Juvenile arthritis is a disease of autoimmune origin with a chronic course.
This disease especially affects children under the age of 16 years.
Juvenile chronic arthritis is characterized by the duration of the inflammatory process, which covers the children's joint apparatus for 1.5 months or longer.
By its nature, juvenile arthritis is a disease that requires a special attitude towards it, which consists of:
Unfortunately, arthritis in children is quite difficult to detect in the initial stages, so doctors most often have to fight its chronic form.
This disease has a high level of disability, since the chronic course of the joint loses its mobility, and deformation and erosive changes can be observed in the articular cartilage.
Children's vision also suffers a lot from juvenile arthritis; it deteriorates sharply. There are cases of complete loss.
A malfunction of the immune system is the true cause of JCA. However, the immediate provoking factor for this condition in children can be:
Depending on the location of the inflammatory process, there are four types of chronic arthritis in children.
Pauciarticular. This type is characterized by damage to 1-4 articular joints. Most often it develops in the knee joint. Pauciarticular arthritis can even affect the eyeballs. The disease occurs much more often in girls than in boys.
Polyarticular. This form of arthritis in children is very dangerous, as multiple inflammations occur, affecting more than four joints at the same time. Treatment of polyarticular arthritis is a very long and complex process. Usually during this period the child is in a hospital setting.
Systemic. This type of juvenile arthritis is dangerous because in the early stages it occurs with a complete absence of symptomatic manifestations. And if signs are present, they can be confused with symptoms of other diseases.
Most often, the disease manifests itself in night attacks: rashes, fever, enlarged tonsils, itching. Systemic juvenile arthritis can be diagnosed by excluding other diseases from the list. Unfortunately, precious time is often lost and the pathology enters a chronic phase.
Spondyloarthritis. This CA in children affects large joints - ankle, knee, hip. But there are cases when inflammation is localized in the vertebral or sacral area.
Spondyloarthritis is diagnosed when a specific antigen, HLA B27, is found in the blood.
As mentioned above, childhood CA is quite difficult to diagnose, so if there is the slightest suspicion of pathology in a child, visiting a doctor should not be delayed.
Children may complain about:
There are also visual symptoms of the disease, such as fever and maculopapular rashes.
There are violations of the usual sizes and shapes of internal organs, which is confirmed by diagnostic research methods.
To determine chronic arthritis in children, doctors use all kinds of laboratory and instrumental techniques.
These include:
If a disease is detected, the child must be taken to see an ophthalmologist. The doctor will use a slit lamp to conduct a microscopic examination of the eyeball and its membranes.
JCA is treated mainly with medications, but proper nutrition, a special complex of physical education and physiotherapeutic techniques play an important role in the fight against the disease.
To alleviate the child’s condition and stop the pain syndrome in juvenile arthritis in children, the following medications are prescribed:
They are prescribed only by a doctor, who relies on the medical history, age and weight of the child. For example, in younger children, GCs are not recommended for use due to their hormonal effects on the body, especially on the endocrine system.
Long-term use of NSAIDs can cause gastrointestinal problems.
Drugs from the group of biological agents are aimed at stopping the deformation of articular cartilage. Immunosuppressants are recommended to be used in combination with other drugs.
Medicines most often prescribed for juvenile arthritis:
During the period of remission of the disease, in order to prevent exacerbation, maintenance doses of medications are prescribed.
Daily physical therapy exercises help improve the activity levels of a small patient. However, adults should help the child perform the exercises and monitor their correctness. It is very good if the child goes swimming and rides a bicycle.
Physiotherapeutic procedures play an important role in the treatment of chronic childhood arthritis:
During an exacerbation, laser or cryotherapy is used. These methods have, albeit minor, anti-inflammatory effects. Massage procedures should be performed carefully.
Today it is still not known for certain why juvenile chronic arthritis occurs in children. However, the simplest preventive measures that need to be taken in a child with this disease will help prevent or delay the onset of relapse.
Juvenile rheumatoid arthritis most often appears in childhood in girls; its symptoms differ from rheumatoid arthritis, which is typical for adults. The disease develops due to infectious diseases such as acute respiratory viral infections, tonsillitis, and may also be a consequence of vaccinations. Juvenile rheumatoid arthritis also occurs due to genetic predisposition.
Medicine has proven that this disease occurs in childhood due to disruptions in the immune system, which provokes damage to the joints. Antibodies begin to be produced, which have a negative effect on the joint tissue, causing an inflammatory process.
The disease has its own classification, which is based on how many joints are affected; if there is one, then we can talk about monoarthritis; if there are fewer than four joints, this means oligoarthritis; if more than four, it means polyarthritis. In cases where, in addition to the joints, problems arise from systemic organs, this indicates systemic rheumatoid arthritis.
Immunologists classify the disease as seropositive rheumatoid juvenile arthritis, in which specific antibodies are observed, and seronegative arthritis, in which antibodies are not identified.
Severe pain occurs in the joints, in the morning the joints are stiff, the body temperature may rise high, and the person feels intoxication in the body.
Juvenile arthritis in children differs from adult rheumatoid arthritis in its localization. In children, the disease affects the knees, ankles, and elbows; in boys, problems with the hip joints may occur. In adults, the disease develops gradually; at first it can affect small joints - hands, feet, fingers.
The disease is dangerous when it begins to affect many joints and affects internal organs. Fever may occur, it is very difficult for the child to move, and the joints become very swollen. In girls, due to the disease, the iris can become very inflamed, which subsequently leads to blindness, so it is very important to examine the child in a timely manner. If the doctor has identified the disease, urgent treatment is necessary. Systemic juvenile rheumatoid arthritis is characterized by a temperature of up to 40 degrees, which often rises in the evening, then it drops sharply. At elevated temperatures, the child feels very bad; a severe rash may be noticed on the arms and legs, which is characterized by pale pink spots; it may appear and disappear. In systemic juvenile rheumatoid arthritis, the lymph nodes and spleen are enlarged.
Due to juvenile rheumatoid arthritis, the child's growth is impaired, problems with the jaw joints may occur, and they become smaller.
It is very important to identify the disease in time; for this you need to take a general blood test, it will show the inflammatory process. It is also necessary to take an x-ray in order to find out in time about a tumor, bone fractures, and also about the condition of the joints.
Additionally, you will need to undergo an electrocardiogram and a test for rheumatoid factor to detect antibodies. You should definitely consult an ophthalmologist; you may need a biopsy.
The course of therapy consists of taking special medications to stop the inflammatory process in the joints. Immunosuppressants are also often prescribed; methotrexate is popular in modern medicine; others may also be prescribed.
To relieve pain and stop the inflammatory process, corticosteroids are prescribed; with their help, the child’s condition can be improved and the joints can resume function, but if these drugs are used for a long time, this can lead to joint deformation. Therefore, treatment with hormonal drugs is only an addition to the main course of therapy.
Modern medicine uses anti-cytokine therapy to treat juvenile rheumatoid arthritis; for this purpose, inhibitors are used to relieve inflammation and prevent the autoimmune system from destroying joint tissue, and most importantly, prevent the appearance of a tumor in later life. This is one of the effective treatment methods in modern medicine; with its help, you can prevent the disease from worsening and thereby protect yourself from relapse in the future. But such treatment is expensive, it is carried out only abroad, and not every person can afford it.
Many parents, in order to relieve their children from pain, give a large dose of aspirin, this cannot be done, because it is very harmful and can cause Raynaud's syndrome. It is best to pay attention to other non-steroidal anti-inflammatory drugs; naproxen helps well.
In order to avoid joint contracture, you need to perform special physical exercises, and splints are also used.
If the eye shell is inflamed, the doctor prescribes special eye drops, ointments that contain corticosteroids and other medications that can dilate the pupil. In advanced cases, surgical intervention will be required.
Thus, the methods of treating juvenile rheumatoid arthritis include surgical, medicinal, hormonal, and physical therapy is also necessary. It is very important to consult a doctor immediately if stiffness or stiffness occurs in the joints, also if you notice that the child’s joints begin to swell and hurt, because all this can lead to lameness and the child may become immobile. If a child has a sharp rise in temperature, a rash, or red eyes, call an ambulance; the child must be hospitalized in order to begin the necessary course of treatment on time.
Juvenile idiopathic arthritis includes a group of chronic rheumatic diseases in children under 16 years of age. Common typical symptoms include inflammation of the joints, accompanied by pain, swelling of the joints and limitation of movement. Treatment reduces symptoms and improves laboratory values, but does not guarantee complete recovery.
Juvenile arthritis (JA) is rare and is diagnosed in children under 16 years of age, most often from one to 4 years of age. Chronic inflammatory rheumatoid joint disease affects girls more often.
It is difficult to suspect signs of arthritis in a small child, since swelling of the joint is not always noticeable. Children cannot complain of pain, they are capricious and refuse food. If they begin to limp or do not give a hand, do not want to play, are stiff in the morning - this can be regarded as the first signs of illness.
Juvenile arthritis is most often diagnosed in preschool age
As a result of many years of research, scientists have not been able to develop a single hypothesis explaining the etiology of the disease. Juvenile arthritis in children was previously associated with exposure to Epstein-Barr viruses, streptococci, staphylococci and other infectious agents. However, this connection has not been confirmed by laboratory and clinical tests.
It is believed that juvenile rheumatoid arthritis in children is a polyetiological disease. The presence of a genetic predisposition, characteristics of the immune system, and the influence of previous viral infections cannot be ruled out.
Important! JA is one of the diseases that threatens the patient’s disability. The consequence of the disease may be the development of more severe rheumatoid pathology, ankylosing spondylitis, and immobilization of the child.
Juvenile chronic arthritis slows down the physical development of children: it disrupts the growth of joints in the affected area, the lower jaw remains underdeveloped, fingers are too short or long.
JA in children in the later stages causes eye damage: uevitis, mild conjunctivitis, episcleritis, keratoconjunctivitis sicca.
Juvenile rheumatoid arthritis causes inflammation of the synovial membranes of the joint
Based on the nature of the lesion and the extent of its spread, juvenile arthritis can be:
Rheumatoid seronegative juvenile arthritis and seropositive are noted. In seropositive arthritis, rheumatoid factor is detected in the blood; in seronegative arthritis, it is absent.
Symptoms of seropositive juvenile rheumatoid arthritis in children appear:
Rheumatoid seronegative arthritis begins with acute fever and a violation of the general condition . There is no RF in the blood. The initial stage is characterized by damage to one large joint, for example, the knee, or several smaller joints.
Seronegative arthritis affects small joints
Later, arthritis affects the small joints of the feet or hands. Stiffness in the morning and the appearance of rheumatoid nodes were not noted. Manifestations of visceritis and lymph node enlargement occur less frequently. Seronegative arthritis can become seropositive.
Seronegative juvenile arthritis is more common in children than seropositive juvenile arthritis. Children after 5 years of age suffer, girls are more often affected .
Treatment of juvenile rheumatoid arthritis in children is carried out taking into account the general condition of the joints and the whole body, the condition of bone and cartilage tissue, and the nature of the immunological pathology.
The basic drugs of drug therapy are NSAIDs and glucocorticoids. The following NSAIDs are used: Naproxen, Ibuprofen, Indomethacin, Diclofenac, etc. Try not to use aspirin so as not to cause serious complications .
Corticosteroids are prescribed in short courses, often administered intra-articularly, especially in cases of severe inflammation of several joints with limited movement.
Methotrexate is a basic drug in the treatment of juvenile arthritis
If iridocyclitis is present, corticosteroid eye drops are used. More severe cases require peribulbar or intraocular corticosteroid injections.
Immunotherapy is carried out by slow intravenous drip administration of Intraglobin, Pentaglobin, Sandoglobulin at a rate of 10-20 drops/min. Gradually increase the injection rate to 2 ml/min. Repeat infusion therapy every month (if necessary).
Rheumatoid uevitis in acute and seropositive forms of JRA is treated by a rheumatologist and ophthalmologist with cytostatics (Cyclophosphamide, etc.).
In recent years, as part of complex therapy, treatment with biological drugs has been introduced:
If left untreated, rheumatoid arthritis can lead to disability
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Arthritis is manifested by inflammatory processes in the joints, accompanied by severe pain due to the destruction of cartilage tissue and bone deformation. This disease is often associated with old age, but it can also manifest itself in young people and even children.
Inflammation in the knee joint in a child
In this case, patients under the age of 16 are diagnosed with juvenile rheumatoid arthritis.
With timely and correct treatment, the prognosis is positive, but some forms of the disease can result not only in disability, but also in the death of the child.
Juvenile rheumatoid arthritis is a rather rare disease, and in order to diagnose it in children, young patients sometimes have to be monitored for up to one and a half months. Statistics show that inflammatory processes in the joints are more often found in girls.
What juvenile rheumatoid arthritis looks like on a child’s feet
The cause of the development of childhood arthritis has not yet been established by science. It is assumed that genetic predisposition, on the one hand, and autogenicity of the immune system, on the other, are manifested here.
Juvenile arthritis has several categories into which it is classified:
Rheumatoid arthritis is treated in children based on a correct diagnosis and taking into account the forms of development of the disease.
For an unknown reason, certain joints are affected. Immediately inside the synovial membrane, microcirculation is disrupted, and cells are destroyed. This, in turn, provokes the production of immunoglobulins G, the body perceives them as foreigners.
In response, the system produces antigens that destroy foreign bodies. This confrontation of two opposing immunoglobulins constitutes a destructive complex called rheumatoid factor. Under its influence, the synovial membrane of the cartilage and the joints themselves are gradually destroyed.
Pathology of juvenile arthritis development
As a reaction to such pathogenesis, cytokines are produced that destroy the joint tissues themselves along with foreign bodies. Inflammatory processes in children become chronic, preventing nutrients from penetrating into the joint cavity.
But the penetration of rheumatoid factor beyond the joint is in full swing - the antigen, along with the blood, spreads throughout the body, transforming juvenile rheumatoid arthritis into a more severe form.
This disease manifests itself in children in different ways, but there are common signs for all forms of arthritis:
Swelling and redness on the hands of a child
In children, as a rule, very small and fairly large joints are affected.
The main places of localization can be called the mandibular-temporal regions, as well as the articulations of the cervical spine. As children grow, damage to these joints manifests itself in various deformities.
According to the nature of the course, arthritis in children manifests itself as follows:
Despite the fact that the subacute form of arthritis in children is milder than the acute form and is more treatable, the disease should be taken seriously. It is the subacute form that is more difficult to identify at the initial stage of development, and this is already lost time, which affects the success of recovery.
Juvenile rheumatoid arthritis of the systemic type causes complications - damage to internal organs is observed. In addition to high fever (especially in the morning), this form of the disease also has its own specific symptoms:
Such symptoms are quite serious and often lead to serious consequences.
Most of all, the oligoarthritis form can be observed in children, when a small number of joints (less than four) are affected, and it affects both large bones and fairly small ones. The disease progresses slowly, but manifests itself in children of any age - both one-year-olds and schoolchildren.
Despite the fact that this juvenile rheumatoid arthritis is more often unilateral, it has severe consequences:
Arthritis of the knee joint in a child
It is difficult to diagnose this form in the initial stage, so the prognosis is disability.
This form of the disease is less common than the one described above and has its own characteristics. Unlike oligoarthritis, with this type of disease there are much more joints affected by inflammation.
Based on the manifestation of rheumatoid factor, polyarthritis is divided into subtypes:
Both subtypes of polyarthritis are considered an unfavorable form, because already in the primary stage of the disease, growth retardation occurs, which is irreversible. So in the future the child only has a disability.
Pediatric rheumatoid arthritis must be diagnosed as early as possible in order to make timely adjustments to the child’s development. Therefore, a trip to the doctor is mandatory even with mild symptoms. It is the specialist who will accurately say whether the child has arthritis or not. And for this you need to undergo diagnostics:
Child at a doctor's appointment
If a doctor diagnoses the presence of the disease, serious treatment should begin immediately.
Since it is difficult to completely cure rheumatoid arthritis, the main aspects of therapy will be aimed at stopping inflammatory processes, suppressing reactions in the joints, protecting the body from systemic manifestations, and minimizing the negative consequences of the disease.
One of the important aspects in the treatment of childhood arthritis is compliance with the motor regimen. The child’s activity should not be completely limited to prevent persistent contractures from developing. But you should also avoid large physical overloads, sudden movements, jumping, running and especially falling.
A sick child will need daily leisurely walks in the fresh air. Depending on the severity of the disease, doctors recommend swimming and cycling. Advanced pathological processes require special therapeutic exercises under the supervision of a specialist or with his participation.
Sometimes children are prescribed crutches and corsets. A prerequisite is protection from stress, exposure to cold and sunlight.
A boy who suffers from juvenile arthritis is in a special corset
. or: Still's disease
Inflammation in rheumatoid arthritis is autoimmune in nature - this means that for unknown reasons the body begins to perceive its own cells as foreign and actively produce antibodies to them. In rheumatoid arthritis, antibodies primarily attack the joints, leading to the development of chronic inflammation in them. Gradually, it leads to the destruction of articular cartilage, disruption of the structure of the bones that form the joint, the development of gross deformities and, ultimately, to the loss of the functional ability of the joint. The inflammatory process in various organs and systems also gradually leads to dysfunction of the corresponding organs.
Much less common in chronic rheumatoid arthritis are:
There are Still's syndrome and Wisler-Fanconi allergosepsis.
Articular syndrome is limited to pain in the joints (arthralgia) or limited incoming exudative arthritis (inflammation of the joint with the presence of exudation - fluid that has come out of the vessels into the inflamed tissues). There is a threat to the child's life due to severe injuries.
Process activity levels:
A pediatrician will help in treating the disease
Great hopes are placed on biological genetically engineered drugs that affect impaired immune processes. They are also basic and slow down the progression of the disease.
Chronic juvenile arthritis is a disease of autoimmune origin. Children under 16 years of age suffer from this disease. The chronic nature of this disease is expressed in a long-term inflammatory process that affects the joint apparatus of a child from 6 weeks or longer.
Juvenile arthritis by its nature is a disease that requires a special attitude - lifestyle, long-term drug treatment, constant dynamic diagnostics, preventive and rehabilitation procedures. But since it is quite difficult to identify this disease in the initial stages of its occurrence, it is often necessary to deal with its chronic form.
This disease has a high level of disability, so in a chronic course the joint becomes less mobile, and erosive and deformative processes in the articular cartilage can be observed. High pathological risks also apply to vision; it drops sharply, and there have been cases of its complete disappearance.
Immune system dysfunction is the main cause of juvenile chronic arthritis. However, the immediate impetus for this state of the body can be:
There are 4 types of this disease based on the location of the inflammatory process:
This type is characterized by lesions of one to four articular joints. To a greater extent, it originates in the knee joints. With pauciarticular arthritis, the eyeballs can be damaged, and the disease occurs more often in girls than in male children.
A very dangerous form of the disease, since the spread of inflammation occurs multiple times, affecting more than 4 joints at the same time. Treatment of polyarticular arthritis is complex and lengthy, often requiring hospital stay.
The insidiousness of this type of arthritis lies in the complete absence of symptoms in the early stages and similar symptoms to other diseases. Most often, the disease begins to manifest itself in night attacks - fever, rashes, itching, enlarged tonsils. By excluding all kinds of diseases from the list, you can establish a diagnosis of systemic juvenile arthritis. Unfortunately, very often, precious time is lost and the disease takes a chronic form.
This form of chronic juvenile arthritis affects large joints - hip, knee, ankle. But there are cases when the inflammation is “located” in the sacral or vertebral area. I diagnose this type after detecting a specific antigen in the blood - HLA B27.
As already noted, juvenile arthritis is very difficult to recognize, so at the first complaints of a child, it is worth visiting a doctor to rule out or confirm the disease. Complaints may concern:
Visual signs of the disease may include:
Multiple instrumental and laboratory tests will help determine juvenile chronic arthritis in children. These include:
The list of doctors who will have to be visited when a disease is diagnosed must include an ophthalmologist. Using a slit lamp, the specialist conducts a microscopic examination of the eyeball and membranes.
For juvenile chronic arthritis in children, drug treatment is mainly used, but adherence to a special diet, physiotherapeutic manipulations and special physical training will be important.
To stop the pain syndrome and alleviate the child’s condition during drug treatment of JCA, the following is prescribed:
Their appointment is carried out only by a specialist based on the medical history and depending on the age and weight of the child. For example, due to the influence of hormonal GC on the body, in particular on the endocrine system, it is not recommended in young children. NSAIDs are also not taken for a long time - problems with the gastrointestinal tract are possible.
Drugs from a series of biological agents are aimed at stopping the deformation of articular cartilage. It is also recommended to use immunosuppressants in combination.
Drugs that are commonly used in children for juvenile chronic arthritis:
Maintenance doses of medications are sometimes also carried out during the period of remission of the disease in order to prevent provoking an exacerbation of the condition.
Carrying out daily physical therapy helps improve motor activity. An adult needs to monitor the child’s performance of exercises and help him so that such therapy turns out to be of high quality. Swimming and cycling are also recommended.
Physiotherapeutic manipulations play an important role in the treatment of JCA. These include:
Massage procedures are performed carefully. If exercise therapy is not enough, then during the period of remission you can help the periarticular area restore blood circulation, thereby improving the nutrition of the joint with the necessary substances.
It is not known for certain why JCA occurs in children, but taking simple precautions in a child with this pathology will help delay or stop the possibility of a relapse: