Juvenile oligoarthritis in children. Traditional medicine

Date: 19.04.2019

Arthritis is manifested by inflammatory processes in the joints, accompanied by severe pain due to the destruction of cartilage tissue and bone deformation. This disease is often associated with old age, but it can manifest itself in young people and even in children.

Inflammation in the knee joint in a child

In this case, patients under the age of 16 are diagnosed with juvenile rheumatoid arthritis.

With timely and correct treatment the prognosis is positive, but some forms of the disease can end not only with disability, but also with the death of the child.

Classification of childhood arthritis

Juvenile rheumatoid arthritis is a rather rare disease, and in order to diagnose it in children, it sometimes takes up to one and a half months to observe young patients. The statistician testifies 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?

Juvenile arthritis has several categories by which it is classified:

based on the type of lesion, systemic arthritis, oligoarthritis and polyarthritis are distinguished;
by 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 released;
according to the site of localization, they are divided into articular and articular-visceral (when internal organs) form.

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

Causes and signs

For some unknown reason, certain joints are affected. Immediately inside the synovial membrane, microcirculation is disturbed, and cells are destroyed. This, in turn, provokes the production of immunoglobulins G, the body perceives them as aliens.

In response, the system produces antigens that destroy foreign bodies. This confrontation of two opposing immunoglobulins is a destructive complex called "rheumatoid factor". Under its influence, the synovial membrane of the cartilage and the joints themselves are gradually destroyed.

Pathology of the development of juvenile arthritis

As a reaction to such pathogenesis, cytokines are produced that destroy, together with foreign bodies and the articular tissues themselves. Inflammatory processes in children become chronic, preventing nutrients from penetrating into the articular cavity.

But the penetration of the rheumatoid factor beyond the joint is in full swing - the antigen, along with the blood, is carried throughout the body, translating juvenile rheumatoid arthritis into a more severe form.

Clinical manifestations

This disease manifests itself in children in different ways, but there are common signs for all forms of arthritis:

soreness is felt at the site of the inflamed joint, leading to stiffness of movements;
a little later, there is redness of the skin and swelling;

Swelling and redness on the hands of a child

typical for a similar disease and hyperthermia (local temperature increase).

In children, as a rule, very small and rather large joints are affected.

The main places of localization can be called the mandibular-temporal regions, as well as the joints of the cervical spine. As children grow up, the damage to these joints is manifested by various deformities.

By the nature of the course, arthritis in children is manifested as follows:

Acute manifestation of the disease can be observed in students primary grades and preschoolers. A jump in overall body temperature is added to the above symptoms. Sometimes an allergic rash is observed on the body. When examining the child, an increase in nearby lymph nodes, as well as some internal organs (spleen, liver). At first, the disease manifests itself with one-sided symptoms, but this is only at first glance - the lesion comes from two sides and is symmetrical. The prognosis here is unfavorable, since the disease progresses rather quickly and ultimately turns out to be malignant.
Under acute form arthritis in children is not detected immediately, because it proceeds rather slowly. Soreness in the joints may be absent or insignificant. Therefore, swelling is not always associated with arthritis. The diagnosis is based on morning stiffness of the body, which can last more than an hour. Such a dysfunction of the joints is manifested by inactivity, the child has difficulty walking. In young children (up to 2 years old), temporary paralysis is sometimes observed.
Examination in the initial stages reveals a one-sided lesion - inflammation of other areas will develop later if treatment is not started on time. The temperature in this form, if it rises, then insignificantly. Lymph nodes also increase slightly. The liver and spleen do not change, so the prognosis in this case is more favorable - the disease is treatable.

Despite the fact that the subacute form of arthritis in children manifests itself more easily than the acute one, and is more amenable to therapy, the disease should be taken seriously. It is the subacute form that is more difficult to identify at the initial stage of development, and this is already wasted time, which affects the success of recovery.

Systemic arthritis

Systemic juvenile rheumatoid arthritis causes complications - damage to internal organs is observed. In addition to high temperature(especially in the morning) this form of the disease also has its own specific symptoms:

The body reacts to high temperature with a rash, which manifests itself in the form of papules on the face, thighs and the lateral surface of the buttocks. These rashes are not accompanied by itching and go away on their own.
As for the lymph nodes, almost everything on the body increases. They are well felt, since they become quite large, sometimes significantly protruding. The adjacent nodes do not merge with each other and do not solder with the skin. Touching them causes severe pain.
When examining the internal organs, an accumulation of serous fluid is observed, which can capture the lung cavity and heart muscle. Pulmonary and heart failure are often classified.
The body is subject to general intoxication, which is why the spleen and liver increase in size.

Such symptoms are quite serious, and often lead to serious consequences.

Oligoarthritis

Most of all, in children, an oligoarthritic form can be observed, when not affected a large number of joints (less than four), and it captures both large bones and rather small ones. The disease progresses slowly, but it manifests itself in children of any age - both one-year-olds and schoolchildren.

Despite the fact that this juvenile rheumatoid arthritis is often unilateral, the consequences are severe:

The one-sidedness of the inflammatory process in a growing organism leads to asymmetry of the limbs.

Arthritis knee joint The child has

The affected joints stop developing, and this affects the slowdown in the growth of the whole body.
Oligoarthritis often seizes eyeball- there is an inflammation of the inner lining (uveitis). In the future, this can manifest itself as cataracts and even blindness.

It is difficult to diagnose this form at the initial stage, therefore, the prognosis is disability.

Polyarthritis

This form of the disease is less common than the one described above, and has its own characteristics. In contrast to oligoarthritis, in this type of disease, joints affected by inflammation are already much larger.

According to the manifestation of rheumatoid factor, polyarthritis is divided into subtypes:

The seronegative form captures the cervical vertebrae and the jaw-temporal articulations. The disease may already appear on early stages development of the body (up to a year), but the character is benign.
Polyarthritis seropositive affects the limbs. The bones on the articular surfaces quickly develop irreversible consequences. The disease in children is subacute and is considered the initial stage of adult rheumatism.

Both subtypes of polyarthritis are considered an unfavorable form, since already in the initial stage of the disease, growth retardation occurs, which is irreversible. So in the future, the child has only a disability.

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 visit to the doctor is required even with mild symptoms. It is the specialist who will say with precision whether the child has arthritis or not. And for this you need to go through diagnostics:

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 the diseased joints to determine the nature and stage of the lesion. The picture will show how much the articular cartilage is changed, whether there is fusion of the synovial membranes, narrowing of the cavity, etc.
The presence of antibodies and rheumatoid factor will be shown by examining the blood of a small patient. The presence of anemia and neutrophilic leukocytosis are already signs of arthritis. The ESR level will indicate how active the disease is. But sometimes blood counts can be within normal limits.
During the examination, the child will be sent for an ultrasound of the heart and an electrocardiogram to detect changes in the myocardium.
Observation by an ophthalmologist is mandatory in order to notice changes in the fundus in time.

Child at the doctor's appointment

If a doctor diagnoses the presence of an illness, serious treatment should be started immediately.

Therapy

Since it is difficult to completely cure rheumatoid arthritis, the main aspects in therapy will be aimed at stopping inflammatory processes with suppressing reactions in the joints, protecting the body from systemic manifestations as well as minimizing negative consequences illness.

Therapy includes:

Treatment of arthritis with rheumatoid manifestation is carried out exclusively in a hospital setting. Oral medications are supposed to relieve inflammation and relieve pain. Doses of drugs are selected individually for each child, based on his body weight.
With malignant manifestations of the disease and all kinds of complications, glucocorticosteroid drugs are prescribed, with the help of which a number of problems can be effectively and quickly solved. But here you should take into account the early age of children, so it is necessary to select these funds with caution.
To reduce humoral pathological immunity, immunosuppressive agents such as "Sulfosalazine" or "Methotrexate" are used in treatment. Since some toxicity of the body can be observed here, in parallel with therapy, blood parameters are monitored and the effect of the drug on the bone marrow is assessed.
Surgery is sometimes recommended if the changes in the joints are sufficiently pronounced and lead to limited mobility. The consequences of the operation are the removal of contractures and further prosthetics.

One of the important aspects in the treatment of childhood arthritis is adherence to the motor regimen. You should not completely limit the child's activity so that persistent contractures do not develop. But you should also avoid large physical overloads, sudden movements, jumping, running and especially falls.

Video. Juvenile arthritis

A sick child will need daily leisurely walks in the fresh air. Depending on the degree of illness, doctors recommend swimming and cycling. Launched pathological processes require special therapeutic exercises under the supervision of a specialist or with his participation.

Sometimes children are credited with crutches and corsets. A prerequisite is protection from stress, exposure to cold and sun rays.

A boy with juvenile arthritis wears a special corset

An autoimmune disease that affects the locomotor apparatus in adolescence is called juvenile rheumatoid arthritis. The reasons for the occurrence of this pathology can be the most unexpected or commonplace infections. In the first place among the risk factors for JRA is elevated level the reactivity of the body. The aggression of one's own immunity to healthy cartilaginous and connective tissues triggers the mechanism of inflammation of the joints: first of the small type, then of the large type, and ultimately affects the cardiovascular system, gastrointestinal tract, lungs, liver and kidneys. Among the "victims" of this type of rheumatism are young men aged 14-16, especially girls.

The trigger mechanism for the development of juvenile rheumatism in children aged 5 to 16 can be the most harmless infections, as well as gas pollution of the atmosphere or ordinary fast food. But, not all children are exposed to this pathology, it all depends on heredity, the state of the immune system, lifestyle, nutrition, as well as the incidence of ARVI, infectious pathologies of the gastrointestinal tract and general sensitivity to allergens.

Common causes of juvenile rheumatoid arthritis include:

hereditary factor;
frequent injuries to the limbs;
excessive exposure to ultraviolet rays up to sunstroke;
sudden hypothermia of the body;
viral, microbial and fungal infection;
overdose of antibiotics, NSAIDs and antifungal drugs;
frequent injuries to the limbs;
poisoning with poisons;
frequent consumption of canned products of factory production;
reactions after vaccinations;
hypersensitivity of the body to drugs, food and household chemicals.

V childhood the onset of the JRA disease resembles acute respiratory diseases with severe and cutting pain in the joints and bones, as well as elevated temperature... Treatment of children at home is categorically not recommended, otherwise rheumatism can be triggered to a chronic stage, and this fact is fraught with lifelong treatment and a group of disabilities.

Risk factors:

late use of vaccinations;
the presence in the family of cases of rheumatism;
frequent diseases of streptococcal and staphylococcal infections;
hepatitis C;
gastrointestinal diseases;
abuse of fast food;
anemia;
avitaminosis;
blood diseases;
helminthic invasion.

Juvenile rheumatic arthritis is dangerous due to fast flow with severe complications. In adults, the pathology has a slow development, so the disease can be stopped at a certain stage, and in adolescence, rheumatism of the joints is difficult to stop. At the first symptoms of ARVI, you need to donate blood for a rheumatic factor, if it is negative, then the pathology of a viral nature and there is no reason to fear rheumatism.

Attention! If symptoms similar to a viral infection or poisoning do not disappear within 3-7 days, an urgent need to be tested for rheumatoid fluoride. Quick reaction of parents and timely treatment will save children from complications and disabilities.

Juvenile rheumatoid arthritis classification

JRA (juvenile rheumatic arthritis), in terms of manifestation and complications, are included in the group of dangerous diseases leading to disability with early age... In adults, rheumatism is slower, so it can be stopped at some point. To make an accurate diagnosis, you need to determine the type of pathology, which will help in the accurate selection of drugs.

Type of disease:

Classification	Name, description
Type	True articular rheumatic arthritis JRA: affects only the joints of the locomotor apparatus (joints of the arms and legs: both small and large). Other systems and organs remain normal. System type: affects joints and internal organs (heart, liver, kidneys and lungs). The course of the disease is severe, difficult to treat, many patients become disabled for life.
By the number of joints involved in the process	Oligoarticular: about 4 joints of small and large type are affected, often found in one-year-old babies. Depending on the body's response to drug therapy, this type of JRA is treated and the process of destruction of the joints can be stopped. Otherwise, the pathology may progress and involve other segments of the skeleton. Multiple arthritis (polyarthritis): the joints of the arms, legs, maxillofacial, as well as joints are affected spinal column... Girls get sick more often than boys, the age of patients varies within 5-7 years. The disease is treatable; after puberty, JRA can disappear forever.
By progression	Slow type. Moderate form. Rapid progression.
For rheumatoid factor	Seronegative type: C-reactive protein is not detected in blood serum and synovial fluid. Seropositive type: the rheumatoid index or marker is positive, its titer depends on the depth of the damage to the joints and organs.
With the flow	Reactive nature: the acute form of the course is the most dangerous, the disease is difficult to stop, it covers many joints and systems. Subacute type: This is a slow seizure with a more tolerant course, which is stopped by medication.

The course of the disease is conditionally divided into: prolonged continuous, as well as recurrent and latent (latent) course. According to the developmental phase, JRA is divided into active (the third degree has high activity, the second: moderate, the first - minimal activity) and an inactive phase of development.

Important! Juvenile rheumatic arthritis can proceed in completely different ways, there is no ideal symptomatology. JRA can be confused with other pathologies, therefore, a thorough examination and differential diagnosis in specialized rheumatic centers are recommended.

Symptoms of juvenile arthritis

General symptoms with seropositive juvenile arthritis consists in patient complaints of pain in certain joints. More often, children complain of pain in the elbows and knees, it is difficult to walk in the morning, and in the evening the joints swell.

The general temperature rises, weakness and loss of appetite appear. The third degree of rheumatic arthritis involves all organs in the process, so little patients show pain in the abdomen and heart. Symptoms depend on the form of the disease.

Subacute form of Jurassic

Patients with this form of JRA complain of leg pain and impaired movement. During the examination, changes in the shape of the joints, swelling and redness of the skin over the diseased joints are visible. The pain is tolerable, but it can get worse with long walking or running and become unbearable. At night, the temperature appears in the range of 37-38 degrees, by morning, it drops to normal limits. With the third degree of complications, palpation reveals a slight increase in lymph nodes, spleen and liver are normal.

Acute form of the disease

With this form of juvenile arthritis, all symptoms are more pronounced than with other forms. Patients, regardless of age, are acutely responsive to pain, crying and lethargic.

A list of symptoms of the acute form:

Sharp pains.
Stiffness in motor function.
Swelling of diseased joints.
Muscle pain.
Local and general temperature rise.
Erythematosity of the skin over the joints.

Sometimes brown pigmentation appears in the nail holes. Patients lose weight due to lack of appetite. When the temperature rises, patients may vomit, and in some cases, digestion is disturbed, the stool is unformed and fetid, clinical picture resembles inflammation of the pancreas or poisoning, therefore differential diagnostics.

System form

JRA of the systemic type attracts inflammatory process internal organs. The liver, spleen, lungs, kidneys and heart are destroyed by the antigen-antibody complex. Patients complain of acute heart pains, pain in the epigastric region or throughout the abdomen, violation of stool and urination, fever plus malaise and weakness. The spleen and liver increase in size. With pneumonia of the rheumatoid type, shortness of breath, cough and cyanosis of the skin occurs. Blood tests reveal persistent anemia and leukocytosis.

Diagnosis of the disease

The examination of the patient consists of laboratory data and hardware confirmations of the preliminary diagnosis. Regardless of the form, type or course of adolescent rheumatism, the following studies should be performed:

blood test for rheumatic factor or marker (C-reactive protein);
X-ray examination of diseased joints and lungs;
ultrasound examination of joints and internal organs;
computed tomography for a deeper study of the degree of damage to joints, systems and organs.

If there are any doubts about the final diagnosis, it is necessary to carry out a differential diagnosis with hepatitis C, pyelonephritis, blood disease, pneumonia, tuberculosis, food poisoning and influenza.

What helps to establish the diagnosis?

The provocateur of pathology is its own immune system. After chronic reactions of an inflammatory and allergic nature, a restructuring of the body occurs, which consists in abnormal changes in the humoral defense. The main targets for killers and helpers are chondrocytes, collagen, elastin and everything related to the presence connective tissue... In the body, under the influence of suitable factors, aggression occurs defensive reaction to healthy tissues. In blood or serum, as well as in synovial fluid, rheumatoid factor is in the form of immunoglobulins belonging to class M, which is a complex of proteins and carbohydrates.

When carrying out biochemical + immunological tests, immunoglobulins are released by the method of immunoelectrophoresis. T-lymphocytes, contribute to the process of rapid multiplication of B-lymphocytes, after which excessive formation occurs plasma cells, they are the source of multiplication of immunoglobulins. These complexes settle inside the joints and walls. blood vessels destroying joints, organs and systems. The inflammatory reaction in the form of mucoid swelling develops rapidly, in parallel with it, complete destruction of the connective and bone tissue.

Healing procedures

Rheumatoid arthritis in adolescence or childhood is treated with the same drugs as adults, the difference in this regimen is only in the dosage of drugs. Healing procedures aim to eliminate main reason- aggression of one's own immunity, and consist in medicines, nutrition, physiotherapy, exercise therapy and, ultimately, in surgery.

Medicines

All drugs are selected according to an individual scheme, taking into account age and concomitant diseases, as well as depending on the form of JRA.

List of drugs:

The group of non-steroidal anti-inflammatory drugs (COG1, COG2, COG3): Diclofenac, Ibuprofen, Piroxicam, Indomethacin, Movalis;
Glucocorticosteroid drugs: Dexamethasone, Prednisolone, Hydrocortisone;
Immunosuppressants: Leflunomide, Methotrexate, Cyclosporin, Penicillamine, Cyclophosphamide, Chlorbutin, Cyclosporin A, Vincristine;
Gold preparations: Auranofin, Aurotiomalat;
Antimalarial medicines: Delagil, Plaquenil, Akrikhin, Quinine sulfate.

Symptomatic treatment drugs such as analgesics, antibiotics and chondroprotectors are added to the list of these drugs.

Baby food

Babies one year old are recommended breast milk, milk mixtures rich in microelements, vitamins and easily digestible amino acids, as well as vegetable and meat purees. As directed by your doctor, you can use natural juices and juices with pulp. In the nutritional diet of children from 5 to 16 years old, the principle of fractional, frequent and good nutrition... All products that cause allergic reactions and dyspeptic symptoms are excluded. The amount of salt, sugar, fat is reduced to a minimum. Fatty meats and fish are excluded, as well as freshly baked butter bakery products... Citrus and red fruits are strictly excluded. The daily diet should be prepared in conjunction with a dietitian.

Traditional medicine

Children or adolescents, in parallel with drug therapy, are prescribed funds from the series traditional medicine... If there is no allergy to one of the components used, the funds can be used for up to a month and a half or more.

Some recipes:

Honey and bile compresses(100 ml of medical bile + 2 tablespoons of honey). Method of application: apply the mixture to the joints of the legs or arms with a brush, wrap with foil for an hour, in case of exacerbation, repeat 2 times every 24 hours.
Appliques from mashed potatoes and honey(200g puree + 1 tablespoon honey): apply to joints, wrap with foil and woolen scarf, keep for about an hour.
Tincture of birch buds on alcohol(200g kidneys + 200ml vodka) leave for two weeks, rub your legs and arms 3 times a day.
Horseradish + honey + garlic compresses(all ingredients are 1 tablespoon each): spread the joints, cover with foil for 10-15 minutes, apply once or twice a day.

Freshly brewed lingonberry, rosehip, cranberry, green tea, mint and chamomile teas are welcome. You can think of an assortment of these ingredients. You need to drink teas 200 ml twice a day.

Surgical intervention

Surgical interventions are recommended at the third stage of destruction, when complete correction of articular elements is required: cartilage, bursae and distal ends of bones. There are two options for operations: open and closed type... In the first, the joint opens completely, in the second, special probes are inserted into the joint. In both cases, the joint is revised with the removal of bone spines, remnants of necrotic tissue and cartilage. Next, augmentation of cartilage plates or prosthetics is performed.

Complications and consequences of the disease

Immobilization of locomotor organs, complete deformation and suppuration are three dangerous complications that occur in the joints. With regard to systemic juvenile arthritis, complications are associated with the cardiovascular system and the genitourinary, gastrointestinal tract and respiratory tract. If rheumatism is diagnosed and treated at an early stage, no complications will occur. It is very important for the child to be constantly examined for rheumatic factor and not to engage in grandmother's methods of treatment at home.

How to reduce the risk of getting sick?

It is up to the parents to reduce the risk factor for juvenile arthritis. From early childhood, children need to be fed correctly, tempered, vaccinated with high-quality vaccinations, constantly examined by a doctor and treated on time. With injuries of the extremities, you need to contact a traumatologist, with allergic reactions is treated by an allergist, with frequent viral infections be tested for C-reactive protein and do not delay treatment.

Advice! If the symptoms did appear and the diagnosis was confirmed, the children need to be hospitalized and treated according to the scheme prescribed by the doctor. Do not neglect physiotherapy, exercise therapy and spa treatment.

At the first symptoms of juvenile rheumatism, such as pain and stiffness of movement in the limbs, hands and feet, all laboratory and instrumental studies must be completed. According to the results, it is possible to determine the degree of damage and timely stop pathology at an early stage of its development. Otherwise, juvenile rheumatism will become chronic up to the operating table or wheelchair. Adults need to be aware of and know everything about juvenile rheumatoid arthritis - causes, symptoms and treatment in children, and then each parent will be able to protect their children from rheumatism.

- childhood disease affecting. the specific reason for 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 the disease has overpowered your child.

Juvenile idiopathic arthritis: forms and symptoms of the disease

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

Systemic... In the presence of this form, joints are affected in whole groups. Inflammation in them is characterized by severe pain and bone aches. In addition, there is a high body temperature, sometimes rising to 40 o C. Plus, this form of juvenile arthritis leads to anemia and slow bone growth. Moreover, complications of the disease are much more dangerous. Its long course threatens the development of pneumonia, pulmonary insufficiency, dysfunction 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. We also note that the rheumatoid form is more often diagnosed in girls. before school age.
Psoriatic... It occurs against the background of psoriasis. In this case, one of the symptoms is inflammation of the iris of the eye. In addition, deformity of small joints, accompanied by pain, is characteristic of psoriatic arthritis.
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 movement and inflammation of the iris are observed. A particular danger is the 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 preschool boys.
Undifferentiated... The most difficult to diagnose form of childhood arthritis. 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 still remains a mystery to medicine. After all, the main causes of this disease have not yet been established. Most experts associate the appearance of this ailment with autoimmune diseases ... That is, with diseases in which the immune system attacks the healthy cells of the body.

Nevertheless, there are suggestions that in the development of the disease involved viruses, bacteria and fungi... In children, immunity is not as strong as in an adult. Because of what microorganisms, getting inside, hit the child harder. This can also 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 rather vague. Moreover, it is impossible to say with confidence that, for example, the sun's rays or hypothermia trigger the mechanism for the development of arthritis.

Juvenile idiopathic arthritis treatment

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

Medicines are used to relieve acute pain in the joints. In addition to this, corticosteroid drugs helping to reduce swelling in the affected area. Natural preparation Licorice P with anti-inflammatory action will be very effective remedy 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 same mass that is characteristic of corticosteroids. It was found that the substances of this plant suppress the synthesis of an enzyme that generates inflammation characteristic of arthritis.

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

Juvenile rheumatoid arthritis is a complex systemic disease, a characteristic feature of which is an inflammatory lesion of the joints. The whole severity of the pathology lies in the fact that the patient has a high chance of getting a lifelong disability. In adults, this pathology occurs in a different form.

What is the disease

So, the disease develops in children under 16, which is why it has this name. Among all, it takes one of the first places. In the world, only 1% of children with such a skeletal lesion. This pathology mainly provokes irreversible consequences not only in the joints, but also in the internal organs.

The disease is autoimmune in nature, so the treatment is lifelong. It is impossible to completely get rid of juvenile rheumatoid arthritis. Experts also cannot yet determine the exact cause of its occurrence. However, we can already say what factors provoke its exacerbation.

It should be noted that the disease is more often diagnosed in girls. In addition, the later it begins to develop, the more difficult it is to treat.

How juvenile rheumatoid arthritis develops

The disease provokes humoral immunity. The fact is that pathological changes occur in the synovial membrane of the joint, as a result of which microcirculation of blood is disrupted, and a gradual destruction of hard tissues occurs. In this case, altered immunoglobulins are produced in the affected joints.

The defense system begins to vigorously produce antibodies that attack the body's own tissues. Because of this, the inflammatory process begins to develop, which is almost impossible to eliminate. It is chronic and is constantly supported by the immune system.

Through the circulatory and lymphatic system antigens spread throughout the body, affecting other structures.

Disease classification

Juvenile, or juvenile, rheumatoid arthritis is a very complex and dangerous disease... In adults, it may develop more slowly. Treatment of pathology should begin immediately - immediately after the patient's symptoms are described and the differential is carried out.

Naturally, you should also consider what types of disease exist:

By type of defeat:

Articular. This juvenile (juvenile) arthritis is characterized by the fact that the main inflammatory process is localized only in the joints, without affecting other structures.
Systemic. In this case, the pathology additionally extends to the internal organs. This form of rheumatoid arthritis is very severe and dangerous. It often leads to permanent disability.

By the spread of the lesion:

Juvenile oligoarthritis (oligoarticular). It is characterized by the fact that no more than 4 joints are affected in a child. In this case, not only large, but also small joints are affected. Such juvenile rheumatoid arthritis is diagnosed in children over 1 year old. This form of the disease can also be limited to affecting only a few joints, but in some cases it progresses and spreads.
Juvenile. Here, the pathology affects the upper and lower extremities. The number of diseased joints is more than 5. In this case, the cervical and jaw joints can also be affected. This type of juvenile arthritis is most common in girls. Treatment of the disease is mainly carried out in a hospital.

By the rate of progression:

Slow.
Moderate.
Fast.

Learn more about the disease in this video:

On an immunological basis:

Juvenile seronegative rheumatoid arthritis. Its peculiarity is that it is not found in the blood.
Juvenile seropositive rheumatoid arthritis. This type of illness is more severe. In this case, it can be detected using the presence of a rheumatological marker in the blood.

By the nature of the flow:

(spicy). This is a malignant form of the disease that progresses rapidly. The prognosis in this case is unfavorable.
Subacute. It is characterized by slow development and flow. Usually affects only one side of the body at first. In the future, the pathological process covers other joints. In this case, the prognosis is favorable, since the disease is treatable.

Juvenile rheumatoid arthritis can manifest itself in different ways. However, in any case, its treatment is necessary, complex and lifelong.

What factors provoke the disease

Though exact reasons the causes of this disease have not yet been established, it is possible to determine the factors that can trigger the pathological mechanism:

Late implementation of preventive vaccinations.
Joint injury.
Hereditary predisposition.
Infection of a viral or bacterial nature.
General hypothermia of the body.
Prolonged exposure to direct sunlight.

Symptoms of pathology

Juvenile rheumatoid arthritis manifests itself in different ways. It all depends on its type. The following symptoms of this joint disease can be distinguished:

Enough pain around the joint, as well as stiffness during movement (especially in the morning).
Redness of the skin in the affected area.
Swelling of the joint.
Sensation of warmth in the affected joint.
felt not only during movement, but also at rest.
The limbs cannot bend normally, and subluxations appear in the joints.
Brown spots appear near the nails.

These symptoms are basic and common to all forms of pathology. However, each type of disease is characterized by additional symptoms:

Reactive juvenile arthritis is manifested as follows:

The overall temperature rises.
Specific allergic rash.
Enlargement of the spleen and liver, as well as regional lymph nodes.
The symptoms of this disease are bilateral.

Subacute juvenile arthritis in children has the following clinical features:

Pain sensations are characterized by low intensity.
In the area of the joint, swelling appears, and its functionality is seriously impaired.
In the morning, a child, like an adult, feels stiffness in movements.
A slight increase in body temperature, which appears extremely rarely.
Weak enlargement of the lymph nodes, while the spleen and liver practically do not change their size.

Oligoarticular juvenile arthritis has the following clinical symptoms:

One-sided character.
Delayed growth of the child.
Inflammation of the inner lining of the eyeballs.
Asymmetrical arrangement of the limbs.
Cataract.

In addition, juvenile rheumatoid arthritis is associated with severe muscle weakness, anemia, and pale skin. It is the systemic type of the disease that is especially dangerous.

Diagnosis of the disease

Diagnostics of this type should be differential. To determine the disease, the following research methods are needed:

which will make it possible to determine ESR level, the presence of rheumatoid factor.
X-ray of the affected joints, which will determine the degree of development of the disease, the condition of the bone and cartilage tissue.
Ultrasound of internal organs.
Collecting a detailed history, which will allow you to establish a hereditary predisposition.
Examination of the fundus.
External examination of the patient with the fixation of his complaints.

Since juvenile chronic arthritis has nonspecific symptoms, it can only be determined by differential diagnosis. The effectiveness of treatment largely depends on its quality.

For the features of treating the disease without pills, see the video below:

Treatment features

Rheumatoid juvenile idiopathic arthritis is a complex disease that requires integrated approach... Therapy is designed not only to remove pain syndrome and manifestations of the inflammatory reaction of the joints, but also to minimize the consequences of pathology.

In addition to the treatment itself, the child needs to be provided with a normal motor regimen. Naturally, both adults (parents) and children must follow the recommendations of doctors. The child will have to learn to live with this disease. Complete immobilization of joints in children cannot be allowed, as this will only aggravate his condition and provoke the rapid development of pathology.

That is, the baby needs to move, but in moderation. For example, walking on a flat road, cycling without unnecessary stress, swimming will be useful for him. You cannot jump, run and fall. If the phase of exacerbation of rheumatoid arthritis has begun, then the child should try to stay away from direct sunlight, not to overcool.

The basis of treatment is drug therapy:

Non-steroidal anti-inflammatory drugs - Piroxicam, Indomethacin, Naproxen, Ibuprofen. These medications should be taken after meals. If it is necessary to provide a quick analgesic effect, the doctor can change the time of taking the drugs. After the child has taken the pill, he needs to move in the first 10-15 minutes so that esophagitis does not develop. cannot stop the process of joint destruction, they only relieve pain and other unpleasant symptoms.
- Prednisolone, Betamethasone. Since juvenile idiopathic arthritis is characterized by severe painful sensations, then these funds are used to quickly achieve an anti-inflammatory effect. In this case, the drug is rapidly excreted from the body. However, corticosteroids have a large number of side effects. So long time they cannot be used.
Immunosuppressive drugs - Cyclosporin, Leflunomide. These drugs inhibit work. protective system organism, therefore their main focus is to protect joints from destruction. It is necessary to take these funds for juvenile rheumatoid arthritis for a long time, for which they are designed. However, the frequency of their use is low. The child will need to take such medications no more than 3 times a week. In this case, drugs are prescribed taking into account the characteristics of the organism and the development of pathology.

Chronic rheumatoid arthritis (oligoarticular or pauciarticular) can also be treated using non-drug methods:

Exercise therapy. It goes a long way towards improving motor activity child. This treatment must be done daily. Naturally, exercises are often performed with the help of an adult, since stress on the joints is contraindicated. Treating rheumatoid chronic arthritis in children is best by cycling on a flat road, as well as by swimming.
Physiotherapy treatment. In this case, pediatrics focuses on just such a therapy, since it improves the effect medications... The doctors' recommendations in this case are as follows: electrophoresis with, magnetic therapy, infrared irradiation, paraffin applications, mud therapy, and laser therapy. If rheumatoid chronic arthritis is treated with these methods, the prognosis may be good. The intensity of symptoms decreases, the immune status changes, muscles relax, as a result of which the joints return to their full functionality. Some procedures help to reduce the inflammatory process.
Massage. Juvenile idiopathic arthritis is characterized by the fact that periodically, and quite often, the patient experiences periods of exacerbation. Physiotherapy treatment in this case is limited. The massage can only be used during the period of remission. This procedure is beneficial in that it allows you to restore normal blood circulation to the muscles and joints. In this case, all movements should be such as not to exert any load on the joint.

In some cases, juvenile rheumatoid chronic arthritis is treated with surgical intervention... The operation is used only as a last resort, when strong changes are observed in the joints, significantly limiting its mobility. During the operation, excess growths are removed, as well as the installation of a prosthesis.

Chronic inflammatory disease joints, which does not have a well-established cause, is noted for more than 6 weeks. It develops in childhood (Juvenile arthritis in children) until the age of 16. More often girls suffer from rheumatoid arthritis. Treatment of juvenile rheumatoid arthritis should be started as early as possible, since in children with early illness and adolescents with rheumatoid factor positive are at risk of developing severe arthritis. All this can lead to disability due to the condition of the musculoskeletal system. In children with late onset of the disease, the transformation of juvenile RA into ankylosing spondylitis is possible.

Pay special attention to the child, watch his gait and gestures so as not to confuse arthritis with bruises

In general, JA (juvenile arthritis) is a group designation rheumatic diseases occurring in childhood. When classifying, juvenile rheumatoid arthritis is accepted, presented in the headings M.08 and M.09-X, to divide:

juvenile rheumatoid arthritis (JRA, M08.0);
juvenile psoriatic arthritis (JAPA);
juvenile chronic arthritis (JHA) of unspecified nosological affiliation (seronegative polyarthritis, M08.3);
juvenile ankylosing spondylitis (JAS, M08.1);
arthritis in inflammatory bowel diseases (nonspecific enterocolitis, Crohn's and Whipple's disease);
M08.2 - systemic onset juvenile arthritis;
M08.4 - juvenile arthritis with pauciarticular onset;
M08.8 - other juvenile arthritis;
M09. - juvenile arthritis in diseases classified elsewhere.

The medical history in children, when diagnosed, contains the following criteria:

the age range does not exceed 16 years;
the duration of the articular syndrome lasts more than three months;
there is a primary character of the articular process. At the same time, other nosological forms are excluded (rheumatism, SLE, tumors, septic arthritis).

An example of the defeat of the joints of the hands

This general classification juvenile rheumatoid arthritis. There is no own definition for each terminological designation, or it is formed as "a chronic inflammatory disease of the joints in children, which began before the age of 16".

The term "juvenile rheumatoid arthritis" denotes an independent nosological unit, it resembles rheumatoid arthritis in the adult population. In children with arthritis more than 3 months old, the following symptoms are noted:

damage to the small joints of the hands with deformation;
polyarthritis proceeding symmetrically with the defeat of the lower and upper extremities;
the presence of rheumatoid nodules;
destructive arthritis;
seropositivity in the RF (titer 1:40 and above).

The nature of the course of the disease

Juvenile arthritis is distinguished by the nature of the course:

acute, with the rapid development of symptoms, with a relapsing course and an unfavorable prognosis;
subacute, with similar symptoms, but less pronounced manifestation.

By spreading the process, doctors diagnose the following forms in children:

articular, mainly the musculoskeletal system is affected;
articular-visceral, internal organs (myocardium, liver, kidneys) are also involved in the pathological process.

With juvenile arthritis, the course of the disease can be:

rapidly progressing;
moderately progressive;
slowly progressive.

Etiology of the disease

In pediatrics, it is noted that rheumatoid arthritis can begin for the following reasons:

hypothermia and excessive insolation;
viral and bacterial infections;
heredity and improper use of drugs;
injury.

The main manifestation of the disease

The symptoms of juvenile (childhood) rheumatoid arthritis are similar to those of ARVI, so don't try to take independent treatment measures!

With symptoms of juvenile (children's) rheumatoid arthritis, large and medium-sized joints are affected (mainly). Pain, swelling, limited movement and deformity are noted, with an increase in local temperature. In children, a typical lesion for JRA is the seizure of the maxillofacial joints and the cervical spine. In this case, pathological changes are characterized by the presence of inflammation, which, as a result, in juvenile arthritis, can lead to the destruction of cartilaginous tissue, narrowing of the joint spaces and the development of ankylosis (fusion).

Extra-articular manifestations are characterized by:

the presence of a high body temperature (especially in the morning);
chills, increased joint pain;
a rash on the skin;
enlargement of lymph nodes, liver and spleen.

When the temperature drops, children experience pouring sweat, bed linen and shirts get wet. Such a febrile period can last for months (in severe cases, if untreated, for years), and often precede severe joint damage. V general analysis blood reveals increased ESR up to 40-60 mm / h, anemia, neutrophilic leukocytosis with shift leukocyte formula to the left, often an increase in the concentration of Ig, mainly IgG.

Acute period

Symptoms in children acute period juvenile arthritis is especially difficult, there is a generalized or articular-visceral (systemic) forms of the disease, occurring with relapses and poor prognosis. Most often they are observed in children of preschool and primary school age, but sometimes they also appear in adolescents.

Subacute period

In this case, the medical history in sick children looks like with the presence of less vivid symptoms. The disease begins first with one joint (ankle, knee), which swells, hurts and loses some of its motor functions. Children under 2 years of age stop walking, cry, ask for hands or sit. In a child, a change in gait can be noted, and after a night's sleep, children develop "morning stiffness", which is expressed in difficulty in movement 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 this symptomatology, and not to blame (simulate) unwillingness to go to kindergarten or school. Some pediatricians (especially those brought up in the "Soviet thinking") are also inclined to argue that the child is just a fake. In this case, parents should treat the health and complaints of their baby with due attention, since the consequences of untreated juvenile rheumatoid arthritis are dire.

Red eyes can be a sign of arthritis, although at first glance, the damage to the eyes and joints is not related in any way

In girls, especially of preschool age, juvenile arthritis is accompanied by rheumatoid lesions of the eyes (rheumatoid uevitis, unilateral or bilateral). In this case, all the membranes of the eye are affected, as a result of which vision can be greatly reduced (to a complete loss), and, sometimes, in just six months. In rare cases, rheumatoid uevitis precedes the articular process, and this is what makes the diagnosis difficult.

In case of subacute course, as a rule, several (2-4) joints are involved in the pathological process - the oligoarticular form. At the same time, pain and exudative changes are softened, body temperature is normal, polyadenitis is moderate. With this form of juvenile rheumatoid arthritis, the course is benign, with rare exacerbations.

System form

Articular-visceral is characterized by the presence of characteristic symptoms:

high (persistent) fever;
allergic polymorphic rash;
hepatolienal syndrome;
lymphadenopathy and arthralgia / arthritis.

This form of juvenile rheumatoid arthritis has two main variations:

Still's syndrome, which often develops in preschool children;
and Wieseler-Fanconi syndrome, commonly seen in schoolchildren.

In the absence of treatment for juvenile rheumatoid arthritis, secondary amyloidosis may appear - this complication manifests itself 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 these vital organs. Most often, the kidneys suffer from this - this is indicated by persistent proteinuria, as a result, children develop chronic renal failure.

Diagnostic measures

During the examination of the child, the specialist may prescribe the following examinations:

X-ray examination. In juvenile arthritis, this can be used to identify characteristic signs diseases - osteoporosis (decreased bone density), narrowing of the intra-articular gap and minor damage to bone tissue (erosion);
MRI, NMR and CT, give the doctor the opportunity to determine the degree of damage to the bone, cartilage in the inflamed joint;
laboratory tests can show - an increased level of ESR and leukocytes (the presence of inflammation). In addition, a blood test should be taken to determine the appearance of antinuclear antibodies, the level C-reactive protein and rheumatoid factor.

Disease therapy

Treatment of JRA is carried out in a comprehensive manner, setting a regimen for children, taking into account the form of the disease and functional state joints. The diet is fortified, low in calories, hypoallergenic, low in saturated fatty acids and high in polyunsaturated ones. During the period of activity of the disease, inpatient treatment and the use of pathogenetic therapy are recommended, taking into account the form of the disease. When choosing a therapy, the following are taken into account, first of all:

the effect of drugs on the activity of the process;
local inflammatory articular syndrome;
the nature of immunopathology;
condition and dynamics of osteochondral destruction.

Diclofenac - good medicine to suppress arthritic pain and inflammation

Drug therapy is based on the use of basic drugs, NSAIDs and glucocorticoids. In general, the modern treatment of pediatric rheumatoid arthritis, although it does not provide complete healing, but relieves pain syndrome, inflammation and resists the further development of the disease. This makes it possible for the child to lead a fulfilling life.

The main treatment includes:

NSAIDs relieve pain well (aspirin, indomethacin, diclofenac), but their use in children requires special care, drugs can cause serious complications;
selective inhibitors, relieve pain and inflammation;
basic lv, prescribed in the early stages of juvenile rheumatoid arthritis (methotrexate, gold, sulfazine);
corticosteroids are prescribed only in short courses so as not to disrupt the growth of the child.

If you have an infection, it is important to get treatment with antibacterial drugs. Plasmaphoresis has a good effect and is used for the immunocomplex nature of the disease. Advanced cases may require the introduction of intra-articular anti-inflammatory drugs, and surgery (arthroplasty) is prescribed if conservative treatment is ineffective.

Immunotherapy

Intraglobulin (intraglobin, pentaglobin, sandoglobulin) is injected intravenously, drip, no more than 10-20 drops per minute for 15 minutes. Then the rate of administration is increased to 2 mlmin. Repetition possible infusion therapy every 4 weeks.

Treatment of rheumatoid uevitis

It is carried out jointly by a rheumatologist and an ophthalmologist. Locally, you can use GCS in combination with agents that improve microcirculation and mydriatics. In the absence of effect within two weeks or with the progression of the syndrome, cytostatics (cyclophosphamide) are prescribed, the "point" of their application is the presence of acute and seropositive forms of juvenile rheumatoid arthritis in children.

Important features of therapy and the consequences of the disease

First of all, you need to pay attention to the nutrition of the child. Limit sodium intake (minimum table salt), exclude salted cabbage, sausage, salted cheese from the diet. To restore the calcium balance, you need to include dairy products, nuts and Ca preparations with vitamin D. A special complex of exercise therapy that supports muscle mass and joint mobility, physiotherapy, massage and spa treatments.

Try not to restrict the child's mobility, give him the opportunity to attend the sports section, and in case of illness, the chances of complications are extremely small

Good to stick active image life, since in energetic children the disease is easier, and complications of arthritis are less common. But children have to self-regulate the degree physical activity, especially when there is pain in the area of inflamed joints.

With late treatment or late detection of the disease, there is a threat of consequences - the likelihood of impaired mobility of the joints increases, which leads to their deformation and destruction (disability). When juvenile rheumatoid arthritis is treated at the first symptoms, the prognosis is generally good.