in the joint area;
  • redness of the skin and pain;
  • In addition to the extremities, pain can spread to the spine.
  • Infectious arthritis has an acute course. It is accompanied by headache, fever, decreased appetite and weakness. Locally, swelling is noted in the area of ​​the affected joints, the skin becomes hot, and movements are painful.

    Treatment methods for reactive arthritis

    Treatment of reactive arthritis in children comes down to the prescription of drugs that relieve inflammation and eliminate infectious damage to the joints. After relieving acute inflammation, physiotherapy and exercise therapy are recommended.

    In advanced cases, surgery is used to pump out excess inflamed fluid from the joint.

    Drug treatment

    One of the main elements of drug treatment for reactive arthritis is antibiotics. They allow you to eliminate the main cause of the disease – infection. For children, antibacterial therapy should be gentle; especially toxic drugs are used only in extreme cases.

    The doctor may prescribe medications such as:

    The course of treatment is up to ten days; if necessary, it is repeated after a seven-day break.

    Another mandatory element is non-steroidal anti-inflammatory drugs. They help reduce inflammation of the joint, and most importantly, get rid of pain. The choice of product and dosage depends on the age of the child.

    Nonsteroidal drugs are used internally, in the form of tablets or injections, and can be used topically in the form of ointments and creams.

    Reactive arthritis of the knee

    Reactive arthritis of the knee joint in children causes the most problems, since this joint is very mobile, and pain in it can bring severe discomfort to the child.

    Treatment is aimed not only at fighting the infection, but also at eliminating the bleat. For this, non-steroidal anti-inflammatory drugs are used; in case of serious damage, the safest corticosteroids can be used, exclusively in the form of local drugs: Advantan (Methylprednisolone), Betamethasone or Prednisolone.

    Reactive arthritis of the hip joint

    Arthritis of the hip joint can also cause severe pain. During its treatment, it is recommended to observe bed rest; the child can return to physical activity only as the course of the disease improves.

    Antibiotics and anti-inflammatory drugs are used in the treatment process. Corticosteroid injections into the affected joint are possible as a last resort for severe pain.

    Other treatments

    Once the inflammation has subsided, treatment may include physical therapy and exercise therapy. Exercise therapy will help develop the joint and reduce pain.

    Among the physiotherapeutic methods chosen:

  • magnetic therapy;
  • paraffin applications;
  • phonoresis;
  • ultraviolet irradiation - UVR;
  • laser therapy.
  • In severe cases of reactive arthritis, surgery may be performed. It consists of removing the inflamed synovial fluid from the joint, and then introducing drugs into the cavity that relieve inflammation.

    Treatment with folk remedies

    Many traditional methods, although they cannot completely cure reactive arthritis, are used as an auxiliary treatment, relieving symptoms and speeding up recovery.

    One of the best and most common remedies for joints is cabbage.

    A compress of cabbage leaves and honey helps relieve pain:

    • A couple of sheets of fresh cabbage are heated by placing a container of hot water on them.
    • After this, they are slightly kneaded and honey is applied to one side.
    • Having applied the resulting honey compress to the affected joint, the sheet is wrapped around the body and covered with cellophane.
    • It is advisable to cover the top of the compress with a warm scarf or handkerchief.
    • Apply a compress in the evenings , before going to bed.
    • An infusion of nettle and parsley seeds, violet flowers and birch leaves will help relieve inflammation:

    • The ingredients are mixed in equal proportions.
    • After that, a tablespoon of the resulting mixture is brewed with a glass of boiling water.
    • Infuse the decoction for three hours.
    • Divide it into three parts and drink throughout the day.
    • A popular folk remedy for treating joints is heating. It should be used carefully so as not to provoke inflammation.

      Clinical guidelines for the prevention of arthritis

      The most important advice to parents whose children suffer from reactive arthritis is to follow all doctor’s orders. Only with comprehensive treatment and compliance with all clinical recommendations will the disease be quickly overcome. One of the biggest challenges can be bed rest, especially for very young children.

      To prevent reactive arthritis, the following measures must be taken:

    • Promptly treat viral and infectious diseases.
    • Be regularly screened for infections , especially chlamydia, so as not to infect the child during pregnancy.
    • Vaccinate dogs and cats.
    • Teach your child hygiene rules.
    • Strengthen your immune system, take vitamins, walk in the fresh air, and do hardening.
    • Explain to teenagers the rules of sexual hygiene and contraception.
    • What is the best food to eat for reactive arthritis?

      For reactive arthritis, nutrition should include:

    • Magnesium, potassium, vitamins - especially vitamin C. This vitamin strengthens the immune system and helps reduce the symptoms of arthritis.
    • Drinking green tea is also recommended ; it removes toxins and serves as a powerful antioxidant.
    • Increase the amount of fruits and vegetables - apples, cabbage, carrots and mushrooms.
    • Children need to eat in such a way that their diet excludes fatty foods, carbohydrates, and reduces the consumption of sugar and salt.

      Dr. Komarovsky about reactive arthritis in children

      The famous pediatrician Dr. Komarovsky recommends consulting a doctor at the first warning signs, and also following all the doctor’s prescriptions and recommendations for effective treatment.

      In addition, Komarovsky draws the attention of parents to the fact that during the period of intensive growth of children, usually from eight to twelve years, children may experience pain in the joints. This condition is called growth syndrome and is often mistaken for reactive arthritis.

      Consequences and prognosis of reactive arthritis in children

      The prognosis for reactive arthritis can be the most optimistic if you start treating the disease in a timely manner. Compliance with all prescriptions will help get rid of the disease and prevent its relapse.

      With proper treatment, reactive arthritis has no consequences - the joints return all their functions in a short time.

      Reactive arthritis in children: symptoms and treatment of the knee joint in a child

      Infectious-allergic arthritis, reactive arthropathy or reactive arthritis is a non-purulent inflammatory disease that affects the small and large bones of the joints.

      Reactive arthritis in children is quite common. The reason for this is previous infections of the genitourinary system, intestines, disorders in the immune system, and respiratory diseases.

      Statistics show that rheumatoid arthritis mostly affects the male half of the world's population. But girls and adult women are also susceptible to this disease, although to a lesser extent.

      Note! Reactive arthritis is not a fatal disease, but if treatment is not started on time, the disease can have the most serious consequences, especially for a child.

      As a result of reactive arthritis, joints lose their mobility and can lead to disability. Moreover, the disease causes severe complications on the heart, which are manifested by carditis and myocarditis.

      Causes of reactive arthritis in children

      Reactive arthritis develops as a result of various infectious pathogens. But the disease is distinguished by its “sterility”, that is, during the acute stage, no bacteria or their antibodies are detected in the synovial fluid.

      This is explained by the fact that by contacting bacteria, blood leukocytes form immune complexes and begin to perceive the cells of their own joints as pathogenic bacteria. This happens due to the similarity of their properties. The immune system malfunctions and inflammation of the joint develops.

      The infection enters the child's body through airborne droplets or dust. In addition, a pet can also be a carrier of the infection. Factors contributing to reactive arthritis are dust, dirt, and dampness in the apartment in which the child lives.

      Therefore, from an early age, children should be taught to observe the rules of personal hygiene and maintain cleanliness in their home at the proper level.

      Clinical symptoms

      The infection can be transmitted to the child from the mother during childbirth. Reactive arthritis is often caused by food poisoning and various allergic reactions of the body.

      But not every child can develop the disease. For this to happen, there must be a genetic predisposition to the disease. If the pathological gene is absent in a particular organism, the child’s chances of developing reactive arthritis are minimal.

      Typically, the first symptoms of reactive arthritis in children occur 1 to 3 weeks after the infectious disease. The main precursors of the disease are acute respiratory, intestinal and urogenital infections.

      The main symptoms of reactive arthritis:

    • the baby begins to limp;
    • complaints of severe joint pain;
    • the child strokes his fingers or supports the other hand with one hand;
    • appetite decreases;
    • general weakness appears;
    • local temperature rises, hyperemia and swelling are observed in the area of ​​the affected joint;
    • general increase in body temperature.
    • Due to the fact that the causes of reactive arthritis are various bacteria, depending on the causative agent, the symptoms of the disease may vary.

      If the disease is caused by a urogenital infection (for example, chlamydia bacteria), its symptoms are usually sluggish and erased. Along with the general symptoms, the child may experience a burning sensation in the eyes and pain - these are factors of inflammation of the mucous membrane of the eyes - conjunctivitis, which also accompanies infection caused by chlamydia.

      There is a high probability of symptoms of cystitis and urethritis. In boys, phimosis is sometimes observed, in girls - vulvovaginitis, vulvitis. If these symptoms all appear at the same time, we are talking about Reiter's syndrome.

      Reactive arthritis of the knee joint in children can be caused by intestinal bacteria (Campylobacter, Salmonella, Yersinia, Shigella). In this case, all the symptoms are pronounced:

    • general weakness;
    • body temperature more than 38°C;
    • severe joint pain;
    • pronounced local swelling;
    • joint deformation.
    • Many patients experience pain in the muscle tendons located in close proximity to the affected joint. The mobility of the joint is impaired.

      Reactive arthritis is difficult to diagnose. This is due to the fact that patients (especially if they are children) often quickly forget about a recent infectious disease.

      The symptoms of reactive arthritis are in many ways similar to those of other types of arthritis. That is why the doctor must have information about the baby’s health status over the past month. To do this, parents are interviewed and appropriate tests are prescribed.

      In addition to a visual examination of inflamed diarthrosis, the doctor prescribes blood, feces and urine tests for the little patient. Reactive arthritis is typically characterized by a high level of white blood cells in the blood and urine. The presence of antibodies to urogenital infections is observed.

      Stool analysis can confirm the presence of intestinal pathogens: salmonella, yersinia, shingella. Methods of culture of feces and scrapings from the conjunctiva of the eyes and from the epithelium of the urethra are used.

      To finally confirm the diagnosis, the doctor may prescribe an X-ray examination and MRI (magnetic resonance imaging) of the joints.

      Therapy of reactive arthritis in children

      Treatment of reactive arthritis occurs simultaneously in three directions:

    • relief of pain in damaged joints;
    • cure the initial infection that triggered the development of reactive arthritis;
    • treatment of other pathologies in the body caused by arthritis.
    • To relieve pain in reactive arthritis in children, doctors usually prescribe NSAIDs - non-steroidal anti-inflammatory drugs: naproxen, meloxicam, diclofenac. For significant pain, when NSAIDs do not provide relief, an intra-articular injection of a hormonal agent from the glucocorticoid group, for example, methylprednisolone, betamethasone, is prescribed.

      Injected directly into the joint cavity, corticosteroid drugs provide a good therapeutic effect. They can only be used if there are no microorganisms in the joint fluid and joint capsule.

      To completely cure a child of an infection caused by chlamydia, the doctor prescribes drugs from the macrolide group, which do not cause serious side effects:

      Medicines from the tetracycline group can only be prescribed to adolescent children.

      Unambiguous antibacterial therapy for the treatment of reactive arthritis caused by intestinal infection does not yet exist today. Typically, by the time arthritis develops, E. coli has already lost its activity.

      But the meaning of antibacterial treatment remains relevant in this case. This is because immunosuppressive therapy may be required at any time. To treat intestinal infections, drugs belonging to the group of aminoglycosides are used - gentamicin, amikacin.

      Pathogenetic treatment of reactive arthritis in children consists of stopping the harmful processes occurring in the body of a sick child. But it is prescribed only in situations where the disease is protracted or becomes chronic.

      In such a case, the child is prescribed drugs that stabilize the immune system (immunomodulators).

      This can be polyoxidonium, lycopid, taquitin. Immunomodulators should be prescribed in combination with antibiotics or alternately.

      Disease prevention

      To prevent the child from developing reactive arthritis, parents should promptly treat any infectious diseases. It is under no circumstances acceptable to let the process take its course. Moreover, the infectious disease should be treated under the supervision of a rheumatologist until complete recovery.

      Where children live, ideal cleanliness must always be maintained, air circulation and proper humidity must be ensured. It is equally important to teach your child to observe the rules of personal hygiene. This primarily concerns hand washing. If you have pets in the house, they should be bathed regularly using special shampoos.

      If even minor signs of reactive arthritis are detected in a child, parents should immediately contact the children's clinic. The pediatrician will prescribe a comprehensive examination and, if the diagnosis is confirmed, adequate treatment.

      If a child is diagnosed with reactive arthritis, the little patient should be under the supervision of a rheumatologist, who will regularly consult the parents and give additional recommendations as the disease progresses.

      Treatment of reactive arthritis in children and its symptoms

      Reactive arthritis is being discovered more and more often in children. As a rule, a child begins to complain about his health after suffering an infectious disease. The disease can be very difficult. It can cause serious complications. Children should be treated only under the supervision of a doctor. Therapy for childhood arthritis has a number of features associated with the side effects of drugs on the growing body. With timely treatment, in most cases it is possible to completely overcome the disease.

      Characteristic features of the disease

      Reactive arthritis is an inflammatory disease of the joint and periarticular bursa. The inflammatory process occurs in a child after an infection of various nature enters the child’s body.

      When the disease was first described, arthritis was considered sterile. The infectious agents that provoked arthritis were not found in the joint fluid and joint tissues. The term reactive explained the origin of the disease by the body's immune response to the invasion of pathogenic microorganisms. However, after the application of modern diagnostic methods, the sterility of arthritis was questioned. Circulating bacterial antigens, as well as DNA and RNA fragments of infectious agents, were found in the serum of the synovial (joint) fluid of sick children.

      Most often, reactive arthritis develops after:

    • urogenital;
    • intestinal;
    • respiratory infection.
    • It is extremely rare that vaccination can trigger the inflammatory process in a joint. The disease is associated with:

    • enterobacteria;
    • chlamydia;
    • respiratory tract infections (Mycoplasma pneumoniae and Chlamydophila pneumonia).
    • There is evidence of the ability of some types of parasites to cause this disease.

      Reactive arthritis predominantly affects boys. The causes of the disease are hereditary. Genetically predisposed children (carriers of the HLA-B27 gene) are at risk. As a result of the studies, similarities between proteins of intestinal bacteria and chlamydia with parts of the HLA-B27 molecule were discovered. Therefore, antibodies arising after infection attack not only pathogenic microorganisms, but also the cells of the child’s body. Due to the presence of the HLA-B27 gene, the immune response to the invasion of infectious agents is weakened. Therefore, in its carriers, the infectious disease often becomes chronic, increasing the likelihood of developing reactive arthritis.

      A dependence of the type of infection that caused reactive arthritis on the age of the children was revealed. In preschool children, the disease usually develops against the background of an intestinal infection. Younger schoolchildren are more likely to develop arthritis after an acute respiratory illness. And in adolescents, arthritis is diagnosed after the discovery of a urogenital infection.

      Symptoms of arthritis caused by urogenital infection

      Symptoms and treatment of the disease are closely interrelated. The type of infection responsible for its development depends on the nature of the ailment.

      If arthritis occurs against the background of a urogenital infection, the body’s reaction will be pronounced. Already 2 - 3 weeks after infection, the teenager’s temperature rises to 37.5 - 38.5 ° C (temperatures above 39 ° C are observed extremely rarely at the early stage of the disease). Later, conjunctivitis (inflammation of the mucous membrane of the eye) and urethritis (inflammation of the urethra) appear. Prostatitis or cystitis often develops. In girls, urethritis can be combined with vulvovaginitis. Boys are sometimes diagnosed with balanitis (inflammation of the glans penis).

      The main symptom is arthritis. It is detected 1-1.5 months after urethritis. A few days before the inflammatory process occurs in the joint, the baby feels pain in it. Most often, inflammation first appears in only one joint of the lower limb. Gradually, the pathological process covers other joints, spreading from bottom to top (staircase symptom) and from right to left (spiral symptom). With moderate severity of the disease, foci of inflammation occur in 4–5 joints.

      The inflamed joint becomes swollen and red. The skin may take on a bluish tint. Pain in the joint is felt with any movement. It intensifies at night and early in the morning.

      Arthrosis caused by urogenital infection is accompanied by damage to ligaments and bursae. When palpated, the baby complains of pain at the place where the ligaments and tendons attach to the bones.

      A sick child may develop dermatological diseases. Often diagnosed:

    • stomatitis (inflammation of the oral mucosa);
    • glossitis (inflammation of the tongue).
    • Various rashes are found on the skin. Arthritis is characterized by a rash on the palms and soles of the feet.

      Symptoms of arthritis caused by intestinal infection

      If arthritis was caused by an intestinal infection, its symptoms are associated with damage to the intestines. Children experience diarrhea. The stool contains blood and mucus. Nausea and severe pain in the right side, reminiscent of appendicitis, may occur. Children complain of pain in the muscles and joints.

      Arthritis is diagnosed 1 to 3 weeks after infection. In most cases, one joint in the lower limb becomes inflamed first. But after a short period of time, a new focus of inflammation appears. The child's body temperature rises to 38 - 39°C. A rash appears on the skin. It is usually localized near large joints. Erythema nodosum develops on the surfaces of the legs. Painful red nodes occur due to inflammation of the blood vessels of the skin and subcutaneous fat. Erythema nodosum disappears on its own without treatment after 2-3 weeks.

      Arthritis that occurs after infection with enterobacteriaceae is often the cause of the development of diseases of the cardiovascular system:

      Signs of arthritis caused by respiratory infection and vaccination

      Under the influence of respiratory tract infections, sick children develop erythema nodosum and enlarged lymph nodes. Every third child is diagnosed with diseases of the cardiovascular system:

      Sometimes aortitis (inflammation of the aortic wall) develops. Aortitis can cause mitral valve insufficiency. If the reaction of the child’s immune system is weak, the following may develop:

      The inflammatory process sometimes spreads to the kidneys. A child with reactive arthritis is diagnosed with pyelonephritis and glomerulonephritis. A prolonged increase in body temperature (not higher than 37.5°C) is often observed.

      Symptoms of vaccine-induced reactive arthritis occur within a month after vaccination. In children, joints become inflamed and body temperature rises. They become restless and lose their appetite. The disease is mild and often goes away on its own within 10 to 15 days.

      Dr. Komarovsky notes that parents often mistake growth syndrome for reactive arthritis. Up to 4 years of age and from 8 to 12 years of age, the child’s body experiences a growth spurt. This process is accompanied by pain. If there are no other signs of reactive arthritis, there is no cause for concern.

      If the disease is caused by a chlamydial infection, antibacterial drugs are selected that can accumulate intracellularly (chlamydia are intracellular parasites). These include:

      When treating children, preference is given to macrolides as the least toxic drugs. A significant improvement in the condition of a sick child occurs after 7-10 days of taking Azithromycin. Instead of Azithromycin, Roxithromycin or Josamycin (Vilprafen) tablets may be prescribed. Babies older than 6 months are best treated with Clarithromycin. Clarithromycin is prepared in the form of granules for suspension. The use of fluoroquinolones and tetracyclines is allowed in the treatment of high school students (over 12 years of age).

      Treatment of arthritis associated with intestinal infection is carried out after identifying the causative agent of the disease. Aminoglycosides (Amikacin, Gentamicin) are prescribed intravenously or intramuscularly. The use of fluoroquinolone drugs for the treatment of children under 12 years of age is not allowed.

      If treatment of reactive arthritis in children does not produce results, immunomodulatory drugs (Likopid, Polyoxidonium, Taktivin) are used. They are prescribed simultaneously with antibiotics.

      To alleviate the child's condition and reduce pain, non-steroidal anti-inflammatory drugs are used. Symptomatic treatment consists of taking Diclofenac, Ibuprofen, Nimesulide or Meloxicam orally.

      If the inflammatory process is actively developing and is accompanied by unbearable pain, the use of hormonal medications is allowed. They are inserted into the joint cavity. A short course of therapy with Methylprednisolone may be prescribed. It is administered in large doses intravenously over 3 days.

      If signs of spondyloarthritis (inflammation of the intervertebral joints), which develops against the background of excessive immune activity, are detected, immunosuppressive drugs are used. The use of Sulfasalazine gives good results. As an alternative, Methotrexate is prescribed.

      Parasitic theory of reactive arthritis in children

      Arthritis can develop as a reaction to an infection. In this case, relative sterility may be present in the tissues of the joint itself:

    • an inflammatory process of a non-pyogenic type is observed in the joint fluid;
    • instead of bacteria or viruses, only individual fragments of their DNA or RNA are detected;
    • There are also antigens of the immune system for the causative agents of certain infections.
    • This type of arthritis is called reactive arthritis. What causes reactive arthritis in children, and how should it be treated?

      Causes of reactive arthritis

      To distinguish infectious arthritis from reactive arthritis, doctors have agreed to consider reactive arthritis the result of intestinal or urogenital infections caused by the following pathogens:

    • Yersinia (enterobacteria, gram-negative rods);
    • salmonella;
    • shigella;
    • campylobacter;
    • mycoplasma;
    • other parasitic infections.
    • Etiological factors of reactive arthritis in children

      Even when infected with the above microorganisms, not all children develop reactive arthritis.

      The main trigger for rheumatoid arthritis is the presence of the HLA-B27 antigen, which has structural similarities to chlamydia and intestinal bacteria. Because of this, a cross-reaction of the immune system occurs, which ceases to distinguish between microbes and tissue’s own cells, which leads to the destruction of healthy cells and chronic inflammatory processes.

      Evidence of genetic inheritance of a tendency to RA - carriers of HLA-B27 get sick about fifty times more often than those who do not have HLA-B27.

      In 80% of cases, RA is provoked by chlamydia: chlamydial infections have reached epidemic proportions, spreading throughout the world.

      Symptoms of reactive arthritis in children

      RA manifests itself from a very early age with the following joint symptoms:

      1. Peripheral oligoarthritis of asymmetric type.
      2. The joints of the legs (knees, ankles, big toes) are mainly affected, less commonly the lumbosacral region, shoulder and wrist joints.
      3. Symptoms of joint inflammation begin two to three weeks after the infectious disease.
      4. Other symptoms directly related to infection:
        • urethritis,
        • conjunctivitis,
        • colitis,
        • diarrhea, etc.
        • How to distinguish reactive arthritis from other types

          Reactive arthritis must be differentiated from septic, viral, gouty, Lyme disease, rheumatism, juvenile rheumatoid arthritis and spondyloarthritis:

        • Septic arthritis occurs when a purulent infection gets inside the joint, for example, due to injury.
        • Viral - due to viral infections: influenza, rubella, herpes, mumps, hepatitis B, enteroviruses, etc.
        • Gout is caused by the accumulation of urate crystals in the blood and their growth in the tissues of the joints.
        • Lyme disease is the consequences of a tick bite infected with Borrelia.
        • Rheumatism is the result of a hemolytic streptococcal infection.
        • Juvenile rheumatoid arthritis is caused by complex immunogenetic factors. Symptoms of oligoarthritis with predominant involvement of the lower extremities and conjunctivitis in rheumatoid arthritis are very similar to reactive arthritis, which becomes a common medical error.
        • Juvenile spondylitis is the result of reactive arthritis. Since oligoarthritis of the lower extremities is combined with inflammatory processes in the joints of the spine and sacroiliac joint, it can be mistaken for ankylosing spondylitis with symptoms of peripheral polyarthritis.
        • Reiter's syndrome in reactive arthritis

          Reactive arthritis in children often manifests itself as Reiter's syndrome, a triad of symptoms:

          arthritis + urethritis + conjunctivitis.

          If keratoderma (dermatosis in the form of excessive keratinization) is added to this triad, then we are talking about a type of Reiter's syndrome in the form of a tetrad of symptoms.

          The nature of clinical manifestations is associated with the type of infection.

          Reiter's syndrome in intestinal infections

          Intestinal infections are characterized by:

        • Acute onset with febrile temperature and intoxication.
        • Classic triad of symptoms:
          • keratoconjunctivitis with signs of photophobia, blepharospasm, corneal ulcer, scleritis, uveitis;
          • urethritis in acute or subacute form;
          • acute arthritis.
          • Joint symptoms in acute reactive arthritis

            In RA caused by Shigella or Yersinia, the following occurs:

          • asymmetric arthritis mainly of small joints of the lower extremities;
          • pronounced pain syndrome;
          • redness of the skin over the sore joint and local increase in temperature;
          • significant swelling of the periarticular tissues due to synovitis (in some children, the fingers become sausage-shaped);
          • destructive changes in joints;
          • skin hypersensitivity;
          • painful contractures;
          • enthesopathy - pain in the places of attachment of the Achilles tendon, plantar aponeurosis, interspinous ligaments.
          • stiffness of movement in the cervical, lumbar and sacroiliac joints (the symptom is more often observed in teenage boys who are carriers of HLA-B27).
          • Chronic reactive arthritis can lead to juvenile spondyloarthritis.

            Reiter's syndrome due to chlamydial infection

            The triad of symptoms has a smoother picture:

          • boys may experience phimosis, synechiae, and balanitis;
          • in girls - cystitis, vulvitis, vulvovaginitis, leukocyturia;
          • conjunctivitis is most often catarrhal, short-lived, but prone to relapse;
          • approximately a third of patients may develop iridocyclitis with serious consequences - loss of vision;
          • arthritis can sometimes lag for several months after the manifestations of conjunctivitis and urethritis and usually have milder forms.

          Joint symptoms in chlamydial infections

        • Arthritis with chlamydia develops as either mono- or oligoarthritis, affecting the joints of mainly the lower extremities in an asymmetrical manner.
        • There are no obvious manifestations in the form of acute pain or limitation of functions and movements.
        • Increased accumulation of fluid in the joint cavities.
        • RA with chlamydial infections gives frequent relapses and tends to become chronic.
        • The risk of developing juvenile spondyloarthritis in children in the future is increased.
        • Diagnosis of reactive arthritis

          It is difficult to diagnose reactive arthritis in children due to the latent course of the infectious process. Articular arthritis, due to its late onset and in the absence of detection of intestinal bacteria, chlamydia and other microbes, is often considered as a separate disease without connection with a possible infection.

          It is also difficult to detect trigger microbes:

        • Direct evidence of the presence of infection is the detection of pathogenic microorganisms in urine, feces, and urogenital tracts using bacteriological analysis.
        • Indirect evidence is the detection in the blood of antibodies to the antigens of the above microbes using an immunological method.
        • Additional laboratory tests:
          • morphological using staining of preparations or immunofluorescence analysis;
          • microbiological - detection of microbial DNA fragments in the blood or joint cavity;
          • cultural - isolation of chlamydia using chicken embryos, laboratory animals and cell cultures.

      Treatment of reactive arthritis in children

      • When treating chlamydia RA, preference is given to antibiotics that can accumulate in cells, because chlamydia are considered intracellular parasites:
        • Macrolides:
          • azithromycin, roxithromycin, vilprafen;
          • clarithromycin (age restrictions - the drug is not approved for children under 6 years of age inclusive).
          • Tetracycline and fluoroquinolone drugs:
            • They are more toxic and have limited use in the treatment of children, but are acceptable for adolescents.
            • In the treatment of RA caused by intestinal infection, antibiotics from a number of aminoglycosides are used:
              • amikacin, gentamicin.
              • Fluoroquinolone drugs are also used.

                Combined treatment

                Antibiotics alone are not enough; it is necessary to include immunomodulators in the combination treatment regimen for reactive arthritis. The use of sublingual lycopid tablets has proven to be particularly effective. Treatment proceeds as follows:

              • The full course of treatment with lycopid is 24 days.
              • At the end of the first week of taking licopid, an antibiotic is added to the regimen.
              • The duration of taking the antibiotic is seven to ten days.
              • After finishing taking antibiotics, treatment with licopid continues until the 24-day course is completed.
              • Symptomatic treatment

                For reactive arthritis aggravated by articular syndrome, the following drugs are used:

              • NSAIDs to relieve inflammation and pain:
                • diclofenac, meloxicam, ibuprofen, naproxen, nimesulide.
                • For severe and persistent pain, short courses of intra-articular glucocorticosteroids are administered.
                • It is also possible to administer intravenous methylprednisolone in large doses for three days.
                • With rapid progression of RA with signs of spondyloarthritis against the background of increased immunological activity, immunosuppressants are prescribed:
                  • sulfasalazine or methotrexate.
                  • Predictions and prevention

                    Most often, with correct diagnosis and correctly selected medications, complete recovery is stated. The exception is children who have the congenital HLA-B27 antigen in their blood - in them the disease often becomes chronic.

                    When preventing reactive arthritis in children, a huge responsibility lies with parents:

                  • It is important to take care of household hygiene and the freshness of food.
                  • If there are animals in the house, constant antiparasitic prevention is necessary.
                  • It is necessary to treat to the end, and not to push atypical cold infections caused by mycoplasma and other similar bacteria inside.
                  • It is very important to take care of cleanliness, not only in everyday life, but also in choosing a partner, protecting yourself from casual relationships, because chlamydia is sexually transmitted:
                    • Advanced chlamydial infections can be passed on to a baby from its mother at birth.
                    • However, they are difficult to identify, since the symptoms resemble ordinary gynecological inflammatory processes with the only difference that treatment with traditional means does not give anything.
                    • Timely detection of atypical, parasitic infections in a child and his family members is a barrier to reactive arthritis.

                      Rheumatoid arthritis in children: symptoms and treatment of a child

                      Children's type of arthritis is a group of diseases where one of the symptoms is inflammatory damage to the joints. Causes of deformation of the articular apparatus: injuries, disruptions in the immune system, infections, allergic reactions.

                      Arthritis in children can be both acute and chronic.

                      Doctors in most cases determine favorable prognoses, but note that arthritis in children can leave behind unpleasant consequences, affecting either one or several joints at the same time.

                      Causes and symptoms of arthritis in children

                      In children, rheumatoid arthritis is in first place in terms of prevalence; it is one of the symptoms of acute rheumatic fever or rheumatism.

                      The disease is based on a hereditary tendency and the negative impact of bacterial infection, especially group A streptococci. Factors causing rheumatoid arthritis:

                      Juvenile rheumatoid polyarthritis ranks second in prevalence. This form of polyarthritis is an autoimmune systemic chronic progressive inflammation of the joints of unknown origin.

                      Mostly, children from one to 16 years of age are affected. Peak incidence is 5-6 years, and also 12-14 years. It is noted that girls get sick more often than boys, on average 2 times.

                      Often a sore throat in a child is a precursor to arthritis. In addition to the joint, the disease can lead to damage to internal organs, which seriously affects the general condition of the body, for example, leading to kidney failure or heart disease.

                      With the active development of the pathological process, rheumatoid inflammation often causes:

                      All of the above violations cause disability in the child.

                      Reactive arthritis is an inflammatory process of joint elements of infectious origin. It is noted that genetic predisposition plays a significant role in the occurrence of the disease.

                      The childhood type of arthritis occurs against the background of previous intra-articular infections, so the inflammation is considered aseptic. There are two groups of reactive arthritis:

                    • Postenterocolitic arthritis. Its cause is a variety of intestinal infections, which are caused by salmonella, escherichia, yersinia, dysentery bacillus,
                    • Urogenital arthritis. Its cause is urinary tract infections, which are caused by ureaplasma, chlamydia, E. coli, and mycoplasma.
                    • Septic or infectious childhood type of arthritis appears due to the entry of pathogenic microorganisms into the joint cavity. These microorganisms can be:

                    • bacterial: staphylococcal, anaerobic, tuberculosis, gonorrheal, brucellosis, streptococcal,
                    • viral: hepatitis virus, rubella, influenza, adenovirus, mumps,
                    • parasitic.
                    • The infection enters the joint in two ways: either through the blood, or from the external environment into an open wound.

                      Allergic arthritis appears as a complication of vaccination when the child is hypersensitive to certain foods or medications.

                      Determining the origin of joint inflammation is required in each specific case, since treatment can vary significantly for arthritis of different etiologies.

                      Unlike adults, in children under 16 years of age, signs of arthritis are divided into general and local. Local symptoms of joint inflammation:

                    • dysfunction of the affected joint,
                    • enlargement of the diseased joint and its swelling, which are visible in the photo and when examining the child,
                    • severe pain that gets worse with any movement,
                    • increased skin temperature and redness of the sore joint.
                    • Common symptoms of arthritis:

                    • increase in body temperature to subfebrile levels, in rare cases to febrile levels,
                    • restlessness and crying of the child when moving,
                    • disturbances in sleep, appetite, child’s weight loss or weight gain,
                    • high fatigue and weakness of the child.
                    • Treatment depends on how old the child is, as well as the cause and type of arthritis. There are certain clinical features of the most common types of joint inflammation.

                      Knee arthritis is when the cartilage in the knee becomes inflamed. The process may occur due to the abrasion of the cartilage or infection.

                      Inflammation of the knee joint is difficult to diagnose, but can be present from the first days of a child’s life. If arthritis of the knee joint is not treated, it will make itself felt in adulthood, but in more severe manifestations. Qualified treatment of knee arthritis will provide effective relief from the disease and prevent the development of complications in the future.

                      The nuances of the clinical picture of a particular type of arthritis make it possible to identify the disease and prescribe a series of examinations to confirm the diagnosis.

                      Categories : Diagnostics

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