Juvenile rheumatoid arthritis is a chronic inflammatory disease of the joints in children under 16 years of age with an unknown etiology and complex pathogenesis, characterized by a steadily progressive course and accompanied in some patients by the involvement of internal organs, often resulting in disability.
Among rheumatic diseases of childhood, juvenile rheumatoid arthritis ranks first in prevalence. The disease is observed in various regions of the globe with a frequency of 0.05 to 0.6% in the population. Primary incidence also varies widely, ranging from 6 to 19 cases per 100,000 children.
The etiology of juvenile rheumatoid arthritis is still unknown. Among its causes, a combination of various environmental factors is considered (viral and bacterial infections, joint injury, hypothermia, insolation, administration of protein drugs, etc.). The basis for an inadequate response in patients with juvenile rheumatoid arthritis is their “hypersensitivity to various environmental factors,” resulting in the formation of a complex immune response, leading to the development of a progressive disease. Family and hereditary predisposition to rheumatic diseases also plays a certain role. Studies in recent decades have revealed a connection between juvenile rheumatoid arthritis and the presence of the HLA DR locus in patients, with a predominance of DR4 in patients with systemic forms of the disease and DR5 in patients with a predominantly articular variant of the disease.
The pathological process in juvenile rheumatoid arthritis begins in the synovial membrane of the joint with disruption of microcirculation and damage to the cells lining the synovial membrane. In response to the changes listed above, altered IgG are formed in the patient’s body, which are perceived by the patient’s own immune system as autoantigens. Immunocompetent cells, including plasma cells of the synovial membrane of the joint, produce antibodies in response - anti-IgG. These antibodies, called rheumatoid factor, interact with the autoantigen in the presence of complement, and immune complexes are formed. CECs have a damaging effect on both the vascular endothelium and surrounding tissues. First of all, the synovial membrane of the joint is affected, resulting in arthritis. In this case, an excessive amount of cytokines of macrophage origin - interleukin-1 and interleukin-6, tumor necrosis factor (TNF-a) - is formed in the synovial fluid and joint tissues. Interleukin-1 induces inflammation and destroys cartilage. Tumor necrosis factor (TNF-a) has the same property. Interleukin-6 promotes hyperproduction of acute phase proteins of inflammation - C-reactive protein and fibrinogen. There is further activation of enzyme systems that destroy cartilage. Increased neovascularization, or angiogenesis, resulting from the action of cytokines on tissue, also increases the destruction of cartilage.
During the process of inflammation, a large number of cells are formed in the joint tissues, forming the so-called pannus, or “cloak”, covering the surface of the articular cartilage, thereby preventing normal metabolic processes and increasing the destruction of osteochondral formations.
A biopsy of the synovial membrane in the initial period of the disease reveals villous hypertrophy and hyperplasia of the superficial layer. Inflammation in the joint in juvenile rheumatoid arthritis, as in adult patients, leads to the formation of erosions and destruction of cartilage. However, these processes develop more slowly in children and in a smaller percentage of cases. As a rule, the number and depth of erosion correspond to the depth and severity of the process. Simultaneously with the pathological process in the joints in children, an increase in lymph nodes is observed, caused by nonspecific follicular hyperplasia. In children with juvenile rheumatoid arthritis, as in adults, vasculitis can develop in all organs without specific morphological signs. Atrophy of muscle fibers is also observed. The most pronounced changes are in the muscles adjacent to the affected joints.
Symptoms of juvenile rheumatoid arthritis
The clinical picture of juvenile rheumatoid arthritis is varied. The onset of the disease can be acute or subacute. With an acute onset, body temperature usually rises, pain appears, and then swelling in one or more joints, often symmetrical. However, the symmetry of the lesions sometimes does not become obvious immediately, but within several days or weeks from the onset of the disease. As a rule, large joints are affected - knees, ankles, wrists, but sometimes small joints of the arms and legs (metatarsophalangeal, interphalangeal) are affected from the very beginning of the disease. Typically for juvenile rheumatoid arthritis, damage to the joints of the cervical spine. All joints are sharply painful, swollen, and in rare cases the skin around them is hyperemic. Body temperature gradually increases and can reach 38-39 °C. In this case, a polymorphic allergic rash often appears on the skin of the torso and limbs, and the peripheral lymph nodes, liver and spleen enlarge. A general blood test reveals anemia, often neutrophilic leukocytosis with a shift in the leukocyte formula to the left, an increase in ESR to 40-60 mm/h, an increase in the concentration of Ig, mainly IgG.
The acute onset of the disease is usually characteristic of severe forms - a generalized articular or articular-visceral (systemic) form of the disease with an often recurrent course and an unfavorable prognosis. This form is most often observed in children of preschool and primary school age, but it can also occur in adolescents.
Subacute onset of the disease is characterized by less severe symptoms. Arthritis usually begins in one joint—the knee or ankle. The joint swells, its function is impaired, sometimes even without severe pain. The child's gait changes, and children under 2 years of age stop walking. So-called morning stiffness in the joints is observed, which is expressed in the fact that after a night's sleep the patient feels for some time difficulty moving the joints and self-care. He gets up with difficulty, his gait is slow. Morning stiffness can last from a few minutes to 1 hour or more. The process may be limited to one joint for a long time (rheumatoid monoarthritis). This form of the disease, especially in girls of preschool age, is often accompanied by rheumatoid eye damage - rheumatoid uveitis, unilateral or bilateral. With rheumatoid uveitis, all membranes of the eye are affected, as a result of which visual acuity drops sharply until it is completely lost, sometimes within six months. In rare cases, the development of rheumatoid uveitis may precede the articular process, which makes timely diagnosis extremely difficult.
The subacute onset of the disease can occur with the involvement of several joints - usually 2-4. This form of the disease is called oligoarticular. Joint pain can be moderate, as can exudative changes. The process may involve, for example, two ankle and one knee joints, and vice versa. Body temperature does not increase, polyadenitis is moderate. This form of juvenile rheumatoid arthritis is more benign, with less frequent exacerbations.
Subsequently, as the disease progresses, two main forms are possible - predominantly articular and articular-visceral in a ratio of 65-70% and 35-30%, respectively.
The articular-visceral (systemic form) includes five signs: persistent high fever, polymorphic allergic rash, lymphadenopathy, hepatolienal syndrome, arthralgia/arthritis. This form of juvenile rheumatoid arthritis has two main variants - Still's syndrome, which most often develops in preschool children, and Wieseler-Fanconi syndrome, usually observed in schoolchildren.
Variants of the systemic form of juvenile rheumatoid arthritis
LECTURE No. 14. Rehabilitation of children with juvenile rheumatoid arthritis
1. Juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA) is an immunopathological process with systemic damage to the joints.
Early rehabilitation is carried out in a hospital. Biogenic stimulants are prescribed - apilak, anabolic hormones. During treatment, physical factors are used: UV rays on the affected joint area (in turn, the affected joints are irradiated daily, but no more than two large ones or a group of small joints) after 2–3 days. In case of trophic disorders, the skin of the collar or lumbosacral zone is irradiated. Effective UHF electric field on joints. Massage, exercise therapy, and novocaine electrophoresis on the joints are used.
Late rehabilitation is carried out at a local sanatorium or clinic. Microwave therapy, ultrasound on joints, diadynamic currents on joints and reflexogenic zones are used. Other factors of sanatorium treatment are also used. Particular attention is paid to exercise therapy and massage.
During restorative treatment, resort treatment factors are used, among which thermal procedures (paraffin, ozokerite, hot sand, mud) and other factors (close tourism, outdoor games, dancing) predominate. When movement in the joints is limited, mechanotherapy, exercise therapy, massage, and balneotherapy in the form of chloride and radon baths are indicated.
Orthopedic care started at the stage of early rehabilitation and movement therapy continue at the stage of rehabilitation treatment.
At all stages of rehabilitation, it is necessary to carry out sanitation of foci of infection and timely treatment of intercurrent diseases.
Dynamic observation is carried out for 5 years after an exacerbation of the disease by a local doctor and an orthopedist (if necessary). The frequency of observation is once a quarter. A full examination and clarification of the diagnosis are carried out in a hospital setting 2 times a year.
2. Systemic lupus erythematosus
Systemic lupus erythematosus (SLE) is an immunopathological disease of connective tissue, characterized by predominant damage to the nuclei of cellular structures by universal capillaritis.
MSE and disability in juvenile rheumatoid arthritis
Medical and social examination and disability in juvenile rheumatoid arthritis
Juvenile rheumatoid arthritis (JRA) is a chronic acquired disease of the joints of an immunological (autoimmune) nature, beginning in a child under 18 years of age, belonging to the group of collagenoses and characterized by systemic damage, recurrent nature and progression of the articular syndrome with destruction and dysfunction of the joints.
Epidemiology: the primary incidence of JRA is 6-19 per 100,000 children.
Pathogenesis of juvenile rheumatoid arthritis (JRA). The pathogenesis of JRA is based on the activation of immune-competent cells, autoimmune reactions and the formation of immune complexes.
Classification: According to clinical and anatomical characteristics:
1) RA, predominantly articular form with or without eye damage - polyarthritis, oligoarthritis (2-3 joints), monoarthritis;
2) RA, articular-visceral form (with limited inflammation, Still's syndrome, allergic septic syndrome);
3) RA in combination with rheumatism and other BDSTs.
According to clinical and immunological characteristics:
1) the test for rheumatoid factor is positive;
2) test for rheumatoid factor is negative.
According to the course of the disease:
1) rapid progression;
2) slow progression;
3) without noticeable progression. According to the degree of process activity:
1) high (III degree);
2) average (II degree);
3) low (I degree).
According to the x-ray stage of arthritis:
1) periarticular osteoporosis, signs of effusion into the joint cavity, compaction of periarticular tissues, accelerated growth of the epiphyses of the affected joint;
2) the same changes and narrowing of the joint space, isolated bone lesions;
3) widespread osteoporosis, severe osteochondral destruction, dislocations, subluxations, systemic disturbance of bone growth;
4) the same changes and ankylosis.
Disability due to JRA in children
Disability criteria for juvenile rheumatoid arthritis in children
Juvenile rheumatoid arthritis (JRA) is the most common rheumatic disease in children. Its prevalence is 0.05-0.6%, the primary incidence is 6-19 per 100,000 children.
JRA is a chronic acquired disease of the joints of an immunopathological (autoimmune) nature, which began in a child under 16 years of age, belongs to the group of “collagenoses” and is characterized by systemic damage, recurrent nature and progression of articular syndrome with destruction and dysfunction of the joint.
The etiology is unknown; the occurrence of the disease is probably associated with a wide variety of environmental influences: bacterial and viral infections (clostridium, mycoplasma, chlamydia, influenza viruses, herpes, Coxsackie, etc.), medications, physical factors, etc. which reveal genetically determined inferiority of the immune response.
The development of JRA is based on a pathological immune response to any set of provoking factors. Given the uncontrolled process of reproduction of immunocompetent cells, this disease is prone to recurrence and progression.
Evgenia, Bryansk 08/16/2010 06:58:10
Hello, my name is Evgenia. From the age of 6 I was recognized as disabled since childhood. At the age of 18 they gave me group 3 (2005) and degree 2. In 2009, group 3, degree 0. There are 18 years in total in the group. On 06/07/2010 the group was removed altogether, explaining that I did not meet the provisions for establishing a disability group. At the moment, 3 ITU compositions have passed, leaving the Federal Bureau (Moscow) and the court. Diagnosis: Juvenile rheumatoid arthritis, polyarthritis, seropositive, chronic course, 2nd degree of activity, with deforming polyosteoarthrosis stage 2, FNS-2nd degree, anemia, myocardial dystrophy. There were 2 hospitals per year. Are the actions of the bureau legal, if I send the case to Moscow? Is it possible for them to consider the case in absentia (without my presence), since I do not have the opportunity to go to Moscow? If so, how can this be done?
Answers from lawyers at the Medical Law Center:
Khasikyan Karen Gevorgovich, 08/16/2010 06:58
Evgenia, the criterion for disability in the case of juvenile rheumatoid arthritis is the polyarthritic form. You have it, especially since stage 2 arthrosis has developed, we think that it is worth appealing the decision of the ITU bureau. For advice on appealing to the court, it is necessary to familiarize yourself with the medical documents.
№10597 Disability group
Both the city and the main ITU bureau refused to determine my disability group, despite the fact that I have been on crutches for a year! The reason is that I was not treated properly; I was not in rheumatology (in the hospital). But no one sends me there, although I went to rheumatologists three times in a year. They said: “Your treatment is only pills for a year, other methods.”
Galina Syktyvkar · 11/18/2013
№10536 Injustice VTEK
Hello, dear ones! I am 24 years old. Ill since 2000. The diagnosis was first made as idiopathic epilepsy, now it is cryptogenic. Those who were not interested sent me to apply for disability, those who were interested said that I was not entitled to disability, I spent 42 days in a mental hospital, I was refused, I received false information from the head of the hospital.
Rheumatoid arthritis is characterized by joint deformation, limited mobility and the development of contractures (immobility). To reduce symptoms, treatment includes exercise therapy, massage, swimming and physiotherapy. Therapeutic exercise for rheumatoid arthritis is aimed at strengthening ligaments and muscles, increasing range of motion in joints and slowing down pathological reactions.
Exercise therapy is indicated for almost all patients. With significant restrictions, it is possible to perform breathing exercises or positional treatment (more details later in the article).
The main contraindications for prescribing physical education:
All approaches to physical therapy for rheumatoid arthritis can be divided into three groups:
Individual classes are ideal for patients with the most severe stage of the disease, as well as for rehabilitation after surgical treatment.
Group classes are the most accessible and rational approach. Patients are grouped according to the degree of mobility limitation.
During consultations, patients are taught techniques and exercises that they can use at home.
The main condition for exercise therapy in the treatment of rheumatoid arthritis is regularity of exercise and systematic increase in load. Exercises should not be performed with force: after proper physical activity, the patient should experience an increase in strength and a decrease in stiffness.
During inpatient treatment, three periods of rehabilitation can be distinguished:
Preparatory, when the doctor teaches the patient relaxation and breathing techniques. The duration of these exercises is about 10 minutes, the duration of training is 1–2 days.
During the main period, a basic set of exercises is performed. Classes take place daily for two weeks, each lasting about half an hour.
The final stage is carried out before discharge: the doctor teaches the patient exercises that he can do at home.
The “position” method of treating rheumatoid arthritis is also classified as exercise therapy and is used for severe lesions, when the patient is practically unable to move and is mainly in bed. It should also be carried out during periods of exacerbation of the disease.
What is its essence? The mattress on which the patient lies must be smooth and hard; it is advisable to use a special orthopedic one. The feet should have support; for this you can use either a moving headboard or a stand. You need to change your body position at least once an hour, if necessary with the help of another person.
If contractures begin to form, special splints (hard strips of plaster-impregnated bandages) are applied. If this is difficult to do, you can use rollers, weights and other devices. For example, if the hip joint is affected, a two-level mattress is made, allowing the leg to be extended in a relaxed position.
In rheumatoid arthritis, the joints of the fingers are most often affected. Usually the hand takes on the characteristic appearance of a flipper, which leads to limited functionality and disability.
To reduce the strain rate it is advisable to:
Here is one set of exercise therapy exercises for hand injuries:
Starting position: hands in front of you, next to each other. Alternately turn your palms up and down.
Place your hands on the table and raise and lower them first, and then only your fingers.
Stretch your hands clenched into fists forward. Rotate the brushes clockwise and counterclockwise.
Place your elbows on the table, clasp your palms, spread and bring your elbows together without lifting them from the surface.
Make up-down, left-right and circular movements with each finger in turn.
Touch each finger to the thumb, as if grasping something round.
Squeeze and unclench the soft ball in your hand, roll it over the surface.
Rotate your hands at the wrist joint, while trying to relax your palm.
Move your fingers along the stick from bottom to top.
Rub your palms together.
Each exercise should be performed 5–7 times, depending on the patient’s condition. There should be no pain during exercise.
Click on the picture to enlarge
Raise and lower your shoulders, make circular movements forward and backward.
Place your palms on your shoulders, alternately bringing your elbows forward.
Clasping your elbows with your palms, raise them and lower them.
Lying on your back, bend, raise and lower your straightened arms.
Place your hands on your belt and alternately place them behind your head.
During exercises, it is very important to maintain the correct breathing rhythm.
The above exercises are called dynamic, that is, related to the movement of the body in space. They are mainly aimed at restoring mobility and preventing contractures.
There is another type of load in which muscle work is not accompanied by movement of the limb, since it is fixed: isometric. Isometric exercise helps strengthen muscle fibers, even with severe mobility limitations. An example of such an exercise: lying on your back, press with straightened arms on the surface.
Lying on your back, bend your leg at the knee joint without lifting the soles from the surface (sliding steps).
Move your legs bent at the knees to the sides and bring them back.
Swing with a straight leg while lying and standing, holding onto a support.
Circular movements in the hip joint with the leg bent at the knee.
Raising straight legs to the sides in a lying position.
Circular movements with a straight leg.
Isometric exercises are performed with the help of an assistant, who provides resistance and prevents the limb from moving.
With rheumatoid arthritis, the ankle joint is not often affected, but its deformation quite quickly leads to limited movement and disability. To prevent contracture, it is recommended to perform the following complex:
While sitting, bend and straighten your feet and toes.
Roll from heel to toe and back.
Stand on your toes against a support.
Try to lift various objects from the floor with your toes.
Roll a stick or ball with your feet.
Walk across the stick, stepping on it with the middle part of the sole.
Make circular movements with your feet.
When performing any complex of therapeutic exercises, it is advisable to alternate isometric and dynamic exercises, breathe correctly, and at the end of the session, conduct a muscle relaxation session.
To increase the load, you can gradually increase the range of motion in the affected joints and the number of repetitions.
Of all the sports, swimming is most suitable for the treatment of rheumatoid arthritis, since in water there is no stress on the joints due to the weight of the body. With a weight of 60 kg, completely immersed in water, a person feels only 7 kg. Therefore, exercises in the pool can be performed even by patients who practically do not move.
The intensity of the load is determined by the degree of immersion, which allows you to gradually restore motor activity. Higher water density requires greater effort to overcome resistance.
The temperature in the pool also has a positive effect: with thermal exposure, the pain syndrome is significantly reduced.
Contraindications to water activities:
In the pool you can perform the following complex:
Walking with straight and bent legs. It is advisable to spread your arms to the sides so as not to lose balance; if necessary, you can hold on to the support. The water level is adjusted depending on the required load.
Swing your legs back and forth, to the side, in circular movements.
Squats with legs wide apart (it is important to keep your back straight).
Having immersed yourself in water up to your neck, spread your straight arms to the sides and perform circular movements in the shoulder, elbow and wrist joints.
The swimming itself can be free or facilitated (using fins, special foam boards or inflatable objects). Depending on the goals pursued, you can increase the load on your legs or arms.
Before the start of the rehabilitation period, the physical therapy doctor assesses the degree of damage to the patient’s motor system. To do this, you can use various tests, but the most popular is the functional motor study, which lasts only 5–6 minutes. The doctor asks the patient to perform various actions, for each of which a certain number of points is assigned. The test results allow you to objectively assess the dysfunction:
Based on the results obtained, patients are divided into groups and the optimal complex of exercise therapy is selected.
If you have rheumatoid arthritis, don’t give up on yourself. Start doing special exercises. Daily physical therapy exercises will tone your muscles, improve your well-being and increase your mobility. Before starting gymnastics, you should consult your doctor.
Clinical picture. Juvenile rheumatoid arthritis begins before the age of 16 years. It is characterized by the following symptoms:
— early involvement of large joints;
- damage to one or more joints;
- lack of connection between the presence of systemic manifestations and the severity of joint damage;
Depending on the clinical picture, three main forms of juvenile rheumatoid arthritis can be distinguished:
- Still's syndrome (characterized by damage to internal organs);
The differences between these forms of the disease are presented in Table 15.8.
A disease similar to Still's syndrome can also occur at a later age.
Laboratory research. The results of laboratory tests conducted during an exacerbation of the disease indicate acute inflammation. However, in many patients, despite clinical signs of exacerbation, ESR will remain normal. In 15% of patients, rheumatoid factor is detected in the serum, which indicates an unfavorable prognosis of the disease. Antinuclear antibodies are detected mainly in patients with chronic uveitis and occasionally in patients with seronegative polyarthritis. In the latter case, despite the absence of rheumatoid factor, IgG to IgG is often detected in the serum of patients. In carriers of the HLA-B27 gene, juvenile rheumatoid arthritis usually manifests itself as oligoarthritis with sacroiliitis (in most cases this is observed in boys). As they age, they may develop ankylosing spondylitis.
Aspirin is the drug of choice in early treatment. The initial dose is 80 mg/kg/day orally in several divided doses. If high fever and joint pain persist, the dose is increased to 120 mg/kg/day. When selecting the dose of the drug, the concentration of salicylate in the serum is sometimes assessed (therapeutic concentration - 20-30 mg%). This indicator is unreliable for assessing toxicity in children. Since aspirin has a hepatotoxic effect in children more often than in adults, every six months, as well as when symptoms of liver damage appear, the activity of AST and the level of bilirubin in the serum are determined.
Other NSAIDs that are effective include tolmetin, naproxen, and ibuprofen. The effectiveness of other drugs in this group (Table 15.7) for juvenile rheumatoid arthritis has not been sufficiently studied. Indomethacin is not used due to its pronounced hepatotoxic effect.
Corticosteroids. Because corticosteroids cause growth impairment, they are rarely used for juvenile rheumatoid arthritis. Short courses of corticosteroids are prescribed only for anterior uveitis and high fever when aspirin is not effective. Gold preparations (1 mg/kg/month orally) are sometimes effective, but they often cause rash, proteinuria, and suppression of hematopoiesis. Methotrexate, sulfasalazine and hydroxychloroquine are considered safer for juvenile rheumatoid arthritis, but are less effective than for rheumatoid arthritis.
Forecast. Juvenile rheumatoid arthritis is a chronic progressive disease that occurs with exacerbations and remissions. In most patients with seronegative juvenile rheumatoid arthritis, disease progression stops in adolescence (Table 15.8).
Juvenile arthritis very often provokes the development of complex disorders in the child’s body and often leads to disability in children.
The most dangerous juvenile arthritis is rheumatoid arthritis - a rather rare disease. However, it ranks first in the group of rheumatic childhood pathologies. Children may “outgrow” the illness, or they may become disabled.
It all depends on the degree of development of the disease, its type and the age of the baby. At the first signs of juvenile arthritis in children, parents should definitely consult a doctor and not delay going to the hospital.
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Juvenile rheumatoid arthritis, abbreviated as “JRA”, is an autoimmune pathology accompanied by chronic inflammation of the joints. Not only connective tissues, cartilage and bones are affected, but also internal organs in some cases. The disease occurs before the age of 16 years.
Rheumatoid arthritis is autoimmune in nature. What does it mean? For currently unknown reasons, the child’s body begins to perceive its own cells as foreign.
The immune system produces a complex of antibodies that actively fight the “enemy.” That is, the body begins to slowly destroy itself.
Antibodies attack the joints, causing inflammation. In some cases, in the same way, they disrupt the functioning of internal organs - heart, kidneys, liver. The course of the disease is accompanied by partial or complete loss of the functional abilities of the joints - the inability to bend the fingers or legs, depending on the location of the inflammation.
Juvenile rheumatoid arthritis is usually classified according to the type of lesion, the nature of the pathology, the localization of inflammation and the type of development.
There are two groups of the disease based on the type of lesion. This is systemic juvenile arthritis and articular. The latter has its own subgroups.
Systemic juvenile arthritis in children is characterized by inflammatory processes not only in the joints, but also in the internal organs. This type of pathology is dangerous due to the accumulation of serum fluid, another name for which is “serous”, in the organs.
This primarily affects the functioning of the heart and lungs. The lymph nodes become inflamed, sometimes they can be clearly observed under the skin - they protrude above the surface, painless on palpation.
The joint type of the disease is characterized by damage only to the joints. Depending on the number of affected areas, the articular type is divided into:
It is not difficult to completely restore JOINTS! The most important thing is to rub this into the sore spot 2-3 times a day.
The disease is divided into four groups according to the degree of activity of the inflammatory process. There are high, moderate, low and remission groups. With successful treatment and timely diagnosis of the disease, the disease goes into remission.
It is also customary to divide juvenile arthritis according to immunological characteristics. There is a seropositive type, in which rheumatoid factor is detected in the blood. The seronegative type is characterized by the absence of a marker indicating rheumatoid factor.
The first category is usually more severe than the last - seronegative. The classification of the disease includes groups separated by the nature of the pathology.
The disease can manifest itself in different ways.
Systemic juvenile arthritis usually has an acute onset. The articular type of pathology can also have an aggressive course.
Not only large but also small groups of joints become inflamed. There is pain with movement and rest. An allergic rash often appears. Acute course of the disease is rare.
Subacute onset is characterized by less pronounced symptoms. No body temperature is observed. Most often one large joint is affected, less often two or three.
The affected area increases in size and swells, but there are no painful manifestations. Children under two years of age move very poorly or stop walking altogether. A striking manifestation of subacute onset rheumatoid arthritis is considered to be morning stiffness in a child. After sleep, the baby finds it difficult to move; the condition lasts about an hour or even more.
Another characteristic sign of the subacute course of the disease is uveitis - damage to the uvea of the eye. Vision deterioration develops gradually and may take six months before an accurate diagnosis is made.
This feature of the disease is often characteristic of girls under 10 years of age. The onset of a disease of this nature is often accompanied by oligoarthritis, a subtype of JRA.
At the first manifestations of one or another course of the disease, you should go to the hospital and begin an examination.
The cause of juvenile rheumatoid arthritis is considered to be genetic predisposition and viral or bacterial infection. However, these are only assumptions and not a precisely established etiology of the disease.
For many decades, scientists have been trying to understand the nature of the disease, but in vain. It is known that more than half of patients have rheumatic pathologies in their family. This gave rise to the establishment of a genetic predisposition as the cause.
It was also found that many patients suffered viral and bacterial infections, against the background of which the joints began to be affected. However, these factors could not be proven.
However, the etiology of the disease began to be considered hypersensitivity to external factors.
Depending on the type of pathology, different groups of symptoms are distinguished. Thus, the articular type of JRA will differ in symptoms from the systemic one.
Manifestations of joint juvenile arthritis include:
The systemic type of JRA and its symptoms are more aggressive. The disease has pronounced symptoms. Among them are:
Along with the general symptoms of systemic JRA, two syndromes are distinguished - Still and Wisler-Fanconi. The first is characterized by the appearance of an allergic rash, inflammation of the serous membranes. The second has signs such as spots on the skin, inflammation of tissue in the heart and fibrosis of the lungs. Both syndromes are accompanied by symptoms characteristic of a systemic type of disease.
A common sign of concern is joint swelling and swelling. That is, juvenile chronic arthritis initially appears, and later rheumatoid arthritis is diagnosed.
To diagnose the disease, they resort to laboratory blood tests to identify indicators of SER, rheumatoid factor, and ACCP - a marker of the disease.
The patient is also referred for an ECG, x-ray and ultrasound. In addition to the standard examination, the doctor collects an anamnesis of the medical history of the child, parents and other close relatives to identify rheumatic pathologies in the family. An examination by an ophthalmologist and rheumatologist may be required.
Only on the basis of the collected test results, images and opinions of other doctors can an accurate diagnosis be made and the type of JRA identified.
Drug treatment of juvenile arthritis in children includes taking non-steroidal anti-inflammatory drugs. They quickly and effectively reduce pain, reduce joint swelling and increase their functionality.
The drugs are taken orally after meals in case of long-term therapy. For a quick, necessary analgesic effect, the doctor prescribes taking the medicine 30 minutes before meals.
Medicines in this group do not block the process of joint destruction itself. The same effect includes drugs of the glucocorticoid group. These include:
The glucocorticoid group of drugs is used to achieve rapid suppression of the inflammatory process. With their help, painful symptoms are relieved. The medication is quickly eliminated from the body.
However, there are a number of contraindications under which intra-articular injections cannot be performed. The drugs are not used for a long time - complications and side effects may occur.
Immunosuppressive therapy is aimed at the process of joint destruction itself. This group of medications is designed for long-term use without interruption. The medicine is prescribed one to three times a week, depending on the body’s tolerance.
The following drugs are distinguished:
Each is prescribed with caution and taking into account the characteristics of the body, the type of disease and tolerability of the components of the medication.
In addition to drug treatment, it is necessary to monitor the child’s mobility. You cannot immobilize the body. Walking, swimming, cycling and other physical activities that do not involve sudden movements are shown.
Depending on the degree of damage to the joints, orthopedic correction is used - wearing special devices, corsets, splints, splints.
Since the disease can affect the child both by weight loss and weight gain, a diet is prescribed. The doctor determines its list depending on the individual characteristics of the body.
Eating foods rich in calcium, vitamin D, and protein is often prescribed. The diet is also prescribed as a prevention of osteoporosis - the consequences of systemic JRA.
An integrated approach to treatment will save the child from disability and other serious complications.
Juvenile rheumatoid arthritis is usually curable and leaves no consequences for the musculoskeletal system. Children often “outgrow” the disease.
However, advanced stages of the disease, which are systemic in nature, do not pass without leaving a trace. Not only joints are affected, but also other organs. Rarely, but if the disease is ignored, death can occur.
Complications include loss of vision, kidney failure, osteoporosis, and joint immobility. Osteoporosis causes frequent fractures. Unfortunately, the systemic form of the disease rarely goes away without a trace.
Prevention of the disease can only include careful monitoring of the child. This is especially true for families where rheumatic pathologies are not uncommon.
The disease cannot be prevented, since the cause of its occurrence is unknown. However, timely detection of the first signs of arthritis will already have the character of secondary prevention.
You cannot delay going to the doctor or self-medicate your child. This can lead to complications and serious consequences.
Juvenile rheumatoid arthritis
What is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory disease of the joints of unknown cause, lasting more than 6 weeks, developing in children under the age of 16 years.
How common is juvenile rheumatoid arthritis?
Juvenile rheumatoid arthritis is one of the most common and most disabling rheumatic diseases that occurs in children. The incidence of JRA is from 2 to 16 people per 100,000 children under the age of 16 years. The prevalence of JRA in different countries is from 0.05 to 0.6%. Girls are more likely to suffer from rheumatoid arthritis.
Why does juvenile rheumatoid arthritis occur?
Hereditary and environmental factors take part in the development of JRA, among which infection is of greatest importance.
There are many factors that trigger the development of the disease. The most common are viral or mixed bacterial-viral infection, joint injuries, insolation or hypothermia, preventive vaccinations, especially those carried out against the background or immediately after an acute respiratory viral infection or bacterial infection. The possible role of infection in the development of JRA has been suggested, but it has not yet been conclusively proven. A connection was identified between the onset of the disease and a history of acute respiratory viral infection, with preventive vaccination against measles, rubella, and mumps. Interestingly, the onset of JRA after vaccination against mumps is more often observed in girls. There are cases when JRA manifested itself after vaccination against hepatitis B. The role of intestinal infections, mycoplasma, and beta-hemolytic streptococcus in the development of JRA is not recognized by most rheumatologists. However, it is known that these infections cause the development of reactive arthritis, which can transform into JRA. The role of viral infection in the development of chronic arthritis is less clear. It is known that more than 17 viruses are capable of causing infection, accompanied by the development of acute arthritis (including rubella, hepatitis, Epstein-Barr, Coxsackie viruses, etc.).
The etiological role of viruses in the development of chronic arthritis has not been proven. Hereditary predisposition to JRA is confirmed by family cases of this disease, studies of twin pairs, and immunogenetic data.
Is juvenile rheumatoid arthritis dangerous?
In JRA, 40-50% of children have a favorable prognosis; remission may occur lasting from several months to several years. However, exacerbation of the disease can develop years after stable remission. In 1/3 of patients, a continuously relapsing course of the disease is observed. Children with early onset of the disease and adolescents with positive rheumatoid factor have a high risk of developing severe arthritis and disability due to the condition of the musculoskeletal system. In patients with late onset, the disease may transform into ankylosing spondylitis. 15% of patients with uveitis may develop blindness. Mortality in JRA is very low and is observed in the absence of timely treatment, the addition of infectious complications or the development of amyloidosis.
How does juvenile rheumatoid arthritis manifest?
The main clinical manifestation of the disease is arthritis. Joint damage is manifested by pain, swelling, deformation and limitation of movement, increased skin temperature over the joint. In children, large and medium-sized joints are most often affected, in particular the knee, ankle, wrist, elbow, hip, and less commonly, small joints of the hand. Typical for JRA is damage to the cervical spine and maxillotemporal joints. Pathological changes in the joint are characterized by the development of inflammatory reactions, which can lead to the destruction of the cartilage and bone tissue of the joints, narrowing of the joint spaces (the space between the ends of the bones that form the joints) up to the development of ankylosis (fusion of the articular surfaces of the bones that form the joints).
In addition to joint damage, the following extra-articular manifestations may be observed:
Increased body temperature, sometimes to high levels; develops, as a rule, in the morning, and may be accompanied by chills, increased pain in the joints, and the appearance of a rash. A drop in temperature is often accompanied by heavy sweats. The febrile period can last weeks and months, and sometimes years, and often precedes joint damage.
The rash can be varied, is not accompanied by itching, is located in the joints, on the face, chest, abdomen, back, buttocks and limbs, quickly disappears, and intensifies at the height of the fever.
To date, the exact causes of juvenile arthritis are unknown. Many scientists are of the opinion that the development of the disease is influenced by many different factors. However, it is quite difficult to single out the primary role of any individual factors. What may predispose or contribute to the occurrence of serious rheumatic pathology in childhood:
The presence of only an inflammatory process in the joints does not always indicate that the child has juvenile rheumatoid arthritis, and not reactive or infectious.
In the vast majority of cases, the disease has a severe chronic progressive course and sooner or later ends in disability for the child. The variety and intensity of clinical symptoms and signs of juvenile arthritis in children are influenced by the patient’s age, heredity, gender, initial state of immunity, living conditions, and adequate therapy. The following main variants of the course of the disease are distinguished:
Juvenile arthritis with systemic onset occurs in 10–18% of cases. Can start at any age. The incidence rate is approximately the same in both boys and girls. Various joint damage is noted. It happens that inflammation of the joints occurs several months, and sometimes years, after the onset of the pathology. In such cases, pain in the joints and muscles dominates, which intensifies at the peak of the fever.
Some may experience symmetrical damage to several groups of joints. Typically the inflammatory process affects the hips, knees and ankles. Some patients are characterized by polyarthritis with the spread of pathological changes to the cervical spine. Serious deformities, contractures and muscle wasting develop quite quickly. What may be the systemic manifestations of this form of juvenile arthritis:
With systemic juvenile arthritis, complications such as amyloidosis, developmental delay, severe impairment of the heart and lungs, hemorrhagic rashes, impaired consciousness, coma, and infection are possible.
If medical assistance is not provided in time, the risk of death is high.
This variant of the course is diagnosed in almost every third patient with juvenile rheumatoid arthritis. The clinical picture largely depends on the detection of rheumatoid factor (RF) during laboratory testing of the patient's blood. Often there is a rise in temperature to 37.5–38.0 °C.
If the laboratory test for RF is positive, the following signs and symptoms may occur:
Clinical picture of the polyarticular form with a negative test for rheumatoid factor:
Among the complications of the polyarticular form, significant joint contracture, early disability and significant developmental delay should be noted, especially if the disease began at an early age and had a severe, rapidly progressive course.
It has been established that pauciarticular juvenile arthritis is observed in 50% of cases. This form of the disease is characterized by two variants of the course:
Early or late onset of the disease will determine the clinical picture of pauciarticular juvenile arthritis. Early onset is observed in children aged 1–5 years. Girls are more often susceptible to this variant of the course. Asymmetric joint damage is noted. First of all, elbows, knees, and ankles suffer. Serious structural changes in the articular elements are recorded in every fourth case. In approximately 30–40% of cases, inflammation of the iris and ciliary body of the eye is detected.
Less common is late-onset pauciarticular juvenile arthritis, which develops between 8 and 15 years of age. Boys are predominantly affected (up to 90%). The joints of the lower extremities (hip, foot) are mainly affected. The pathological process can affect the sacroiliac joint. Quite rarely, compared with the early onset of articular disease, acute inflammation of the iris and ciliary body of the eye is detected (less than 10%).
Possible complications of pauciarticular juvenile arthritis:
Regardless of the form of the disease, juvenile chronic arthritis requires timely and optimal treatment.
Proper clinical examination plays a decisive role in the diagnosis of juvenile arthritis. What characteristic symptoms and signs will indicate JRA:
Laboratory diagnostics are of decisive importance in making a diagnosis. The main indicator that interests the attending physician is the presence or absence of rheumatoid factor. Indicators of clinical and biochemical blood tests are also taken into account, indicating the development of inflammation in the body (leukocytes, neutrophils, erythrocyte sedimentation rate, C-reactive protein, etc.).
In the absence of contraindications, an X-ray examination is performed, which allows detecting periarticular osteoporosis, bone structure disorder, reduction of joint space, ankylosis, and pathological changes in the spinal column. For a detailed assessment of the condition of intra- and periarticular structures, ultrasound examination, computed tomography and magnetic resonance imaging are used. It is worth noting that in most cases, the diagnosis of juvenile arthritis in children is made collectively with the involvement of additional specialists, such as an orthopedist, ophthalmologist, endocrinologist, phthisiatrician, hematologists, etc.
Only a highly qualified specialist can determine what kind of arthritis a child has - juvenile rheumatoid, reactive, infectious, rheumatic or psoriatic.
A comprehensive and individual approach is a priority in the treatment of juvenile rheumatoid arthritis in children. What does the attending physician expect to achieve when prescribing a course of therapy:
There is no primary prevention of juvenile chronic arthritis.
If there is an exacerbation of the disease, it is necessary to reconsider the motor regimen. Complete immobilization of the joint using a splint or splint is not used, as it can lead to contractures, muscle wasting and ankylosis. Dosed physical activity ensures the preservation of joint functionality. Swimming, walking, and cycling will be beneficial. Running, jumping and active sports have a negative effect.
A special diet is not provided, but nutrition must be balanced and nutritious. A diet with an increased amount of vitamins and essential microelements (potassium, calcium, phosphorus, etc.) is recommended. During glucocorticoid therapy, it is better to switch to a protein diet. Therapeutic fasting is strictly contraindicated.
One of the main components of the treatment of juvenile rheumatoid arthritis in children is considered to be therapeutic exercises. A set of physical exercises prescribed by the attending physician is performed every day outside the acute stage. Exercise therapy classes help increase the range of movement in the affected limbs, eliminate contractures, and restore muscle tone, strength and volume. When prescribing physical therapy, the individual capabilities of the patient are taken into account.
Orthopedic correction is carried out using special splints, splints, orthoses, etc. It is recommended to remove them during physical activity and training. If there are signs of osteoporosis in the spinal column, the use of corsets is indicated.
Do not forget that any orthopedic devices can only be used with the permission of a specialist.
The main role in the treatment of juvenile rheumatoid arthritis is assigned to the use of various medications. According to standard clinical practice, drug therapy includes the use of:
Only nonsteroidal anti-inflammatory drugs (monotherapy) are prescribed for mild forms of joint damage without systemic clinical symptoms for no more than 2–3 months. For polyarticular or systemic forms of juvenile rheumatoid arthritis, NSAIDs are usually combined with cytostatic immunosuppressants. To reduce the risk of adverse reactions from the digestive system and kidneys, it is recommended to use NSAIDs of a newer generation (for example, Meloxicam or Nimesulide). It is necessary to be extremely careful when using NSAIDs during an exacerbation of systemic manifestations due to the possible development of serious problems with the circulatory system (DIC syndrome).
The administration of glucocorticoids to children requires special attention. Indications for switching to glucocorticoid therapy are:
Taking glucocorticoids must be combined with immunosuppressive drugs. In some cases, it is worth using pulse therapy with methylprednisolone, which involves using high doses of the drug for several days. It should be noted that the dose of steroid medications should be reduced gradually. If you abruptly stop using glucocorticoids, you may develop pain in muscles and joints, twitching of limbs, fever, chills, vomiting, disturbances in psycho-emotional state, etc. To prevent osteoporosis, it is recommended to take calcium and vitamin D supplements.
Basic anti-inflammatory drugs form the basis of treatment of juvenile rheumatoid arthritis. Basically, basic therapy includes the following types of drugs:
Methotrexate and Sulfasalazine are most effective for articular forms of the disease. However, with a systemic variant of the course, Cyclosporine is more often prescribed. If it is not possible to achieve the desired result with the help of one basic anti-inflammatory drug, switch to combined immunosuppressive therapy. What combinations are possible:
Today, a promising direction in the treatment of juvenile chronic arthritis is the use of monoclonal antibodies (special immunoglobulins). A classic example of this group of drugs is Infliximab.
The dosage of almost all medications for a child suffering from rheumatoid arthritis must be determined with pinpoint accuracy. As a rule, it is calculated per kilogram of the patient’s body weight.
Topical use of glucocorticoids can quickly combat inflammation in the joints and maintain their functionality. As a rule, children are prescribed Diprospan, which is administered intra-articularly. The therapeutic course is determined by the attending physician, but on average, with an active form of the disease, 2-3 injections are used with an interval of 30 days. In addition to Diprospan, Methylprednisolone or Betamethasone, which have a prolonged effect, can be used. If infectious arthritis is suspected, glucocorticoid drugs are not used.
Treatment of juvenile rheumatoid arthritis in children is a very lengthy and scrupulous process.
Patients with juvenile rheumatoid arthritis should be supervised by a pediatric rheumatologist together with a cardiologist, pediatrician, ophthalmologist and other specialists. Features of the management of children diagnosed with JRA:
If juvenile chronic arthritis (JCA) is not treated, the disease will progress and inevitably lead to very serious complications.
It is quite natural that most parents are interested in the future prognosis of children with juvenile rheumatoid arthritis. Many factors determine the outcome of the disease. In approximately 40–50% of cases, the prognosis is favorable. Remission may last several years. However, in some cases, even after a stable long-term remission, a sharp exacerbation may occur. At the same time, almost every third patient has a frequent relapsing course of the disease.
An unfavorable outcome may be expected in children who have undergone long-term glucocorticoid therapy. Every second child develops severe forms of destructive arthritis. Quite often there is pronounced functional insufficiency of vital organs.
In addition, almost all patients with the polyarticular form of the disease that developed at an early age have an unfavorable prognosis. In 40% of cases, early pauciarticular juvenile arthritis leads to destructive damage to many joints. With a late onset, ankylosing spondylitis often occurs, characterized by inflammation of the spinal column with a sharp limitation of mobility in the affected parts. In 15% of children with uveitis, the disease can result in blindness.
Fatal outcome in juvenile rheumatoid arthritis is rarely recorded. As a rule, amyloidosis or infectious complications that develop in JRA with systemic onset as a result of prolonged glucocorticosteroid therapy can lead to the death of the patient.
Juvenile rheumatoid arthritis is a systemic disease of connective tissue, characterized by predominant damage to the joints of the type of erosive-destructive polyarthritis. It follows from this that almost all organs and systems where there is connective tissue can be involved in the process. It is important to know that the disease occurs exclusively among children.
Most often, large joints are affected: knee, ankle, hip, elbow, and much less often - small ones (interphalangeal, etc.).
First of all, the process develops in the synovial membrane, but over time, damage to the cartilage may occur, up to the development of ankylosis (complete immobility).
When only one joint is involved, then we talk about monoarthritis, when several – polyarthritis, but if the pathological process involves other organs, then we talk about systemic juvenile rheumatoid arthritis.
The disease can occur in both chronic and acute forms.
Idiopathic rheumatoid arthritis occupies a special place. This diagnosis is made if there is no connection with other rheumatological pathologies, and symptoms persist for 6 weeks in children.
Why does the main impact fall on the joints? The fact is that the synovial membrane (covers the inside of the joints) contains many vessels and other connective tissue elements, which contain proteins DR5, B27, A2 and others. Studies have shown that the immune system perceives these substances as foreign.
An autoimmune reaction begins: antibodies are formed, which, in combination with specific enzymes, have a damaging effect.
Later, the immune system goes out of control and causes damage to other tissues.
Inflammation forms in the synovial membrane, the wall is infiltrated with lymphocytes, swelling and effusion into the cavity occurs. This joint looks swollen, movement in it is limited, and the skin over its surface is reddened. Over time, the synovial membrane grows onto the cartilage, forming the so-called pannus.
The prognosis and consequences of juvenile rheumatoid arthritis are predictable - destruction of articular cartilage with subsequent disability of the patient.
It is very important to avoid complications of juvenile arthritis.
To learn how to do this, watch the video:
The causes of juvenile rheumatoid arthritis in children can be very diverse:
It should be noted that seronegative forms can occur without pronounced symptoms.
In any case, you can suspect juvenile rheumatoid arthritis in a child if you correctly compare all the symptoms:
If any of the symptoms of juvenile rheumatoid arthritis have been identified, children should be immediately referred to a specialist.
To suspect juvenile rheumatoid arthritis, you should pay attention to the following:
Laboratory and instrumental methods may show the following changes:
Today, doctors have highly effective drugs and methods in their arsenal to stop the progression of the disease.
Treatment is selected based on the degree of activity and stage of the disease.
Let's look at the most popular methods approved by the European League of Rheumatology (EULAR).
As a rule, juvenile rheumatoid arthritis in children is treated exclusively with conservative methods.
The central place in therapy is occupied by 3 main groups of drugs:
Until recently, the main drug in treatment remained ASA (acetylsalicylic acid), which was prescribed at a dosage of 60-70 mg/kg of the child’s weight per day. But the drug can provoke gastropathy and has a hepatotoxic effect, so indomethacin and diclofenac remain more preferable. The safest are selective drugs - nimesulide and rheumoxicam. An equally effective group of drugs are steroid hormones (prednisolone and methylprednisolone). In systemic processes they can be used for pulse therapy.
These drugs are prescribed according to strict indications, because they have a large number of side effects (increased blood pressure, cause peptic ulcers, impaired mental and sexual development).
For children, a standard dosage of 1 mg/kg body weight is recommended for 2-3 weeks. The dosage must be reduced gradually over several weeks to avoid “withdrawal syndrome”;
The “gold standard” is methotrexate, which inhibits the activity of the immune system. Also in modern medicine, cyclosporine A is used, which has a selective effect
They are antibodies that block key parts of the inflammatory process.
For example, adalimumab and tocilizumab are the most commonly used. These drugs can be used to treat both systemic and polyarticular juvenile idiopathic arthritis.
It is very important to radically change the child’s traditional lifestyle, from nutrition to rest.
Experts recommend following this scheme:
So, the disease develops in children under 16 years of age, which is why it has this name. Among all diseases of the musculoskeletal system, it occupies one of the first places. Although, in general, there are only 1% of children in the world with such skeletal damage. This pathology mainly provokes irreversible consequences not only in the joints, but also in the internal organs.
The disease is autoimmune in nature, so treatment is lifelong. It is impossible to completely get rid of juvenile rheumatoid arthritis. Experts also cannot yet determine the exact cause of its occurrence. However, we can already say what factors provoke its exacerbation.
It should be noted that the disease is more often diagnosed in girls. In addition, the later it begins to develop, the more difficult it is to treat.
The disease provokes humoral immunity. The fact is that pathological changes occur in the synovial membrane of the joint, as a result of which blood microcirculation is disrupted, as well as the gradual destruction of hard tissues. In this case, altered immunoglobulins are produced in the affected joints.
In this case, the defense system begins to intensively produce antibodies, which attack the body’s own tissues. Because of this, an inflammatory process begins to develop, which is almost impossible to eliminate. It is chronic and is constantly supported by the immune system.
Through the circulatory and lymphatic systems, antigens spread throughout the body, affecting other structures.
Adolescent or juvenile rheumatoid arthritis is a very complex and dangerous disease. In adults it may develop more slowly. Treatment of the pathology should begin immediately - immediately after the patient’s symptoms are described and differential diagnosis is carried out.
Naturally, you should also consider what types of diseases exist:
By type of lesion:
According to the distribution of the lesion:
By rate of progression:
Learn more about the disease from this video:
According to immunological characteristics:
According to the nature of the flow:
As you can see, juvenile rheumatoid arthritis can manifest itself in different ways. However, in any case, its treatment is necessary, complex and lifelong.
Despite the fact that the exact causes of this disease have not yet been established, it is possible to determine the factors that can trigger the pathological mechanism:
Juvenile rheumatoid arthritis manifests itself in different ways. It all depends on its type. The following symptoms of this joint disease can be identified:
These symptoms are basic and common to all forms of pathology. However, each type of disease is characterized by additional signs:
Reactive juvenile arthritis manifests itself as follows:
Subacute juvenile arthritis in children has the following clinical signs:
Oligoarticular juvenile arthritis has the following clinical symptoms:
In addition, rheumatoid juvenile arthritis is accompanied by severe muscle weakness, anemia and pale skin. The systemic type of the disease is particularly dangerous.
First of all, the main rule is that the diagnosis of rheumatoid arthritis in children of this type should be differential. So, in order to determine the disease, the following research methods are necessary:
Since juvenile chronic arthritis has nonspecific symptoms, only differential diagnosis can determine it. The effectiveness of treatment largely depends on its quality.
About the features of treating the disease without pills, see the video below:
Rheumatoid juvenile idiopathic arthritis is a complex disease that requires an integrated approach. That is, the therapy is designed not only to relieve pain and manifestations of the inflammatory reaction of the joints, but also to minimize the consequences of the pathology.
In addition to the treatment itself, the child needs to be provided with normal motor activity. Naturally, both adults (parents) and children must follow the recommendations of doctors. The child will have to learn to live with this disease. Complete immobilization of joints in children cannot be done, as this will only aggravate their condition and provoke the rapid development of pathology.
That is, the baby needs to move, but in moderation. For example, walking on a flat road, cycling without unnecessary load, and swimming will be useful for him. You can't jump, run or fall. If the phase of exacerbation of rheumatoid arthritis has begun, then the child should try to stay away from direct sunlight and also not get too cold.
The basis of treatment is drug therapy:
Chronic rheumatoid arthritis (oligoarticular or pauciarticular) can also be treated using non-drug methods:
In some cases, rheumatoid juvenile chronic arthritis is treated with surgery. The operation is used only as a last resort, when severe changes are observed in the joints that significantly limit its mobility. During the operation, excess growths are removed and a prosthesis is installed.
So, in pediatrics, juvenile rheumatoid arthritis is considered one of the most complex and dangerous diseases of the musculoskeletal system. Its prognosis depends on the severity and speed of the pathology. With a mild form of juvenile arthritis, the patient may not have any consequences. However, if the baby’s disease is severe, then changes in the skeleton cannot be avoided.
If in children the diagnosis has confirmed systemic rheumatoid arthritis (juvenile), then the prognosis is extremely unfavorable, since gradually the internal organs will refuse to work. Even if the little patient manages to survive, he will remain disabled forever.
As for the prevention of juvenile rheumatoid arthritis, no matter what recommendations a woman follows during pregnancy, they will not always give a positive effect. If rheumatoid arthritis is not congenital, then careful care of the baby can prevent it: absence of injuries, stress, favorable environment for raising the baby.
If symptoms do appear and the diagnosis is confirmed, then treatment cannot be delayed. Only in this case can an adult improve the child’s quality of life.
Elena Malysheva and her assistants provide complete information about the disease: