Translated from Latin, juvenile means youthful, that is, relating to children under 16 years of age. Juvenile rheumatoid arthritis is the most common and most dangerous joint disease in children. Despite the fact that the incidence is not high and does not exceed 1%, this pathology can lead to irreversible changes and disability.
This term began to be used back in 1946 by American doctors to refer to all chronic joint diseases. Currently, this term refers to a separate pathology, and not a group of diseases, as it was before.
The photo shows damage to the joints of the left hand
Juvenile arthritis has various causes, but the key factor is usually an inadequate response of the immune system, which in children is not yet mature and often fails. In girls, juvenile rheumatoid arthritis occurs 1.5-2 times more often than in boys.
The immediate mechanisms that trigger pathological processes are:
Genetic and hereditary predisposition also plays a large role in the development of the disease. This is confirmed by a study of twins and the presence of familial forms of arthritis. In addition, molecular geneticists have established a connection between the incidence and variability of certain genes of the major histocompatibility complex, which is responsible for the functioning of the immune system.
After contact with any environmental factor, the immune system is rebuilt in such a way that the body’s own cells are perceived as foreign, that is, an autoimmune reaction develops, which underlies rheumatoid arthritis.
The immune system is a powerful defense of our body, but, unfortunately, sometimes it can attack it
The signs of juvenile rheumatoid arthritis in children are varied, but the peripheral joints are most often affected. The process begins with the shell and gradually moves to the cartilage. Due to the fact that cells begin to be produced in excess, the joint may change its shape (deform). Next, a layer of cells is formed that covers the surface of the joint and disrupts metabolic processes - this further increases the destruction of tissue. The onset of the disease can be acute or subacute.
In case of acute onset, the following symptoms are noted:
Often juvenile arthritis is accompanied by damage to the spine and temporomandibular joints. Subacute onset is characterized by a less pronounced clinical picture. Function is impaired gradually; if the knee or ankle joint is affected, gait may change, and young children often stop walking. Sometimes there is morning stiffness: after sleep for half an hour there is a limitation in the range of movements.
Articular manifestations in children are typical and account for about 70% of all symptoms of juvenile rheumatoid arthritis. They are usually symmetrical and lead to deformation and fusion of the articular surfaces, which sharply limits mobility. If the pathology of internal organs is added to the damage to the joints, then they speak of the articular-visceral form, which is characterized by the presence of the following symptoms:
In girls, these symptoms are accompanied by uveitis (an inflammatory change in the membranes of the eye), which affects the membranes of the eye. First, lacrimation, photophobia and decreased visual acuity develop, which can ultimately lead to complete blindness.
Typically, juvenile arthritis is characterized by muscle weakness, anemia and pale skin. Vascular damage is also possible, which leads to a deterioration in the blood supply to the extremities; pigmentation or ulcers develop on the skin caused by insufficient oxygen and nutrients. In the area of the elbows and forearms, characteristic nodules can be found; they are painless, sometimes fused to the bone and do not exceed 5 mm in diameter.
During the course of the disease, kidney function also suffers; this is due to the deposition of a special type of protein (amyloid), which clogs the kidney tubules and reduces filtration capacity. 20% of children experience abdominal pain.
Swelling and deformation of joints in a child are some of the symptoms of the disease.
The pathological process begins in the outer lining of the joint, which is called synovial. Its cells, in response to aggressive influences, produce specific antibodies called rheumatoid factor. It is the determination of these proteins in the blood of children that is the main sign in the diagnosis of arthritis.
Rheumatoid factor forms circulating immune complexes that destroy the inner lining of blood vessels and surrounding tissue.
Juvenile rheumatoid arthritis is diagnosed in children based on:
To determine the degree of involvement of internal organs in the process, an ECG and ultrasound are performed. All children with joint involvement should be examined by an ophthalmologist for uveitis.
Skin rash as a symptom
Therapeutic measures for this pathology are aimed at suppressing the main process, maintaining joint mobility, and preventing exacerbations.
Drug treatment for juvenile rheumatoid arthritis includes several classes of drugs:
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used to treat joint pain and suppress the inflammatory process quite well and relieve pain. The duration of treatment should not exceed two months, as side effects often develop, including stomach ulcers.
Glucocorticosteroids are hormonal anti-inflammatory drugs and can be used via the intra-articular route of administration. Since these drugs can negatively affect the function of endocrine organs, they are prescribed to children under 5 years of age only in extreme cases.
Immunosuppressants, which suppress the immune system, should be prescribed immediately after diagnosis, since this therapy targets the cause of the disease. Juvenile rheumatoid arthritis is usually treated with methotrexate, sulfasalazine and leflunomide. These drugs have minimal side effects and are well tolerated with long-term use.
Biological agents are a new group of drugs; data on their effectiveness are currently insufficient.
Non-drug therapy methods are auxiliary, since they cannot eliminate the cause of the development of the disease juvenile rheumatoid arthritis. These include:
Therapeutic exercise, which is of great importance in improving motor activity. Exercises must be performed daily, sometimes with the help of an adult. Cycling and swimming are beneficial.
Physiotherapy, including magnetic therapy and electrophoresis with dimexide, can reduce clinical manifestations and change the immune status. To relax muscles and restore range of motion, it is necessary to perform infrared irradiation and apply paraffin and mud to the affected area. Cryotherapy (that is, cold treatment, we talked about it in detail here) and laser therapy are used during an exacerbation of the disease. They have a mild anti-inflammatory effect.
Massage can be performed only after periods of exacerbation. By improving the blood supply to the diseased joint, its mobility increases and the degree of deformation decreases.
Treatment with folk remedies is usually ineffective and may be unsafe.
In extreme cases, surgical correction of deformities is performed. After the child’s growth is complete, knee and hip replacements are possible.
Juvenile rheumatoid arthritis has a fairly favorable prognosis, with approximately half of children experiencing stable remission for ten years or more. However, in a third of patients the course of the disease is quite severe and leads to disability.
Since the exact cause of the disease has not been established, preventive measures have not been developed. Parents should try to protect their child from hypothermia and overheating, reduce contact with infections and comply with vaccination schedules.
Often the disease has a negative impact on the psyche. A child should not feel like an outcast or disabled. The task of society is to help these children lead a normal life, and parents and doctors are simply obliged to instill optimism in the child.
Juvenile rheumatoid arthritis is a chronic inflammation of the joints in children under 16 years of age with an unknown etiology and a rather complex pathogenesis, which is characterized by a constantly progressive course. Some patients experience changes in internal organs that can lead to disability.
Juvenile rheumatoid arthritis ranks first in prevalence among childhood rheumatic diseases. The incidence of the disease worldwide is 0.05 - 0.6% in the population. There are from 6 to 19 cases of primary morbidity per 100,000 children.
Manifestations of juvenile arthritis are very diverse. At the initial stage, the disease can be acute or subacute. In the acute form, the body temperature rises, the sensations become painful, and later swelling appears in one or more joints, in most cases it is symmetrical. In this case, symmetry may not be detected immediately and appears only a few days or weeks after the onset of the disease.
Most often, large joints such as ankles, knees, wrists are affected, less often, when at the onset of the disease small joints of the legs and arms (interphalangeal, metatarsophalangeal) are affected. The joints of the cervical spine are often affected by juvenile rheumatoid arthritis. There is pain, swelling in the joints, and sometimes the skin around the joints is hyperemic.
There is a continuous increase in body temperature, which can reach 38-39 degrees. In addition, a polymorphic allergic rash appears on the skin, the liver, spleen and peripheral lymph nodes are enlarged.
When performing a general blood test, anemia is observed, manifestations of neutrophilic leukocytosis with a shift in the leukocyte formula to the left, ESR increases to 40-60 mm/h, and Ig concentration increases.
The acute onset of the disease is typical for severe forms, such as the articular-visceral or generalized articular form, while relapses are common, and doctors' prognoses are disappointing. This form of the disease most often affects children at an early age; sometimes teenagers also get sick.
Subacute onset of the disease has less severe symptoms. Arthritis mainly begins in one joint – the ankle or knee. It begins to swell, ceases to function properly, and pain may not occur. The child’s gait changes, and children under 2 years of age stop walking altogether.
In the morning, stiffness in the joints appears, as a result of which after sleep the patient experiences some difficulties in moving the joints and self-care. It is difficult for him to get up and his walking slows down. Morning stiffness can last from a few minutes to an hour or more. For a long time, symptoms may appear in only one joint (rheumatoid monoarthritis).
Very often, girls of preschool age can suffer from unilateral or bilateral rheumatoid uveitis - rheumatoid eye disease. This disease leads to a sharp decrease in visual acuity, and sometimes to its complete loss, in some cases this occurs within six months. Much less commonly, rheumatoid uveitis occurs before the disease begins to manifest itself in the joints, making early diagnosis much more difficult.
With the subacute onset of the disease, several joints can be affected at once - mainly 2-4. This form of the disease is called oligoarticular. Joint pain and exudative changes may not be pronounced. This form of the disease is benign, exacerbations are not observed so often. If the disease progresses, then most likely there are two forms: articular - 65-70% or articular-visceral - 35-30%, respectively.
The articular-visceral form or systemic form is accompanied by five main symptoms:
There are two main types of juvenile rheumatoid arthritis: Still's syndrome, which is most often observed in children at an early age, and Wieseler-Fanconi syndrome, which usually affects schoolchildren.
When the disease occurs in the articular form, there is a permanent deformation of the joints, mobility in them is partially or completely limited. As a result, for 25% of children the disease ends in disability.
Diagnosing juvenile rheumatoid arthritis is difficult in most cases, especially if the disease is at an early stage of development.
List of main medications used in the treatment of juvenile rheumatoid arthritis. Should be used ONLY AFTER CONSULTATION WITH A DOCTOR.
Acetylsalicylic acid: dosage – 60-80 mg/kg/day, used no more than 3 g/day after meals 3-4 times a day. The course lasts from 1 to 3 months, taking into account individual tolerance.
Diclofenac: dosage – 2-3 mg/kg/day, but should not exceed 100 mg/day, in 2 divided doses.
Indomethacin – 2-3 mg/kg/day, children at an early age should take 25 mg/day. Older children take up to 100 mg/day.
Naproxen - 250-750 mg/day, taking into account age. Children under 10 years of age are not recommended to take. The duration of treatment can be several months or even several years.
Ibuprofen - 200-1000 mg/day, taking into account age. Taken 40 mg/kg/day, in 3 divided doses.
Methyl prednisolone, betamethasone, administered intra-articularly. The dosage depends on the size of the joints. More than 5 injections into one joint are not allowed, and an interval of 5 days must be observed. Prednisolone is taken orally, dosage: 1 mg/kg/day.
Methotrexate is prescribed orally 2-3 times a week. The weekly dose should be 2.5-7.5 mg/m2 of body surface.
Quinolines: chloroquine and hydroxychloroquine. Hydroxychloroquine, dosage 200-300 mg, taken once a day. Chloroquine, dosage - 125-250 mg/day, taking into account age, taken once a day after meals and before bedtime.
Penicillamine, used 60-125 mg in 1 dose, in the morning 2 hours before meals, the course lasts from 1.5 to 2 months.
Sulfasalazine, used 0.5-1 g/day, in 2 doses.
Cyclosporine, dosage 2-3 mg/kg/day in 2 divided doses, it is necessary to monitor the level of plasma creatinine. If it is increased by 30% or more, then the dose is reduced or the drug is discontinued. The course lasts 2 months and can be continued if necessary. Most often, basic drugs are taken for a long period (from one to several years).
When treated with basic drugs, the need for NSAIDs and glucocorticoids decreases, the quality of life improves, a favorable prognosis appears, and life expectancy increases.
Only secondary prevention of relapses of the disease is possible, which should be carried out under the supervision of a rheumatologist. During secondary prevention, continuous monitoring of the clinical picture and laboratory parameters of the disease should occur.
If symptoms of an early stage of exacerbation are observed, then drug therapy begins to be carried out more intensively, it is desirable to reduce physical activity, and if necessary, the patient can be admitted to a hospital.
. 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.
Juvenile rheumatoid arthritis is a progressive destructive-inflammatory lesion of the joints in children, which developed before the age of 16 years and is combined with extra-articular pathology. The articular form of the disease is manifested by swelling, deformation, contracture of large and small joints of the extremities, and the cervical spine; the systemic form is accompanied by general symptoms: high fever, polymorphic rash, generalized lymphadenopathy, hepatosplenomegaly, damage to the heart, lungs, and kidneys. The diagnosis of juvenile rheumatoid arthritis is based on the clinical picture, laboratory examination, radiography and joint puncture. For juvenile rheumatoid arthritis, NSAIDs, glucocorticosteroids, immunosuppressants, exercise therapy, massage, and physiotherapy are prescribed.
Juvenile (adolescent) rheumatoid arthritis is a diffuse connective tissue disease with predominant damage to the joints, developing in childhood and adolescence. Juvenile rheumatoid arthritis is the most common disease in pediatric rheumatology. According to statistics, it is diagnosed in 0.05-0.6% of young patients worldwide. Typically, the pathology appears no earlier than two years of age, and is 1.5-2 times more common in girls. Juvenile rheumatoid arthritis is a disabling rheumatic pathology that often leads to loss of ability to work at a young age.
Presumably, the development of juvenile rheumatoid arthritis is caused by a combination of various exogenous and endogenous damaging factors and the body’s hypersensitivity to their effects. The manifestation of juvenile rheumatoid arthritis can be facilitated by an acute infection (most often viral, caused by parvovirus B19, Epstein-Barr virus, retroviruses), joint trauma, insolation or hypothermia, injections of protein drugs. Potentially arthritic stimuli can be collagen proteins (types II, IX, X, XI, oligomeric matrix protein of cartilage, proteoglycans). An important role is played by family genetic predisposition to the development of rheumatic pathology (carriage of certain subloci of HLA antigens).
One of the leading links in the pathogenesis of juvenile rheumatoid arthritis is a congenital or acquired disorder of immunity, leading to the development of autoimmune processes. In response to the influence of the causative factor, modified IgG (autoantigens) are formed, to which autoantibodies are produced - rheumatoid factors. As part of circulating immune complexes, RF triggers a series of chain pathological reactions leading to damage to the synovial membrane and vascular endothelium, the development of non-purulent chronic inflammation of an exudative-alterative, and then proliferative nature.
The formation of microvilli, lymphoid infiltrates, proliferation of granulation tissue (pannus) and erosions on the surface of the articular cartilage, destruction of cartilage and bone epiphyses, narrowing of the joint space, and atrophy of muscle fibers are noted. Progressive fibrosclerotic joint damage occurs in children with seropositive and systemic variants of juvenile rheumatoid arthritis; leads to irreversible changes in the joints, the development of subluxations and dislocations, contractures, fibrous and bone ankylosis, and limitation of joint function. Destruction of connective tissue and changes in blood vessels also occur in other organs and systems. Juvenile rheumatoid arthritis can occur in the absence of rheumatoid factor.
Juvenile rheumatoid arthritis is an independent nosological entity that resembles rheumatoid arthritis in adults, but differs from it in articular and extra-articular manifestations. The American College of Rheumatology (AKP) classification identifies 3 types of juvenile rheumatoid arthritis: systemic, polyarticular and oligo-(pauci-)articular (types I and II). Oligoarthritis type I accounts for up to 35-40% of cases of the disease, mainly girls are affected, and onset occurs before the age of 4 years. Oligoarthritis type II is observed in 10-15% of patients, mainly in boys, the onset is over the age of 8 years.
Based on immunological characteristics (the presence of rheumatoid factor), juvenile rheumatoid arthritis is divided into seropositive (RF+) and seronegative (RF-). According to clinical and anatomical features, they are distinguished:
The course of juvenile rheumatoid arthritis can be slowly, moderately or rapidly progressive. There are 4 degrees of activity of juvenile rheumatoid arthritis (high - III, medium - II, low - I, remission - 0) and 4 classes of the disease (I-IV) depending on the degree of joint dysfunction.
In most cases, juvenile rheumatoid arthritis begins acutely or subacutely. An acute onset is more typical for generalized articular and systemic forms of the disease with a relapsing course. With the more common articular form, mono-, oligo- or polyarthritis develops, often of a symmetrical nature, with predominant involvement of large joints of the extremities (knee, wrist, elbow, ankle, hip), sometimes small joints (2nd, 3rd metacarpal, phalangeal, proximal interphalangeal).
Swelling, deformation and local hyperthermia in the area of the affected joints, moderate pain at rest and during movement, morning stiffness (up to 1 hour or more), limited mobility, and changes in gait occur. Young children become irritable and may stop walking. There are cystic formations and hernial protrusions in the area of the affected joints (for example, a cyst of the popliteal fossa). Arthritis of the small joints of the hands leads to spindle-shaped deformities of the fingers. Juvenile rheumatoid arthritis often affects the cervical spine (pain and stiffness in the neck) and the TMJ (bird jaw). Damage to the hip joints usually develops in the later stages of the disease.
Low-grade fever, weakness, moderate splenomegaly and lymphadenopathy, weight loss, growth retardation, lengthening or shortening of the limbs may occur. The articular form of juvenile rheumatoid arthritis is often combined with rheumatoid eye damage (uveitis, iridocyclitis) and a sharp drop in visual acuity. Rheumatoid nodules are characteristic of the RF-positive polyarthritic form of the disease, which occurs in older children, has a more severe course, and has a risk of developing rheumatoid vasculitis and Sjögren's syndrome. RF-negative juvenile rheumatoid arthritis occurs at any childhood age and has a relatively mild course with rare formation of rheumatoid nodules.
The systemic form is characterized by pronounced extra-articular manifestations: persistent febrile fever of a hectic nature, polymorphic rash on the extremities and trunk, generalized lymphadenopathy, hepatolienal syndrome, myocarditis, pericarditis, pleurisy, glomerulonephritis. Joint damage may appear in the initial period of systemic juvenile rheumatoid arthritis or several months later, taking a chronic relapsing course. Still's syndrome is more often observed in preschool children; it is characterized by polyarthritis affecting small joints. Wissler-Fanconi syndrome usually occurs at school age and occurs with a predominance of polyarthritis of large, including hip joints without pronounced deformities.
Complications of juvenile rheumatoid arthritis are secondary amyloidosis of the kidneys, liver, myocardium, intestines, macrophage activation syndrome with a possible fatal outcome, cardiopulmonary failure, and growth retardation. Type I oligoarthritis is accompanied by chronic iridocyclitis with a risk of vision loss, type II oligoarthritis is accompanied by spondyloarthropathy. The progression of juvenile rheumatoid arthritis leads to persistent deformation of the joints with partial or complete limitation of their mobility and early disability.
Diagnosis of juvenile rheumatoid arthritis is based on medical history and examination of the child by a pediatric rheumatologist and pediatric ophthalmologist, laboratory tests (Hb, ESR, presence of RF, antinuclear antibodies), radiography and MRI of joints, joint puncture (arthrocentesis).
The criteria for juvenile rheumatoid arthritis are: onset before 16 years of age; duration of illness over 6 weeks; the presence of at least 2-3 signs (symmetrical polyarthritis, deformities of small joints of the hands, joint destruction, rheumatoid nodules, RF positivity, positive synovial biopsy data, uveitis).
The X-ray stage of juvenile rheumatoid arthritis is determined by the following characteristics: I - epiphyseal osteoporosis; II - epiphyseal osteoporosis with narrowing of the joint space, single marginal defects (usures); III - destruction of cartilage and bone, numerous lesions, subluxations of joints; IV - destruction of cartilage and bone with fibrous or bone ankylosis.
Treatment of juvenile rheumatoid arthritis is long and complex and begins immediately after diagnosis. During the period of exacerbation, physical activity is limited (running, jumping, active games are excluded), and exposure to the sun is prohibited. Dietary restrictions include salt, proteins, carbohydrates and fats of animal origin, and sweets. It is recommended to eat foods high in vegetable fats, low-fat fermented milk products, fruits, vegetables, and take vitamins B, PP, and C.
Drug therapy for juvenile rheumatoid arthritis includes symptomatic (anti-inflammatory) fast-acting drugs and pathogenetic (basic) drugs. In the acute period of articular syndrome, NSAIDs (diclofenac, naproxen, nimesulide) are prescribed, and, if necessary, glucocorticosteroids (prednisolone, betamethasone) orally, locally and intra-articularly or in the form of pulse therapy. Long-term use of basic immunosuppressive drugs (methotrexate, sulfasalazine) can reduce the need for symptomatic drugs, prevent progression, prolong remission and improve the prognosis of juvenile rheumatoid arthritis.
An important component of the treatment of juvenile rheumatoid arthritis is exercise therapy, massage, physiotherapy (medicinal phonophoresis, mud, paraffin, ozokerite applications, ultraviolet irradiation, laser therapy) and treatment with natural factors. In case of severe joint deformities and the development of severe ankylosis, joint replacement is indicated.
Juvenile rheumatoid arthritis is a lifelong diagnosis. With adequate treatment and regular monitoring by a rheumatologist, long-term remission without significant deformities and loss of joint function with a satisfactory quality of life (study, professional work) is possible. The risk of exacerbation may persist for many years. A more unfavorable prognosis is with early onset, continuously relapsing course, RF+ polyarthritis and systemic forms of juvenile rheumatoid arthritis, leading to the development of complications, severe limitations of joint movements and disability. To prevent exacerbations of juvenile rheumatoid arthritis, it is necessary to avoid insolation, hypothermia, changing climate zones, limit contact with infectious patients, and exclude preventive vaccinations and the use of immunostimulants.
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.
Chronic inflammatory disease of the joints, which has no clearly established cause, lasts more than 6 weeks. Develops in childhood (Juvenile arthritis in children) until the age of 16. Girls are more likely to suffer from rheumatoid arthritis. Treatment of juvenile rheumatoid arthritis should begin as early as possible, since children with early disease and adolescents with positive rheumatoid factor are at risk of developing severe arthritis. All this can lead to disability due to the musculoskeletal system. In children with late onset of the disease, juvenile RA may transform into ankylosing spondylitis.
Pay special attention to the child, watch his gait and gestures so as not to confuse arthritis with a bruise
In general, JA (juvenile arthritis) is a group designation for rheumatic diseases occurring in childhood. When classifying, it is customary to divide juvenile rheumatoid arthritis, presented in the heading M.08 and M.09-X:
When making a diagnosis, the medical history of children contains the following criteria:
An example of damage to the joints of the hands
This is a general classification of juvenile rheumatoid arthritis. There is no proper definition for each terminological designation, or it is formed as “a chronic inflammatory disease of the joints in children that began before the age of 16.”
The term “juvenile rheumatoid arthritis” denotes an independent nosological entity; it resembles rheumatoid arthritis, which occurs in the adult population. In children with arthritis more than 3 months old, the following symptoms are noted:
Nature of the disease
Juvenile arthritis is classified according to the nature of its course:
Based on the distribution of the process, doctors diagnose the following forms in children:
In juvenile arthritis, the course of the disease can be:
In pediatrics, they note that rheumatoid arthritis can begin for the following reasons:
The symptoms of juvenile (childhood) rheumatoid arthritis are similar to the symptoms of ARVI, so do not try to take independent treatment measures!
With symptoms of juvenile (childhood) rheumatoid arthritis, damage to large and medium-sized joints (mainly) is observed. There is pain, swelling, limited movement and deformity, with an increase in local temperature. In children, a typical lesion for JRA is the involvement of the maxillotemporal joints and the cervical spine. In this case, pathological changes are characterized by the presence of inflammation, which, ultimately, in juvenile arthritis, can lead to the destruction of cartilage tissue, narrowing of joint spaces and the development of ankylosis (fusion).
Extra-articular manifestations are characterized by:
When the temperature drops, children experience heavy sweating, bed linen and shirts become wet. This febrile period can last for months (in severe cases, if untreated, years), and often precedes serious damage to the joints. A general blood test reveals an increase in ESR to 40-60 mm/h, anemia, neutrophilic leukocytosis with a shift in the leukocyte formula to the left, often an increase in the concentration of Ig, mainly IgG.
Symptoms in children in the acute period of juvenile arthritis are especially severe; there are generalized or articular-visceral (systemic) forms of the disease, which occur with relapses and an unfavorable prognosis. Most often they are observed in children of preschool and primary school age, but sometimes they also appear in adolescents.
In this case, the medical history of sick children appears to have less severe symptoms. The disease begins first with one joint (ankle, knee), which swells, hurts and loses part of its motor functions. Children under 2 years old stop walking, cry, ask to be held or sit. A change in the child’s gait may be noted, and after a night’s sleep, children experience “morning stiffness,” which is expressed in difficulty moving and self-care. The child gets up with difficulty, his gait is tense, slow and painful.
This condition can last up to an hour, so it is important for parents to pay attention to these symptoms and not attribute their reluctance to go to kindergarten or school to (feigning). Some pediatric doctors (especially those brought up on “Soviet thinking”) are also inclined to argue that the child is simply a malingerer. In this case, parents should pay due attention to the health and complaints of their baby, since the consequences of untreated juvenile rheumatoid arthritis are disastrous.
Red eyes may be a sign of arthritis, although at first glance, damage to the eyes and joints appears to be unrelated
In girls, especially preschool age, juvenile arthritis is accompanied by rheumatoid eye damage (one- or two-sided rheumatoid uevitis). In this case, all membranes of the eye are affected, as a result of which vision can be greatly reduced (to the point of complete loss), and, sometimes, in just six months. In rare cases, rheumatoid uevitis precedes the articular process, which is what makes diagnosis difficult.
In the subacute course, the pathological process usually involves several (2-4) joints - the oligoarticular form. At the same time, pain and exudative changes are mitigated, body temperature is normal, and polyadenitis is moderate. With this form of juvenile rheumatoid arthritis, the course is benign, with rare exacerbations.
Articular-visceral is characterized by the presence of characteristic symptoms:
This form of juvenile rheumatoid arthritis has two main variants:
If juvenile rheumatoid arthritis is left untreated, secondary amyloidosis may occur - this complication occurs due to the constant circulation of immune complexes in the bloodstream. Amyloid begins to be deposited on the walls of blood vessels, in the liver, kidneys, myocardium and intestines, which ultimately leads to disruption of the functioning of these vital organs. Most often, the kidneys suffer from this - this is indicated by persistent proteinuria, as a result, children develop chronic renal failure.
During the examination of the child, the specialist may prescribe the following examinations:
Treatment of JRA is carried out comprehensively; a regimen for children is established taking into account the form of the disease and the functional state of the joints. The diet is fortified, low-calorie, hypoallergenic, with a low amount of saturated fatty acids and high polyunsaturated ones. During the period of disease activity, inpatient treatment and the use of pathogenetic therapy are recommended, taking into account the form of the disease. When selecting therapy, take into account, first of all:
Diclofenac is a good medicine for suppressing arthritic pain and inflammation
Drug therapy is based on the use of basic drugs, NSAIDs and glucocorticoids. In general, modern treatment of childhood rheumatoid arthritis, although it does not provide complete healing, relieves pain, inflammation and resists further development of the disease. This gives the child the opportunity to lead a full life.
Basic treatment includes:
If an infection is present, it is important to undergo treatment with antibacterial drugs. Plasmophoresis gives a good effect and is used for the immune complex nature of the disease. Advanced cases may require the administration of intra-articular anti-inflammatory drugs, and surgical intervention (endoprosthetics) is prescribed if conservative treatment is ineffective.
Immunoglobulin (intraglobin, pentaglobin, sandoglobulin) is administered intravenously, no more than 10-20 drops per minute for 15 minutes. Then the injection rate is increased to 2 mlmin. It is possible to repeat infusion therapy every 4 weeks.
It is carried out jointly by a rheumatologist and an ophthalmologist. Locally, GCS can be used in combination with agents that improve microcirculation and mydriatics. If there is no effect within two weeks or if the syndrome progresses, cytostatic drugs (cyclophosphamide) are prescribed; the “point” for starting their use is the presence of acute and seropositive forms of juvenile rheumatoid arthritis in children.
First of all, you need to pay attention to the child’s nutrition. Limit sodium intake into the body (minimum table salt), exclude salted cabbage, sausage, and salted cheese from the diet. To restore calcium balance, you need to include dairy products, nuts and calcium supplements with vitamin D. A special exercise complex that supports muscle mass and joint mobility, physiotherapy, massage and spa treatment can have a good effect.
Try not to limit the child’s mobility, give him the opportunity to attend a sports section, and in case of illness, the chances of complications are extremely small
It is good to maintain an active lifestyle, since in energetic children the disease is milder and complications of arthritis are less likely to occur. But children must independently regulate the degree of physical activity, especially when pain appears in the area of inflamed joints.
If treatment is not timely or if the disease is detected late, there is a threat of consequences - the likelihood of impaired joint mobility increases, which leads to their deformation and destruction (disability) . When juvenile rheumatoid arthritis is treated at the first symptoms, the prognosis is usually good.