Jewelry arthritis in children. Juvenile systemic rheumatoid arthritis

juvenile arthritis - a disease characterized by inflammation (swelling) of the synovial membrane in children under the age of 16 years. The synovial membrane is the tissue that covers the joint cavity. Inflammation is often accompanied by fever and skin rash.

Juvenile arthritis is an autoimmune disease, a condition in which the immune system begins to mistakenly destroy itself. The disease occurs spontaneously, and the exact cause of its development has not yet been established. Researchers believe that juvenile arthritis may develop under the influence of genetic and infectious factors.

Types of juvenile arthritis

There are five main types of juvenile arthritis:

Systemic arthritis or Still's disease that affects various body systems. Systemic juvenile arthritis is usually accompanied by high fever and skin rash. The rash often appears on the trunk, arms, and legs. The disease can also affect internal organs, including the heart, liver, spleen, and lymph nodes, but excluding the eyes. Boys and girls are affected in equal proportions.

Oligoarthritis or pauciarticular juvenile arthritis the first six months is limited to the defeat of a maximum of five joints. At the same time, eye pathologies such as uveritis and iridocyclitis or iritis develop. This type of arthritis mostly affects girls. For most children, the disease resolves as they grow older.

Polyarthritis or polyarticular arthritis affects, as a rule, five or more joints during the first six months of the disease. Most often, this is a symmetrical lesion of the joints on both sides of the body. This type of arthritis can affect the jaw, cervico-occipital region, and joints of the extremities, and is also found mainly in girls.

It occurs in children with symptoms of arthritis and skin diseases. The child may have had psoriasis or another form of arthritis for several years before developing another disease. Children with this form of arthritis often have pitted nails.

Arthritis associated with muscle pathology of traumatic origin has another variety. The disease affects the spine, hip joint, eyes, and the junction of tendons and bones. This type of arthritis is more common in boys over the age of 8. However, there is usually a family history of arthritis of the lower back (spondylitis), usually in men.

Causes of juvenile rheumatoid arthritis

Doctors cannot determine the exact cause of the development of the disease. However, it is assumed that the disease develops under the influence of certain factors:

Hyperactivity of the immune system that destroys healthy joint tissues.

Viruses and other infections that cause an autoimmune reaction.

Hereditary predisposition that causes an autoimmune reaction.

Symptoms of juvenile arthritis

The disease is almost asymptomatic. Symptoms may vary depending on the type of arthritis:

Stiffness in the joints, aggravated after waking up.

Pain, swelling and pain in the joints.

Lameness (in children younger age acquired motor skills may be impaired).

Constant elevated temperature.

Weight loss.

Weakness.

Irritability.

Redness, pain in the eyes, blurred vision.

Symptoms may get worse and worse. Young children can continue to crawl after learning to walk. The child may feel stiff in the morning or have difficulty walking.

Juvenile rheumatoid arthritis It can also be accompanied by inflammation of the eyes, which, if left untreated, can cause blurred vision and blindness. Eye disease is often asymptomatic, and loss of vision can occur suddenly. Therefore, your child should have regular check-ups with an ophthalmologist. Treatment should be started before the child develops serious vision problems.

Diagnosis of juvenile rheumatoid arthritis

Your doctor will ask you to describe your child's symptoms, illnesses, and medical checkup. Your child's blood and urine tests may also be needed to check for symptoms of the disease. If symptoms are present, these tests will help your doctor determine the type of disease.

No visible symptoms signs of juvenile arthritis, as well as the presence of other diseases in a child, can complicate the diagnosis of juvenile arthritis. Due to lack effective way Juvenile arthritis is diagnosed by ruling out other conditions that present with similar symptoms, such as bone pathology or fractures, fibromyalgia, infection, Lyme disease, lupus, and cancer.

Before conducting a complete physical examination, the doctor will examine medical card child. Additional tests may be needed to determine the form of arthritis. Diagnostic methods may include:

A detailed blood test (blood test for leukocytes, erythrocytes and platelets).

Radiography (detection of bone fractures).

Scanning or magnetic resonance imaging (MRI).

A blood test to check for the presence of bacteria in the blood, which may indicate an infection in the bloodstream.

Virus testing.

Testing for Lyme disease.

A bone marrow test used to detect leukemia.

Erythrocyte sedimentation rate test (in people with inflammation, the erythrocyte sedimentation rate is higher than normal).

Test for the detection of rheumatoid factors - antibodies present in the blood of people with arthritis (a positive result is observed mainly in adults).

A test for the presence of antinuclear antibodies to check for an autoimmune response. (An autoimmune reaction is a condition in which protective system organism - the immune system, begins to self-destruct. This test also detects signs of eye disease in children with juvenile arthritis.)

Bone scan to detect bone and joint changes. (This test can also be used for joint pain of unknown origin.)

Analysis of samples of synovial fluid and synovial tissue, usually performed by an orthopedic surgeon.

Treatment Methods

The choice of treatment depends on the type and degree of arthritis your child has. Traditional treatment is to reduce pain and swelling with the help of painkillers and anti-inflammatory drugs (NSAIDs) in combination with physiotherapy procedures. Intra-articular steroid injections may also be used to reduce pain and swelling.

Failure of the immune system true reason, causing YUHA. However, the direct provoking factor of this condition in children can be:

1. mechanical damage to the joint;
2. presence of bacteria or viral infection;
3. hereditary predisposition to rheumatoid arthritis;
4. overheating or vice versa, severe hypothermia, for example, when swimming in a pond;
5. carrying out a routine vaccination in a child who is not completely healthy at that time.

Depending on the localization of the inflammatory process, four types of chronic arthritis in children are distinguished.

Pauciarticular. This type is characterized by damage to 1-4 articular joints. It most often develops in the knee joint. Pauciarticular arthritis can even affect the eyeballs. In girls, the disease is observed much more often than in boys.

Polyarticular. This form of arthritis in children is very dangerous, as multiple inflammations occur, in which more than four joints are affected at the same time. Treatment of polyarticular arthritis is a very long and complicated process. Usually during this period the child is in a hospital.

System. This type of juvenile arthritis is dangerous because in the early stages it occurs with a complete absence of symptomatic manifestations. And if signs are present, they can be confused with symptoms of other diseases.

Most often, the disease is manifested by night attacks: rashes, fever, enlarged tonsils, itching. Systemic juvenile arthritis can be diagnosed by excluding other diseases from the list. Unfortunately, precious time is often lost and the pathology enters a chronic phase.

Spondyloarthritis. This CA in children affects large joints - ankle, knee, hip. But there are cases when inflammation is localized in the vertebral or sacral zone.

Spondylitis is diagnosed when a specific antigen, HLA B27, is found in the blood.

The trigger for the development of juvenile arthritis can be such factors:

1. Severe hypothermia.
2. hereditary predisposition.
3. Joint and ligament injuries.
4. Inappropriate drug therapy.
5. Viral or bacterial infection.

In some cases, excessive exposure to the sun becomes the cause of the disease.

Classification

In a general sense, juvenile rheumatoid arthritis is characterized by a group definition of rheumatic-type diseases that occur in adolescence. The disease is classified by the following designations:

Juvenile rheumatoid arthritis is a rare disease, and in order to diagnose it in children, young patients sometimes have to be monitored for up to one and a half months. Statistics show that more often inflammatory processes in the joints are found in girls.

What does juvenile rheumatoid arthritis look like on the feet of a child?

Arthritis juvenile has several categories, according to which it is classified:

• based on the type of lesion, systemic arthritis, oligoarthritis and polyarthritis are distinguished;
• according to the nature of the course of the disease - acute and subacute;
• along the course of the disease itself, slowly, moderately and rapidly progressive forms are distinguished;
• according to the place of localization, they are divided into articular and articular-visceral (when internal organs are also affected) form.

Rheumatoid arthritis is treated in children based on the correct diagnosis and taking into account the forms of development of the disease.

There are several divisions of JRA into groups depending on which factor is being assessed. For example, according to the number of diseased joints, there are:

• monoarthritis;
• oligoarthritis - subdivided into type 1 and type 2;
• polyarthritis;
• systemic form, with the involvement of other organs.

With monoarthritis, the pathology affects only one joint, this form is quite rare. With oligoarthritis of the first type, large joints (knee, elbow) are more often affected, mostly girls are ill.

Characteristic of this type is a combination with an eye disease - iridocyclitis. The second type affects boys, in most cases - adolescents.

The condition is accompanied by inflammation of the sacroiliac joint. Polyarthritis affects more than five joints at the same time.

According to the nature of the course of rheumatoid, subdivided into acute, subacute and chronic. According to the specific antigen (rheumatoid factor) determined in the blood - into seropositive (if RF is present) and seronegative (RF is absent).

Clinical symptoms are:

During childhood rheumatoid arthritis, 4 degrees are distinguished: zero - remission, first - low activity, second - medium and third - high.

The International Classification of Diseases distinguishes the following types of diseases:

1. Pauciarticular juvenile chronic arthritis in children (most common - approximately 50% of all known cases of the disease):

• Only 1 joint is affected (often the knee);
• Inflammation develops in children under 5 years of age;
• In the blood, as a rule, there is a rheumatoid factor;
• Eye inflammation develops;
• After several years of therapy in 70% of patients, the disease goes into remission.

1. Multi-articular juvenile chronic arthritis (JJA) (the lesion extends to 4 or more articular joints);
2. Systemic JXA (is the most difficult to diagnose);
3. Juvenile spondyloarthritis:

• Diagnosed in 10% of children with arthritis;
• Develops in adolescents 12-16 years old;
• Affects large joints (knee, ankle, hip, joints are also affected spinal department);
• The inflammation goes to soft tissues;
• In 90% of patients with a similar diagnosis, a specific HLA B27 antigen is present.

1. Juvenile idiopathic arthritis (diagnosed when the cause of arthritis in children is not known):

• It occurs in approximately 85 out of 10 thousand children;
• Has an autoimmune character;
• It is established if signs of the disease are present for more than 6 weeks;
• Internal organs may be involved in the inflammatory process.

Juvenile arthritis is a collective term that includes all rheumatoid diseases in children. There is an official classification of the Jura:

• JRA M 08.0 - juvenile rheumatoid arthritis;
• JPA, juvenile psoriatic arthritis;
• JuHA, juvenile chronic arthritis (seronegative polyarthritis M 08.3);
• JCA M 08.1 - juvenile ankylosing spondylitis;
• M 08.2 - juvenile arthritis with a systemic onset;
• M 08.4 - juvenile arthritis with pauciarticular onset;
• M 08 8 - juvenile arthritis of other types;
• M 08.9 - juvenile arthritis as an accompanying disease in other pathologies.

Clinical signs

Three months after getting juvenile rheumatoid arthritis, children develop the following symptoms:

• destructive arthritis;
• the appearance of rheumatoid ligaments;
• small joints on the hands are deformed;
• seropositivity for rheumatoid factor;
• polyarthritis, progressing in parallel with damage to the limbs of the arms and legs.

Juvenile rheumatoid arthritis is of various types:

• acute, with a rapid progressive increase in signs that have a negative course and an unfavorable prognosis;
• subacute, with approximately similar signs that are not so noticeable demonstrative.

With the progression of the disease, doctors determine the following forms in the child:

• articular form, which primarily damages the apparatus of muscles and joints;
• articular-visceral form, involving the process of damage to the insides of the body (kidneys, liver, etc.).

The development of JRA disease can proceed as follows:

• develop quickly;
• develop moderately;
• develop slowly.

Symptoms depend on the form of rheumatoid arthritis; children often have an acute onset, with fever, weakness, and malaise. There may be an increase in lymph nodes (lymphadenitis) and the appearance of a characteristic nodular rash.

The appearance of tubercles on the skin is associated with damage to small blood vessels. Further inflammation of the joints develops: swelling, redness, pain.

Morning stiffness is noted, which can last up to half an hour and gradually disappears. The pain is aching, worse in the evening.

In the subacute course, all the symptoms are not so pronounced. Since rheumatoid arthritis is often accompanied by eye damage, a sharp decrease in visual acuity can also appear at the very beginning of the disease.

The most severe manifestations are observed in the generalized form of the disease. Prolonged febrile fever, a large number of rheumatoid nodules on the skin, rash, enlargement of the spleen and liver, heart damage in the form of myo- or pericarditis, the development of renal disorders up to acute renal failure.

If all of the above symptoms are observed in a child at the age of 2, then they speak of such a form of rheumatoid arthritis as Still's syndrome. Its course is more favorable.

Inflammation of the small joints is characteristic. In older (school) age, large lesions are noted, and this condition is called Wissler-Fanconi disease.

Attention! Due to age, children cannot clearly localize pain and formulate complaints, so parents should be alerted that the child has become irritable, eats poorly, loses weight, refuses to walk or crawl. It is better to consult a doctor immediately.

Complications of JRA:

• amyloidosis internal organs;
• myocarditis;
• growth retardation;
• vision loss;
• heart, kidney or lung failure.

Symptoms of a disease such as juvenile rheumatoid arthritis in children vary depending on the cause of the development of the inflammatory process, the form of arthritis and age group child.

Signs and symptoms of the disease

As mentioned above, children's CA is rather difficult to diagnose, therefore, at the slightest suspicion of a pathology in a child, a visit to the doctor should not be postponed.

Children may complain about:

1. general fatigue;
2. frequent headaches;
3. pain in the legs or arms (after all, children do not yet know what joints are).

There are also visual symptoms of the disease, such as fever and maculopapular rashes.

There are violations of the usual sizes and shapes of internal organs, which is confirmed diagnostic methods research.

To determine chronic arthritis in children, doctors use all kinds of laboratory and hardware techniques.

These include:

1. Blood tests: peripheral, ESR in arthritis, biochemical, to detect infections, immunological parameters.
2. X-ray of the chest and joints with a possible inflammatory process.
3. Electrocardiogram.
4. CT scan.
5. Ultrasound of internal organs (heart, abdomen, kidneys).
6. Examination of the esophagus and stomach.

If a child is diagnosed with a disease, it is necessary to take him to an appointment with an ophthalmologist. The doctor uses a slit lamp to conduct a microscopic examination of the eyeball and its membranes.

Juvenile rheumatoid arthritis is a separate nosological entity, in its manifestations it is very similar to adult rheumatoid arthritis. In children ill for more than three months, one can note such characteristic symptoms:

Deformation of the small joints of the hands;

Symmetric polyarthritis of the joints of the arms and legs;

The formation of rheumatoid nodules;

The presence of destructive arthritis.

According to the results of the examination, seropositivity for the Russian Federation is manifested

Diagnosis of the disease

Children's rheumatoid arthritis must be diagnosed as early as possible in order to be on time, to make adjustments to the development of the child. Therefore, a trip to the doctor is mandatory even with mild symptoms.

It is the specialist who will say with accuracy whether the child has arthritis or not. And for this you need to pass the diagnosis:

• At least one suspicious clinical manifestation- already a reason to pay attention to family ties in order to identify the presence of a genetic predisposition to rheumatoid arthritis.
• The child is assigned an x-ray of diseased joints to determine the nature and stage of the lesion. The picture will show how the articular cartilages are changed, whether there is an fusion of the synovial membranes, a narrowing of the cavity, etc.
• The presence of antibodies and rheumatoid factor will show a blood test of a small patient. The presence of anemia and neutrophilic leukocytosis are already signs of arthritis. ESR level indicates how active the disease is. But sometimes blood counts can be within the normal range.
• During the examination, the child will be sent for an ultrasound of the heart and an electrocardiogram to detect changes in the myocardium.
• Obligatory observation by an ophthalmologist in order to notice changes in the fundus in time.

Child at the doctor's office

If the doctor diagnoses the presence of the disease, serious treatment should immediately begin.

In the group of rheumatic diseases in children, juvenile arthritis occupies a leading position. The diagnosis is based on complaints, a survey of parents, clinical symptoms detected during a thorough examination and laboratory and instrumental methods.

General blood and urine tests are mandatory. They will help to identify the presence of inflammatory changes (increased ESR, low hemoglobin, a decrease in the number of red blood cells, a shift in the formula to the left), as well as initial changes in the functioning of the kidneys.

Biochemistry will determine the presence or absence of rheumatoid factor, C-reactive protein, antistreptolysin and a number of other important indicators.

X-ray studies and magnetic resonance imaging will confirm not only the diagnosis, but also the stage of JRA:

• osteoporosis of the epiphyses of bones;
• narrowing of the joint space and the appearance of marginal usury;
• multiple usura, destruction of not only cartilage, but also bone, subluxations are possible;
• deformation with proliferation of bone or connective tissue.

Diagnosis and treatment of rheumatoid arthritis depends on a number of criteria: onset in children under adolescence, duration of symptoms for more than six weeks and the number of reliable signs (3-4 - probable JRA, 5-6 - definite, 8 or more - reliable).

Treatment

JRA therapy is carried out in a complex way, while setting a certain regimen for the child, taking into account the form of the disease and the performance of the joints. The diet is issued with large quantity content of fatty acids and a large number of polyunsaturated. It is mostly low in calories and high in essential hypoallergenic vitamins. During the progression of JRA, inpatient therapy with the use of pathogenetic treatment is offered. In this case, the form and degree of rheumatoid arthritis are necessarily taken into account. When choosing the type of treatment, the pediatrician takes into account the following factors:

• how much the drugs will affect the activity of the process;
• type of immunopathology;
• the degree and dynamics of damage to bone and cartilage tissues;
• inflammatory articular syndrome at the local level.

Medical treatment is based on the use medications, glucocorticoids and non-steroidal anti-inflammatory drugs (NSAIDs). AT general plan topical therapy for juvenile rheumatoid arthritis does not give a complete recovery, but at the same time helps to remove pain, inflammation and does not allow the disease to progress and develop.

The child will be able to live fully with almost no difficulties.

JRA therapy includes:

1. Painkillers (diclofenac, aspirin, indomethacin), NSAIDs. They should be used with great caution, as they can cause certain complications. It is advisable to constantly monitor the attending pediatrician.
2. In the early stages of JRA, basic drugs such as methotrexate and sulfazine are prescribed.
3. Corticosteroids are used for short courses, otherwise they can interfere with the growth of the baby.
4. Selective inhibitors are used to relieve pain and inflammation.

If there is any infection, it is necessary to carry out therapy with antibacterial drugs. Plasmapheresis has a good effect and is used in the case of the immunocomplex nature of the disease.

In especially complicated situations, it is necessary to introduce intra-articular medicines preventing the inflammatory process. If such treatment does not help, then arthroplasty is possible, which is carried out through surgical intervention.

Immunotherapy is carried out using intravenous administration immunoglobulin drip. It is necessary to observe a certain mode when entering: approximately 10-20 drops per minute for a quarter of an hour.

After that, you need to increase the speed to 2 ml per minute. Infusion treatment can be repeated 1 time per month.

Therapy for rheumatoid uevitis is carried out by a specialist in rheumatology and an ophthalmologist. It is possible to use GCS in combination with mydriatics, as well as drugs that improve microcirculation.

If there is no result after two weeks of treatment and the disease still develops, then cytostatics are prescribed. They begin to be used when acute and seropositive forms of JRA are found in a child.

Juha is treated mainly with medicines, but plays an important role in the fight against the disease. proper nutrition, a special complex of physical education and physiotherapy techniques.

To alleviate the condition of the child and stop the pain syndrome in juvenile arthritis in children, the following medications are prescribed:

• Non-steroidal anti-inflammatory drugs - NSAIDs.
• Glucocorticoids - GC.

They are prescribed only by a doctor who relies on the medical history, age and body weight of the child. For example, in junior childhood GCs are not recommended for use due to their hormonal effects on the body, especially on the endocrine system.

Long-term use of NSAIDs can cause problems with the gastrointestinal tract.

Preparations from the group of biological agents are aimed at stopping the deformation of articular cartilage. Immunosuppressants are recommended to be used in combination with other drugs.

The most commonly prescribed medications for juvenile arthritis are:

1. Leflunomide.
2. Sulfasalazine.
3. Methotrexate.

During the period of remission of the disease, in order to prevent exacerbation, maintenance doses of drugs are prescribed.

Complementary therapies

Daily exercise therapy helps to improve the activity of a small patient. However, adults should help the child with the exercises and monitor their correctness. It is very good if the child will go swimming and ride a bike.

An important role in the treatment of chronic childhood arthritis is played by physiotherapy procedures:

• infrared irradiation;
• magnetotherapy;
• applications with therapeutic mud or paraffin;
• electrophoresis (with Dimexide).

In the period of exacerbation, laser or cryotherapy is used. These methods have, albeit insignificant, anti-inflammatory effects. Massage procedures should be performed carefully.

Treatment of juvenile rheumatoid arthritis in children is carried out taking into account the general condition of the joints and the whole body, the condition of the bone and cartilage tissue, and the nature of the immunological pathology.

The basic drugs of drug therapy are NSAIDs and glucocorticoids. Of the NSAIDs used: Naproxen, Ibuprofen, Indomethacin, Diclofenac, etc. They try not to use Aspirin, so as not to cause serious complications.

Corticosteroids are given in short courses, often administered intra-articularly, especially in severe inflammation of several joints with limited movement.

If iridocyclitis is present, corticosteroid eye drops are used. More severe cases require peribulbar or intraocular corticosteroid injections.

Immunotherapy is carried out by drip intravenous slow injection of Intraglobin, Pentaglobin, Sandoglobulin at a rate of 10-20 drops / min. Gradually increase the rate of administration to 2 ml / min. repeat infusion therapy every month (if necessary).

Rheumatoid uevitis in acute and seropositive forms of JRA is treated by a rheumatologist and ophthalmologist with cytostatics (Cyclophosphan, etc.).

AT last years, as part complex therapy, treatment with biological preparations was introduced:

• TNF blockers (Etanercept, Adalimumab, Infliximab) in combination with Methotrexate;
• CTL4Ig blocker (Abatacept);
• blockers of Interleukin 1 (Anakinar and Canakinumab) and Interleukin 6 (Tocilizumab).

Endoprosthetics

With a significant limitation of mobility in the joints, surgery: knee arthroplasty or hip joint. Operative removal of muscle contractures is also practiced.

Rehabilitation and prognosis

During rehabilitation, physiotherapy, exercise therapy, massage and non-traditional folk methods of treatment are carried out. great attention given to child nutrition. When conducting complex therapy, the prognosis for juvenile arthritis in children is favorable, with long-term remission without relapses.

Important. physical activity should be regulated, especially in pain syndromes.

Treatment of JRA should be started at the first symptoms in order not to lose joint mobility. Adequate treatment and diet will help to avoid deformation and destruction of the joints.

Given that the disease is chronic and progressive, the treatment of rheumatoid arthritis in children should be long-term. The complex includes drug therapy, physiotherapy, proper regimen and nutrition, physiotherapy exercises.

For the period of an acute condition, the load is limited. The diet includes a large number of vegetables and fruits, dairy products. Animal proteins and fats are limited, salt and sugar intake is reduced. Additionally, vitamin complexes are prescribed.

In rheumatoid arthritis, several groups of drugs are used. First of all, these are non-specific anti-inflammatory drugs (nise, diclofenac, indomethacin, ibuprofen) and COX inhibitors - a special enzyme (movalis, piraxicam).

They relieve pain and reduce inflammation. Cytostatics (methotrexate) are used as basic drugs - they suppress the autoimmune reaction.

As an addition, with insufficient effectiveness of immunosuppressants, glucocorticosteroids (prednisolone) are prescribed.

After the removal of acute manifestations, physiotherapy becomes an important link in the treatment. Phonophoresis with medicine, ultraviolet, ozocerite and paraffin applications, laser, mud therapy are widely used.

Surgical intervention shown only as a last resort, when the joint is completely deformed and immobile.

Treatment of juvenile arthritis is based on the following principles:

1. Therapy of the disease should be complex:

• Conservative drug treatment;
• Physiotherapy;
• Medication treatment traditional medicine;
• Detoxification therapy;
• Massage and exercise therapy;
• Spa treatment.

1. In acute arthritis, the child is placed in a hospital;
2. The limb is completely immobilized with special splints or bandages;
3. If necessary, surgical treatment is used (if acute destructive changes in the structure of the joint develop).

Purpose of therapy

The treatment process contributes to the achievement of such therapeutic goals:

• Relief of pronounced signs of the disease (symptomatic treatment);
• Destruction of foci of the development of the disease;
• Elimination of the consequences of the inflammatory process;
• Restoration of the natural functions of the joint;
• Removal of products of inflammatory reactions.

Drug treatment of juvenile rheumatoid arthritis can be classified into two types:

• symptomatic therapy, that is, treatment with non-steroidal anti-inflammatory drugs;
• immunosuppressive therapy, which helps to suppress the work of the body's immune forces.

The use of the first group of drugs contributes to quick withdrawal pain and reduce inflammation in the joints, as well as improve the functioning of the joints, but without preventing the process of their destruction.

The second group of drugs contributes to some stop development destructive changes and reduces the risk of disability.

Surgical intervention is required in the presence of severe deformities in the joints that interfere with the implementation of the simplest daily activities or in the case of severe ankylosis. Main method surgical intervention- This is a prosthesis of damaged joints.

Possibilities for disease prevention

It is impossible to prevent the disease itself, due to the lack of information about the causes of its development. And to prevent exacerbation, patients need to follow some rules:

• avoid exposure to sunlight;
• avoid hypothermia;
• reduce the possibility of contact with infections;
• refuse contact with animals.

Patients suffering from juvenile arthritis should not perform any preventive vaccinations and use drugs that increase the immune response.

The treatment program for children is compiled depending on the form of the disease and the condition of the joints. In the "quiet" period, diet is mandatory.

Food should be low-calorie, rich in vitamins and polyunsaturated fatty acids. Saturated fatty acids and allergenic foods should be completely avoided.

• The effect of various medications on the patient's condition;
• The nature of immunopathology;
• The nature and development of osteochondral destruction.

Non-steroidal anti-inflammatory drugs and glucocorticosteroids are used. Therapy is aimed at stopping the inflammatory process, relieving pain and maintaining the functionality of the joints. All this allows the child to lead a full active life.

Basic treatment includes the use of such drugs:

1. NSAIDs - these drugs are effective, but can cause a number of complications and side effects, therefore they are used with caution.
2. Glucocorticosteroids - are used in short courses to minimize the impact on the growth and development of children.
3. Selective inhibitors - with their help relieve inflammation and pain.
4. Basic lv on early stage rheumatoid arthritis.

If the disease is provoked by an infection, it is necessary to conduct a course of antibiotic therapy. If the disease has an immunocomplex etiology, plasmapheresis is used. With very severe pain, drugs are administered intraarticularly.

In the fight against the symptoms of the disease, proper nutrition of the child is very important. Salt intake should be kept to a minimum. This means that the diet should not contain sausages, hard cheeses, pickles, homemade food should also be salted very moderately. Thus, the intake of sodium in the body is reduced.

To maintain calcium balance, the menu should include nuts, dairy products, supplements with calcium and vitamin D are additionally recommended.

To maintain muscle tone and joint mobility, a set of gymnastic exercises is prescribed. As supportive and preventive measures, massage, a variety of physiotherapy, trips to resorts and sanatoriums are very useful.

Procedures for diagnosing JRA

During the diagnosis of children, the pediatrician may prescribe the following types of examinations:

1. Examination of the body through radiology. This method will allow you to determine the necessary symptoms of juvenile rheumatoid arthritis, which may include osteoporosis (decreased density of bone tissue), narrowing of the cracks inside the joints, as well as erosive damage to bone tissue.
2. Magnetic resonance imaging, nuclear magnetic resonance and CT scan will give the pediatrician the opportunity to diagnose the level of damage bone tissue and cartilage in inflamed joints.
3. Taking a blood test to detect antinuclear antibodies, rheumatoid factor and the degree of C-reactive protein. Laboratory tests will show how high the level of erythrocyte and leukocyte sedimentation rate is. In addition, existing inflammation can be detected.

Features of treatment and consequences of the disease

By its nature, juvenile arthritis is a disease that requires a special attitude to it, which consists of:

• in long-term use medicines;
• in the right way life;
• in constant dynamic diagnostics;
• in rehabilitation and preventive measures.

Unfortunately, arthritis in children is diagnosed on initial stages quite difficult, so doctors often have to fight with its chronic form.

At this disease high level disability, since the joint loses its mobility in the chronic course, and deformation and erosive changes can be observed in the articular cartilage.

A lot of juvenile arthritis also affects the eyesight of children, it deteriorates sharply. There are cases and its complete loss.

megan92 () 2 weeks ago

Tell me, who is struggling with pain in the joints? My knees hurt terribly ((I drink painkillers, but I understand that I am struggling with the effect, and not with the cause ...

Daria () 2 weeks ago

I struggled with my sore joints for several years until I read this article by some Chinese doctor. And for a long time I forgot about the "incurable" joints. So it goes

megan92 () 13 days ago

Daria () 12 days ago

megan92, so I wrote in my first comment) I will duplicate it just in case - link to professor's article.

Sonya 10 days ago

Isn't this a divorce? Why sell online?

Yulek26 (Tver) 10 days ago

Sonya, what country do you live in? .. They sell on the Internet, because shops and pharmacies set their margins brutal. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs and furniture.

Editorial response 10 days ago

Sonya, hello. This drug for the treatment of joints is really not sold through the pharmacy network in order to avoid inflated prices. Currently, you can only order Official website. Be healthy!

Sonya 10 days ago

Sorry, I didn't notice at first the information about the cash on delivery. Then everything is in order for sure, if the payment is upon receipt. Thanks!!

Margo (Ulyanovsk) 8 days ago

Has anyone tried traditional methods of treating joints? Grandmother does not trust pills, the poor woman suffers from pain ...

Andrew a week ago

What kind of folk remedies I have not tried, nothing helped ...

Ekaterina a week ago

I tried to drink a decoction of bay leaves, to no avail, only ruined my stomach !! I no longer believe in these folk methods ...

Maria 5 days ago

Recently I watched a program on the first channel, there is also about this Federal program for the fight against diseases of the joints spoke. It is also headed by some well-known Chinese professor. They say that they have found a way to permanently cure the joints and back, and the state fully finances the treatment for each patient.

– childhood disease, striking . the specific cause of it is usually difficult to establish. Experts name several factors at once that lead to the disease. We will consider them and also tell you what to do if your child has overcome the disease.

Juvenile idiopathic arthritis: forms and symptoms of the disease

Doctors allocate 6 forms this ailment. Moreover, each of them is characterized by a special course and its own symptoms. In other words, juvenile arthritis can occur in one of the following 6 forms.

• Systemic. In the presence of this form, the joints are affected in whole groups. Inflammation in them is characterized by severe pain and aching in the bones. In addition, it is noted heat body, sometimes rising to 40 o C. Plus, this form of juvenile arthritis leads to anemia and slow bone growth. At the same time, complications of the disease are much more dangerous. Its long course threatens with the development of pneumonia, lung failure, disruption of the heart and other life-threatening manifestations.
• Rheumatoid. This form of the disease is similar to rheumatoid arthritis, which often occurs in older people. In this case, the symptoms of the disease are prolonged joint pain, anemia and muscle weakness. Note also that the rheumatoid form is more often diagnosed in girls before school age.
• Psoriatic. Occurs against the background of psoriasis. In this case, one of the symptoms is inflammation of the iris. In addition, psoriatic arthritis is characterized by deformity of small joints, accompanied by pain.
• Oligoarticular. This form of the disease is diagnosed if no more than 5 joints are affected. In this case, symptoms such as pain, swelling, stiffness of movements and inflammation of the iris are observed. Of particular danger is a complication of this form of arthritis - complete loss of vision due to eye problems.
• Enthesopathic. In this case, not only the joints become inflamed, but also the tendons. Most often, this form affects the ankles, lower back and knees. As a rule, it is this type of juvenile arthritis that occurs in boys of preschool age.
• undifferentiated. The most difficult form of childhood arthritis to diagnose. In this case, the diagnosis is made if there are no symptoms of the other 5 forms of the disease. However, the big disadvantage is that this form of the disease is poorly treatable.

Possible causes of the disease

Juvenile idiopathic arthritis remains a mystery to medicine. After all, the main causes of this disease have not yet been established. Most experts attribute the appearance of this disease to autoimmune diseases. That is, with diseases in which the immune system attacks healthy cells in the body.

However, there are suggestions that the development of the disease involved viruses, bacteria and fungi. In children, immunity is not as strong as in adults. Because of this, microorganisms, getting inside, hit the child harder. This may justify why juvenile idiopathic arthritis occurs only in children and has slightly different symptoms than rheumatoid arthritis.

To date, doctors distinguish the following causes of idiopathic arthritis in children:

• hypothermia;
• prolonged exposure to the sun;
• infection with the Epstein-Barr virus or cytomegalovirus infection;
• vaccination against measles, hepatitis, rubella, etc.

As you can see, the reasons are very vague. Moreover, it is impossible to say with certainty that, for example, Sun rays or hypothermia trigger the mechanism for the development of arthritis.

Treatment of juvenile idiopathic arthritis

Treatment for juvenile arthritis includes taking medications and supplements. Plus, it also includes diet, exercise therapy and physiotherapy.

Medicines are used to relieve acute pain in the joints. In addition to this, they are assigned corticosteroid drugs helping to reduce swelling in the affected areas. natural preparation Licorice P with anti-inflammatory action will be very effective tool with arthritis.

The point is that the plant licorice naked contains phytohormones that have an effect similar to that of the hormone cortisone. At the same time, licorice does not have the mass that is characteristic of corticosteroids. It has been established that the substances of this plant inhibit the synthesis of an enzyme that causes inflammation characteristic of arthritis.

Physiotherapy helps to restore and speed up the metabolic processes in them. Plus, regular exercise under the supervision of a specialist removes the stiffness of movements and eliminates the appearance of joint pain.

The problem of inflammatory diseases of the joints in children is one of the most discussed in pediatrics. It is juvenile chronic arthritis that often leads to disability in children. Over the past 10-15 years, some progress has been made in the treatment of this pathology. The number of children transferred to the adult network with a disability has been significantly reduced. However, not all problems have been solved. Statistics indicate a high percentage of children with a long-term progressive course of the disease, with functional insufficiency, with signs of a drug disease caused by antirheumatic drugs.

For a long time, a variety of terms have been used to refer to this pathology: Still's disease, juvenile arthritis, juvenile rheumatoid arthritis (JRA), infectious nonspecific arthritis, juvenile chronic arthritis (JCA), deforming arthritis.

In 1994, the WHO Standing Committee on Pediatric Rheumatology proposed to eliminate all previous terms and name all chronic inflammatory diseases joints in children with juvenile idiopathic arthritis (JIA). In 1997, the pediatric subcommittee of ILAR (International League of Rheumatological Associations) in Durban (South Africa) modified the classification aspects, uniting under this name all arthritis of childhood that have chronic course.

Juvenile idiopathic arthritis is defined as arthritis of unknown cause, present for 6 weeks, onset before the age of 16 years, with other conditions excluded. In table. 1 presents three classifications of childhood chronic arthritis.

JIA is a collection of diseases that have a different onset, course and outcome, as well as a different etiology. According to the compilers, such a classification is necessary for the cooperation of scientific research and for better treatment JIA. The ILAR classification is not perfect and needs to be improved, as approximately 20% of children with arthritis either do not meet the criteria for any category or meet the criteria for several categories at once. This once again emphasizes the difficulty of diagnosing various forms of arthritis in children. Regardless of the classification used in each specific case, it must be remembered that juvenile rheumatoid (chronic, idiopathic) arthritis is a heterogeneous disease that needs early diagnosis and adequate therapy.

The experience of the specialized cardio-rheumatological department of the Children's City Hospital No. 2 of St. Petersburg, which for many years was led by Professor I. M. Vorontsov, Honored Scientist of the Russian Federation, made it possible to develop and confirm the main provisions regarding the nosology and therapy of juvenile arthritis. We traditionally use the name JRA and are guided by the JRA criteria developed by rheumatologists in Eastern Europe and Russia in the late 1970s.

JRA diagnostic criteria:

Arthritis lasting 3 months or more;

Arthritis of the second joint, occurring after 3 months and later;

Symmetrical damage to small joints;

contractures;

tenosynovitis or bursitis;

Muscular atrophy;

morning stiffness;

Rheumatoid eye disease;

Rheumatoid nodules.

Radiological signs:

Osteoporosis, small cystic restructuring of the bone structure of the epiphysis;

Narrowing of the joint spaces, bone erosion, ankylosis of the joints;

Violation of bone growth;

Damage to the cervical spine.

Laboratory signs:

Positive rheumatoid factor;

Positive biopsy of the synovial membrane.

Total number of positive signs:

JRA probable — 3 signs;

JRA defined - 4 signs,

JRA classic - 8 signs.

Despite the imperfection of these criteria (as well as any criteria), they help with the greatest probability to make a diagnosis. JRA is a chronic inflammatory disease of the joints with an unclear etiology and a complex, predominantly autoimmune pathogenesis, leading to gradual destruction of the joints and, in a number of patients, combined with severe extra-articular manifestations. In cases that are unclear and doubtful, the name JXA is applicable as a diagnosis of observation, trying to replace it with a clearer nosological form of arthritis in 3-6 months from the onset of the disease. The key to diagnosis is:

The desire for the maximum decoding of all forms of acute and recurrent arthritis to exclude their viral or bacterial nature;

Division of chronic arthritis into JRA and juvenile spondylitis (JSA). These groups have independent mechanisms of immunopathogenesis, different molecular genetic basis of the disease. The targets of immune attack are also different in these groups: synovial lining in JRA and cartilage cells in B27-associated arthritis (Table 2);

Identification of three main types of JRA: monooligoarthritis, polyarthritis, systemic form, radically different in course and outcomes.

The described distinctions made it possible to make therapy more targeted, to work out therapy algorithms for each type of lesion.

JRA drug therapy is divided into symptomatic (nonsteroidal anti-inflammatory drugs (NSAIDs) and glucocorticoids) and pathogenetic (immunosuppressors).

According to the classification adopted at the 5th meeting of the WHO International Rheumatism League (1993), antirheumatic drugs are divided into symptom-modifying, disease-modifying and disease-controlling drugs (Table 3).

In the treatment of juvenile rheumatoid arthritis, gold salts, D-penicillamine and chlorambucil are practically not used due to low efficiency and significant side effects. Neither of modern drugs does not fully reliably prevent the development of bone destruction, and therefore there is not a single drug that could be attributed to the disease control group of antirheumatic drugs.

The main provisions of JRA therapy:

NSAIDs and glucocorticoids are symptomatic agents, have anti-inflammatory and analgesic effects, but do not stop the progression of the disease, destruction of the joints.

In the case of an accurate diagnosis of JRA of a progressive course, therapy should be "advanced", i.e., include "basic" agents that affect progression.

In some cases, even when using all variants of hormonal-cytostatic therapy, it is not possible to achieve the desired effect, which forces us to look for new groups of drugs.

Therapy of any form of arthritis should be comprehensive and include orthopedic and rehabilitation measures, which should be started in a hospital and continued in an appropriate sanatorium and at home.

Oligomonoarthritis in young children. Much more common in girls. The knee, ankle joints are affected (usually one at a time, asymmetrically), sometimes individual fingers on the hands. The main danger is the addition of uveitis, which in this form takes a chronic course and leads to blindness.

In the absence of uveitis, arthritis has a rather favorable course, although it can take a long time (for several months and years). The spread of the process to other joints is rare. NSAIDs are used in therapy, although there are certain difficulties with the choice of the drug due to the younger age of the child. Indomethacin and Aspirin have age restrictions due to toxicity, Nise (nimesulide), approved for use, is also not safe for long-term use. Brufen, which has the least toxicity, has weak anti-inflammatory activity, mainly has an analgesic effect and can be used in some cases. With pronounced clinical activity, the most commonly used drug is Voltaren (diclofenac) (Table 4).

Any of the non-steroidal anti-inflammatory drugs has side effects associated primarily with the effect on the gastrointestinal tract (gastritis, ulcerative lesions, colitis) and kidneys (interstitial lesions). Therefore, their appointment must be justified.

There is individual sensitivity to various NSAIDs, both in terms of efficacy and tolerability of treatment. Do not exceed recommended doses. Inappropriate is the simultaneous use of two or more drugs. Patients receiving NSAIDs require monitoring of liver enzymes (ALT, AST) and serum creatinine levels, and in the presence of complaints from organs gastrointestinal tract(GIT) - gastroenterological examination. Tolerability of NSAIDs in childhood is better than in adult patients, but still I would like to warn pediatric rheumatologists against excessive, thoughtless prescription of NSAIDs for any arthritis.

Some forms of oligomonoarthritis occur practically without pain, without paraclinical activity. The emphasis in therapy in such cases should be on topical application means (ointments and gels with NSAIDs, applications with Dimexide, physiotherapy treatment).

With insufficient effectiveness of NSAIDs, intra-articular administration of glucocorticoids (GC) is indicated. Currently, methylprednisolone acetate and Betamethasone are used for intra-articular administration. Betamethasone is a combined drug containing fast-acting (betamethasone diphosphate) and long-acting (betamethasone dipropionate) components. The effect of intra-articular administration of HA persists for 6 weeks. 1 ml of Betamethasone is injected into large joints, and 0.5 ml into medium joints. It should not be forgotten that the local administration of HA also gives a systemic anti-inflammatory effect. American pediatric rheumatologists prefer triamcinolone hexacetonide and triamcinalone acetonide for intra-articular administration of HA due to their longer local effect and minimal systemic effect. Intra-articular administration of HA is carried out no more than 3 times in one joint and no more than 1 time per month.

With the ineffectiveness of the therapy for 6 months, even with monooligoarthritis, immunosuppressive therapy in the form of methotrexate at a dose of 10 mg/m 2 /week is connected.

Oligomonoarthritis with uveitis. Involvement of the eyes in the process changes tactics towards increased therapy (prescription of stronger NSAIDs, local therapy for uveitis). Requires early appointment of immunosuppressive therapy in the form of methotrexate at a dose of 10 mg/m 2 /week. When severe course uveitis - combination with cyclosporine at a dose of 3.5-5 mg / kg / day.

Immunosuppressive (basic) therapy is the main component in the treatment various forms JRA and in the absence of contraindications should be prescribed to each patient with this diagnosis. The appointment of immunosuppressive therapy in the early stages of the disease is especially important, which favorably affects the prognosis of JRA. The main property of basic preparations, regardless of the mechanism of action, is the ability to suppress the proliferation of immunocompetent cells, as well as synoviocytes and fibroblasts, which makes it possible to stop rheumatoid inflammation. A feature of all immunosuppressive drugs is the slow development of a significant clinical effect (usually within 1-3 months from the start of administration). Basic first-line drugs include methotrexate, leflunomide (Arava), cyclosporine A, sulfasalazine (Table 5). In case of insufficient effectiveness of monotherapy with any of the basic drugs, a scheme of combined basic therapy with first-line drugs can be chosen, but not more than two basic drugs in children.

The drug of choice among the first-line immunosuppressive agents is methotrexate, which is administered orally or intramuscularly once a week, and on other days, in order to reduce toxic effects, it is recommended to prescribe folic acid from 1 to 5 mg per day. The optimal ratio of immunosuppression/toxicity in the treatment of methotrexate, most rheumatologists note with the introduction of 15-20 mg/m 2 body surface per week. Increasing the dose above 25 mg/m 2 per week increases the frequency adverse reactions and, accordingly, changes this ratio on the contrary - toxicity / immunosuppression.

Second-line immunosuppressive drugs: cyclophosphamide, chlorambucil, azathioprine are used in pediatric practice to a limited extent, mainly due to their side effects.

With the ineffectiveness of therapy within 6-12 months, biological preparations are prescribed. This term is applied to medicines, produced using biotechnology and carrying out targeted blocking of key moments of inflammation with the help of antibodies or soluble receptors for cytokines, as well as other biologically active molecules. A feature of this group of drugs is the rapid (often within a few days) development of a pronounced improvement, which combines biological therapy with intensive care methods. A characteristic feature of biological agents is the potentiation of the effect in combination with basic drugs, primarily methotrexate. A drug from this group, infliximab (Remicade), has been registered in Russia. Remicade is a chimeric monoclonal antibody to tumor necrosis factor-α (TNF-α). Indications for biotherapy with infliximab in children are severe forms of JRA that are not sensitive to previous immunosuppressive therapy. The standard dose is 3-6 mg/kg per injection. The initial dose of infliximab is 3 mg/kg. The next administration of the drug after 2 and 4 weeks from the start of treatment at the same dose. Thereafter, this drug is administered every 8 weeks. In case of insufficient effectiveness of the therapy, the dose of infliximab should be increased. The drug is administered intravenously by drip for at least two hours, at a rate of no more than 2 ml/min, using an infusion system with a built-in sterile pyrogen-free filter with low protein-binding activity (pore size no more than 1.2 μm). It is used in combination with methotrexate at a dose of at least 15 mg / m 2 / week. Remicade is more effective than methylprednisolone pulse therapy. Before starting treatment, it is necessary to completely exclude the presence of a patient with tuberculosis infection, HIV infection, chronic carriage of hepatitis B and C viruses. The most common adverse reactions: allergic reactions, induction autoimmune syndromes, inhibition of anti-infective immunity and, possibly, antitumor immunity. Remicade is currently the most effective drug in the treatment severe forms early and late JRA, but is an expensive drug, which limits its use in practice. In the long term for the treatment of JRA, especially in forms resistant to conventional DMARDs, biotherapy is likely to be the preferred technology for the management of rheumatoid inflammation.

Polyarthritis. The classic polyarthritic variant in older girls is analogous to the adult form of rheumatoid arthritis and, especially in the presence of a positive RF, means rapid progression. There are signs of arthritis of small joints of the hands, joints of the lower extremities. Very quickly, almost all joints can be involved in the process, including cervical region spine, mandibular joint. It is with this variant that the use of NSAID monotherapy is insufficient, and early administration of immunosuppressive therapy is necessary. The drug of choice in this situation is methotrexate, administered at a dose of 12-15 mg/m 2 /week subcutaneously or intramuscularly. With ineffectiveness within 6-12 months, the dose of methotrexate can be increased to 20 mg / m 2 / week with good tolerance. The efficacy and tolerability of methotrexate improves when combined with glucocorticoids with intra-articular administration and / or a short course per os at a low dose (not more than 0.5 mg / kg), prescribed according to an alternating regimen with complete withdrawal. With inefficiency high doses methotrexate within 3-6 months and / or the appearance side effects it is advisable to use combination therapy with the combined use of methotrexate with cyclosporine at a dose of 3.5-5 mg/kg/day or methotrexate at a dose of 10-12 mg/m 2 /week and leflunomide.

Being generally negative about hormonal therapy in articular forms of JRA, we note positive effect from the use of Metipred pulse therapy (20-25 mg / kg per day for three days IV) in case of high paraclinical activity of the process.

With the ineffectiveness of the therapy within 6-12 months - the use of biological therapy (infliximab).

Systemic form JRA. The most severe variant of the course of the disease, characterized by high fever, rash, lymphadenopathy, hepatosplenomegaly. Polyserositis, myopericarditis, pulmonitis may occur. Pronounced reactive shifts in the blood are noted. The articular syndrome at the onset is unstable and is represented by arthralgias and/or unstable synovitis. In some patients, the "fixation" of the articular syndrome occurs very quickly with the rapid onset and progression of destruction.

Diagnosis of systemic forms of JRA at the onset of the disease is very difficult. It is necessary to exclude generalized forms of infection, sometimes - oncological pathology. In the treatment of such conditions, glucocorticoid therapy is necessary. It helps to quickly stop the activity of the process, to alleviate the condition of the child. In the debut pulse therapy with Metipred is used, in the future - a course of oral therapy with prednisolone. Doses (not less than 1 mg / kg per day) and the duration of the course are individual. As soon as possible, you should switch to an alternating scheme of application. When conducting pulse therapy with Metipred, antibiotic therapy is indicated.

In systemic variants, intravenous use of immunoglobulins (IVIG) is indicated. In systemic forms of JRA, IVIG is administered at a dose of 1-2 g/kg per course (daily, no more than 5 g per administration). This stops systemic manifestations, suppresses the activity of intercurrent infections. IVIG administration is contraindicated in selective immunoglobulin A deficiency.

With systemic forms of JRA in severe cases, rituximab (chimeric anti-CD20 monoclonal antibodies) can be prescribed as an intensive care drug.

The course of the systemic form may be complicated by macrophage activation syndrome. This significantly complicates therapy and worsens the prognosis. The drug of choice in these situations is cyclosporine.

In conclusion, it should be noted that the therapy of various forms of JRA, especially severe, progressive ones, is not an easy task, requiring the joint efforts of a doctor, a sick child, his parents and the family as a whole. The main goals of treatment of patients with JRA are suppression of the immunopathological activity of the process, slowing down and preventing destructive processes in the joints, as well as maintaining the functional ability of the patient, improving his quality of life. Monthly and sometimes long-term drug therapy should be combined with physiotherapy exercises, special exercises aimed at maintaining joint function, preventing muscle atrophy, and orthopedic correction means. Close cooperation between the specialized department and the sanatorium is optimal, as well as teaching parents and the child the correct functional stereotype of behavior, methods of physical rehabilitation.

Effective therapy leads to the achievement of remission of the disease and an improvement in the quality of life of the patient. It should never be forgotten that the aggressiveness of therapy should correspond to the degree of aggressiveness of the disease. The emergence in recent years of new biological agents (infliximab, etanercept, rituximab, adalimumab, etc.), which significantly affect the course of the disease, and the first experience of using some of them gives hope for improving the outcome of the disease.

For literature inquiries, please contact the editor.

G. A. Novik, doctor medical sciences, Professor
L. N. Abakumova
N. M. Letenkova, Candidate of Medical Sciences, Associate Professor
N. V. Slizovsky, Candidate of Medical Sciences, Associate Professor
N. N. Slizovskaya
SpbGPMA, St. Petersburg

Juvenile rheumatoid arthritis in children (JRA) is a term that refers to several forms of rheumatic diseases that develop before the age of 16 years. Epidemiological studies have shown that approximately 300 thousand suffer from manifestations of the disease, the conditions for which are being clarified to this day.

What are the causes and risk factors

Scientists provide compelling evidence for the involvement of genetic and environmental factors involved in the development of the disease in children. Studies have shown that if the pathology develops in one twin, the probability of developing rheumatoid arthritis in the second is 25-40%. The formation of the disease in non-identical sisters appears with a probability of 15-30%.

The specific causes of the development of JRA are unknown. There is no evidence that toxins, foods, or allergies in children cause joint inflammation. For unknown reasons, the immune system begins to attack its own structures ( synovium, then joints, muscles, eyes, etc.). Some data support the occurrence of juvenile rheumatoid arthritis due to a viral or bacterial infection. Not the last role is played by genetic predisposition.

Types of juvenile rheumatoid arthritis and their features

There are several types of JRA (ICD code 10 - M08) and each affects the body in different ways. Types of juvenile rheumatoid arthritis:

• pauciarticular;
• polyarticular;
• systemic;
• undifferentiated;
• arthritis associated with enthesitis;
• psoriatic.

The International League of Associations for Rheumatology highlights some similarities between these types of JRA. One feature common to all six forms is morning stiffness, which resolves after a series of physical exercises.

Common features, among most JRA subtypes:

• joint pain, stiffness and swelling;
• loss of joint function (limitation of range of motion);
• lameness due to pain;
• joint deformity;
• periodic fever;
• skin rash;
• myalgia (muscle pain);
• weight loss.

Attention! The disease can begin at any time, in children of different ages. It is considered chronic if the symptoms last from 6 weeks to 3 months.

Some children have persistent symptoms throughout their lives.

Possible complications of the disease

Babies under one year old have growth problems, resulting in different arm or leg lengths. Many patients experience moderate joint pain resulting in limited movement. The result is a loss of calcium from the bones, leading to osteoporosis.

In some cases, complications may occur: iritis, uveitis, glaucoma, iridocyclitis. These problems occur in parallel with the disease or after JRA is in remission. Perhaps these are the most insidious consequences of JRA. They cause inflammation in the eyes, resulting in blurred vision, pain, redness, sensitivity to light, and clouding of the cornea (cataract). The last stage of the disease threatens with loss of vision.

Important! Children need to be constantly shown to the ophthalmologist, because often the signs of eye diseases go unnoticed.

Juvenile arthritis also affects the muscles and affects the functioning of the gastrointestinal tract.

Dr. Komarovsky says that children with such a diagnosis and their parents can become victims of emotional stress associated with chronic illness. Long-term mild pain syndrome stimulates feelings of helplessness and hopelessness. School-age children often develop depression due to limited social life.

How should a child eat?

Children with arthritis have poor appetite leading to weight loss and poor growth; side effects drugs lead to weight gain. Chronic disease places increased demands on the body and creates the necessary additional calorie intake. Try to give your child a balanced diet. Distribute the meal in such a way that he does not go hungry. Give food rich in calcium and protein. For example, processed cheese, sauces, whole milk will dilute the usual diet a little. In addition, they are rich in calories, so that the child will gain weight.

Overweight children should be limited in sweets, fried, smoked and other foods rich in calories. Overweight only adds stress to the joints. The diet does not exclude vitamin products. Give kids a multivitamin for breakfast, they need extra calcium and vitamin D to build strong bones.

Which specialists treat JRA?

At the first visit to the hospital, after the described symptoms, the pediatrician on duty will refer the parents with the child to a rheumatologist. After passing the diagnosis, clarifying the signs and duration of such a condition, a rheumatologist can give a referral for an examination by an ophthalmologist, physiotherapist, pharmacologist.

How is the disease treated

JRA cannot be completely cured. However, an integrated and coordinated approach to the treatment of the disease will reduce pain, inflammation and stop the course of the disease. Treatment of juvenile rheumatoid arthritis in children is primarily carried out with the help of drugs:

• non-steroidal anti-inflammatory drugs;
• steroids;
• antirheumatic drugs;
• biological agents.

NSAIDs are widely used as first line therapy due to their positive effect on reducing inflammation and relatively few side effects. Usually, children are prescribed Indomentacin, Advil, Motri, Naproxen.

Steroids are used by those who suffer from moderate or severe disease. These drugs are administered intravenously, orally, or directly into the joint itself (Methylprednisolone, Decardon, Prednisolone).

Antirheumatic agents are required to prevent damage. They are administered intravenously or orally (Methotrexate, Sulfasalazine, Imirali, Neoral, Sandimmun). Antirheumatic drugs are more powerful, so serious side effects (pulmonary toxicity, liver dysfunction, decreased appetite, abdominal pain, bone marrow toxicity) are possible.

Biological agents may reduce disease progression. They are administered either by superficial injection under the skin or intravenously. Examples of biologics used in the treatment of JRA include etanercept (Enbrel), Kineret, Adalimumab (Humira), Tocilizumab (Actemra), and Abatacept (Orencia).

Attention! Autologous stem cell transplantation is required only for those children who have not been helped by other therapeutic agents.

treatment is not ruled out folk remedies. Use of funds home cooking allowed after consultation with a doctor. Such precautions are necessary so as not to start the inflammatory process.

What is the prognosis for children

The prognosis for the future is unequivocal: approximately 50% of children with JRA have rheumatoid arthritis already in adulthood. The remaining 50% manage to outgrow the disease. In patients with the progression of rheumatoid in adulthood, mobility is significantly limited, they are at risk for disability. Prevention of the disease cannot be performed due to insufficient determination of the causes. In any case, it is important to avoid hypothermia, heavy loads, viral and infectious diseases.