Rheumatoid arthritis in children: causes, symptoms, treatment

Full Characteristics of Rheumatoid Arthritis in Children: Causes, Symptoms, Treatment

The lesion of joints of nontraumatic origin at a young age is rare. One of these diseases is rheumatoid arthritis in children.

There is a disease in 6-19 people per 100 thousand children under 18 years old. Girls get sick 2-3 times more often than boys. In some cases, the ailment is hereditary.

Causes of the disease

Despite numerous studies, the reasons for the development of juvenile or juvenile rheumatoid arthritis have not yet been elucidated. At the heart of the pathology is the defect of the immune system, as a result of which the articular cells begin to be perceived by the body of the child as alien.

Initially, the pathological process is localized in the synovial membrane, which lining the inner surface of the joint cavity. It proceeds in the form of inflammation and microcirculation disorders.

In response, the body produces a large number of autoantibodies (substances that destroy their own cells), which further damage articular tissues - develops arthritis - inflammation of all structures the joint.

These substances are called rheumatoid factor.

To provoke the start of the disease can:

• diseases of a viral nature (ARI, influenza, herpes, rubella);
• bacterial infections, including intestinal infections;
• injury or joint damage;
• general hypothermia of the body;
• excessive exposure to the open sun;
• sharp climate change;
• hormonal bursts during puberty;
• vaccination.

The main manifestations of rheumatoid arthritis in children

At an early age, rheumatoid arthritis can occur in two clinical forms: articular and joint-visceral.

Articular form of the disease

With articular form, the onset of the disease is gradual. It begins, as a rule, with inflammation of one large joint (monoarthritis) - the ankle or knee.

The joint is swollen, its function is severely impaired, the child's gait is changing, and younger children may stop walking at all. In this case, soreness in the lesion can not always be observed.

A characteristic symptom of rheumatoid arthritis is morning stiffness, when the patient complains of a restriction mobility of the limb after a night's sleep, which decreases or disappears completely within an hour after ascent with bed.

The asymmetry of the lesion is characteristic: simultaneous inflammation of various joints (knee, ankle, elbow, wrist).

As with monoarthritis, the pain syndrome is moderately expressed, the body temperature does not increase, the lymph nodes increase insignificantly.

Often the joint form of rheumatoid arthritis in childhood is accompanied by symptoms of a specific lesion eye - rheumatoid uveitis - inflammation of the membranes of the eye, which quickly leads to a decrease or total loss view.

The joint form of the disease is more benign, as it progresses slowly enough with infrequent exacerbations of the process.

Swelling of the joints is possible (in the photo lesion of the left knee)

Articular-visceral form

This variant of the disease is the heaviest. It is characterized by a violent acute onset, accompanied by a high temperature rise, a sharp pain in the joints and their edema.

More often the defeat is symmetrical and affects large joints - knee, ankle or wrist. But sometimes the debut of the disease is characterized by inflammation of the small joints of the foot and hand.

A typical manifestation of the joint-visceral form of rheumatoid arthritis is the involvement of the cervical spine in the inflammatory process.

The child notes a sharp pain in the affected area, the inability to perform any movements in the limbs.

With this variant of the disease, in addition to articular manifestations, there may be allergic skin rashes, significant increases in lymph nodes (up to several centimeters), an increase in liver size and the spleen. In the analysis of blood, inflammatory changes are noted. With the involvement of internal organs in the pathological process, symptoms associated with their defeat appear.

Articular-visceral variant of rheumatoid arthritis in childhood is unfavorable, since internal organs are often affected: heart, kidneys, lungs, liver. Damage to the musculoskeletal system is rapidly progressing: persistent limb functions develop which can lead to disability of the patient.

Diagnosis of the disease

Detection of the disease is quite a difficult task, especially in its early stages, when the symptoms are nonspecific, and joint damage is very similar to rheumatoid arthritis.

The difference is that the rheumatic lesion of the joint structures is bacterial in nature and is caused microorganism staphylococcus, and rheumatoid inflammation is caused by an incorrect reaction of one's own organism.

To facilitate the diagnosis by physicians rheumatologists use special diagnostic criteria:

1. duration of arthritis is more than 3 months;
2. defeat of the second joint, which occurred after 3 months and later after the first lesion;
3. symmetry in the lesion of small joints;
4. contractures (persistent limitations of mobility in the affected joints);
5. inflammation of the ligamentous apparatus;
6. amyotrophy;
7. stiffness of movements in the morning;
8. rheumatoid eye damage;
9. accumulation of fluid in the joint cavities.
10. X-ray signs:

• osteoporosis of bones (pathological decrease in their density);
• narrowing of the joint cracks, damage to the articular surfaces of bones;
• violation of the correct growth of bones;
• presence of lesions of the cervical spine.

• detection of rheumatoid factor in the blood;
• specific changes in the joint tissue.

If the young patient has only 3 signs from the above, then the probability of having the disease is large enough. If there are 4 or more signs - the diagnosis of rheumatoid arthritis is beyond doubt.

In addition, electrocardiography, ultrasound examination of internal organs and heart, chest X-ray. Also, in all children with joint damage, a mandatory test is performed for viral and bacterial infections.

It is very important to diagnose the disease as early as possible, at the same time it is the earliest diagnosis that is most difficult

Treatment

Treatment of rheumatoid arthritis is a long and very painstaking process, especially in children.Timely initiation of therapy can stop the progression of the disease, reduce the likelihood of complications and significantly improve the prognosis of the disease.

Treatment includes a set of activities aimed at:

1. suppression of the active inflammatory process,
2. the disappearance of joint symptoms,
3. preservation of mobility in the limbs,
4. prevention of disability,
5. achievement of a stable state without exacerbations,
6. improving the quality of life,
7. prevention of side effects of treatment.

Drug therapy includes the following types: symptomatic (taking non-steroidal anti-inflammatory drugs and glucocorticoid hormones) and immunosuppressive (immunosuppressive).

Admission of anti-inflammatory and hormonal drugs quickly eliminate pain and inflammation. But they do not prevent the destruction of joint structures.

Immunosuppressive drugs stop the processes of destruction.

Treatment of children with rheumatoid arthritis is an actual and difficult task for pediatrics

Non-steroidal anti-inflammatory drugs (NSAIDs)

In children, it is preferable to use a new generation NSAID that has a selective effect on cartilage and bone tissue, but does not affect the gastrointestinal tract. This allows you to take them for a long time without the high risk of side effects.

Glucocorticoid preparations

Hormonal drugs have a strong enough anti-inflammatory effect and quickly remove the acute symptoms of arthritis. In children, it is advisable to inject glucocorticoids directly into the joint cavity.

Reception of such funds inside should be prescribed only if other methods of administration are ineffective. Undesirable oral (through the mouth) appointment of hormonal drugs in children under 5 years of age.

Glucocorticoids for children under 3 years of age are prescribed only in extremely severe cases.

Immunosuppressive therapy

The use of immunosuppressive drugs is the basis of the treatment of the disease in children. The prognosis for the life and health of the patient depends on how effective it is.

The appointment of drugs of this group should be done the same after the diagnosis. Their reception should be continuous and continuous.

During the period of remission, methods for restoring the normal functioning of the joint structures come to the fore in the treatment:

• physiotherapy methods,
• massage,
• physiotherapy,
• Spa treatment.

Below is a video with a detailed story about the disease. In the video there are complex terms, but you do not get scared - the topic in this video is revealed very well.

Prevention

Since there is no reliable reason for the development of rheumatoid arthritis in childhood, it is impossible to prevent its primary occurrence. In the presence of pathology in the stage of remission, prevention of exacerbations is possible:

1. minimum stay in the open sun regardless of the region of residence;
2. avoid even slight hypothermia;
3. Avoid contact with any animal species;
4. refusal of preventive vaccinations;
5. ban on the use of medicines that increase the body's immune defenses;
6. less contact with infections.

Unfortunately, rheumatoid arthritis in children is life-long illness.

Butwith timely begun and properly selected treatment it is possible to achieve a state of long-term remission while maintaining a satisfactory quality of life.

However, we must admit that with frequent relapses with the defeat of internal organs, disability and limitation of active life quickly come.

A source: http://SustavZdorov.ru/artrit/revmatoidnyj-u-detej.html

Rheumatoid arthritis in a child: causes, symptoms, diagnosis and treatment

Rheumatoid arthritis in a child is a very difficult and dangerous problem. This disease in modern pediatrics is relatively rare.

Nevertheless, with information about its symptoms and reasons, each parent should be acquainted.

The fact is that this disease can not be completely cured, but if the therapy is started in time and preventive measures, the course of arthritis can be greatly facilitated and reduce the likelihood of dangerous complications.

General information about the disease

Rheumatoid arthritis in a child, better known in medicine as juvenile rheumatoid arthritis (JRA), is a chronic disease of joints of autoimmune origin.

For 100 thousand children there are approximately 16-19 patients with a similar diagnosis. According to statistics, girls suffer from ailment 2-3 times more often.

In addition, the disease is usually diagnosed in children under the age of five.

The ailment is in fact very dangerous, as often the inflammatory process affects not only the joints (that in itself leads to degeneration of the joint structures), but also internal organs (for example, heart, eyes, etc.). The disease leads to a decrease in the quality of life of the child, and sometimes to a serious delay in physical development and disability.

Rheumatoid arthritis in children: causes

Unfortunately, the exact mechanism of the development of the disease is not yet clear. It is known that rheumatoid arthritis is an autoimmune disease.

For one reason or another, the immune system is seriously malfunctioning, as a result of which it begins to perceive articular structures as foreign bodies.

Thus, antibodies are produced in the body, which first attack the cells of the synovial membrane of the joint, causing their inflammation and degeneration. As the disease develops, the immune system begins to damage other parts of the joint, and sometimes the tissues of the internal organs.

It is known that there is a genetic predisposition. There are other factors that can activate the development of this disease:

• a sharp change in the hormonal background (sometimes the disease is activated during puberty as a result of a jump in the level of hormones);
• disturbance of metabolic processes;
• vaccination;
• Infection of the child's organism (it can be bacteria, viruses, mycoplasma, etc.);
• severe overheating or hypothermia;
• sharp climate change;
• injury to the joint.

Rheumatoid arthritis in children: photos and symptoms of the joint form of the disease

Approximately 60-70% of patients suffer from this form of the disease. It begins, as a rule, with the defeat of one large joint (usually knee or ankle). After 1-3 weeks, another joint becomes inflamed. A characteristic feature is the symmetry of joint damage.

You can see that the child began to limp. There is a morning stiffness in the affected joints. You can also note swelling in the inflammatory process.

Due to pain and limited movements, young children stop playing, move little - in a word, refuse physical activity, which is accompanied by discomfort.

As the disease develops, there is degeneration of the joint structures, which can lead to disability.

Articular-visceral form of the disease

The most severe is articular-visceral rheumatoid arthritis in children.

Symptoms here, in addition to joint damage, include all the signs of intoxication, because the immune system damages the tissues of internal organs.

As a rule, exacerbation begins with a sharp increase in temperature, chills, increase in the liver, spleen, lymph nodes. You can see swelling and redness in the area of ​​the affected joints. The child suffers from severe pain.

The defeat of internal organs can lead to the development of amyloidosis, various diseases of the kidneys, heart, lungs, development of vasculitis, loss of vision, etc.

Generalized arthritic arthritis

Rheumatoid arthritis in a child can also occur in other forms, for example:

• oligosuscular chronic arthritis, which is accompanied by the defeat of 1-2 large joints (often knee) and a long, benign course of the disease;
• polyarticular form of the disease, which is accompanied by the defeat of several large structures or a combination of small and large joints; the disease proceeds undulating.

Basic methods of modern diagnostics

Only a doctor knows how to correctly determine rheumatoid arthritis in children. Diagnosis is a long and complex process.

Naturally, for the beginning a general examination is carried out, which allows to determine the presence of the inflammatory process in the joints. In the future, as a rule, laboratory tests are carried out.

By the way, with juvenile arthritis, the rheumatoid factor in the blood is not detected at the initial stages of the disease in about 50% of cases.

Important for diagnosis are x-ray studies. Also, ultrasound of affected joints can be performed.

More information about the state of the body can be obtained through computer tomography.

If there is a suspicion of a visceral form of the disease, the physician recommends electrocardiography, tests for bacteriological culture, and an examination with an ophthalmologist.

Basic principles of therapy in pediatric arthritis

Treatment of rheumatoid arthritis in children is a constant process, because, unfortunately, you can not completely get rid of the disease. Therapy in this case is aimed at inhibiting the inflammatory process, reducing the rate of degeneration of the joints, as well as maintaining their mobility.

In acute and subacute periods, as a rule, medical treatment is performed, helping to eliminate inflammation. The periods of remission also include the holding of various recreational activities, including physiotherapy.

Medication Therapy

Naturally, for many parents, the question of how rheumatoid arthritis is treated is extremely important. Symptoms and treatment in children are closely related - the condition of the child depends on the list of medications used. All drugs can be divided into two groups:

• drugs designed to eliminate the main symptoms during the period of exacerbation of the disease;
• drugs that suppress the activity of the immune system (their patient takes throughout life, even during periods of remission).

As a rule, to begin with, children are prescribed non-steroidal anti-inflammatory drugs. The most effective of them include "Butadion "Indomethacin "Voltaren "Ibuprofen".

Naturally, the dosage and duration of the course of treatment are determined individually. By the way, these drugs act quickly, slow the development of the inflammatory process, relieve soreness and fever.

In addition, they are not so toxic and have few side effects, which is very important for a child's body.

In more severe cases (for example, when generalized or visceral form), it is necessary to take corticosteroids, which cope with the inflammatory process much more effectively.

As a rule, they are not assigned to children under 5 years of age, but sometimes they make exceptions.

Such drugs are used in the form of tablets and solutions, and sometimes are injected directly into the joint bag for maximum effect.

Alas, anti-inflammatory drugs can not slow the process of joint degeneration. Therefore, patients along with them are prescribed and so-called immunosuppressors - drugs that inhibit the activity of the immune system.

The most effective include "Plakvenil "Krizanol "Sanokrezin "Delagil." Such drugs should be taken by courses, but constantly, even during the period of remission, in order to prevent the onset of another exacerbation.

Depending on the condition of the child, the doctor may prescribe the use of cytostatics (it is advisable for allergic-septic form of the disease), drugs, causing synovial coagulation (for example, "varicocid"), means that provide a reduction in the level of rheumatoid factor ("Kuprenil").

Physiotherapy methods and their effectiveness

Treatment of juvenile rheumatoid arthritis in children at a later stage, in addition to traditional medication, may include physiotherapy. There are many methods that are used to achieve remission, but they are selected by the attending physician individually for each child.

Almost all children are recommended from time to time to undergo therapeutic massage courses that help improve blood circulation, relieve muscle tension and strengthen them.

Also useful will be therapeutic gymnastics, which helps to maintain joint mobility.

Naturally, the pattern of exercises and exercises are selected individually, depending on the degree of development of the disease, the age and condition of the small patient.

Quite often effective are mud therapy, paraffin therapy, balneotherapy, etc. At later stages, treatment with currents is possible.

With properly selected sets of physiotherapeutic methods and schemes for taking medications, you can achieve good results.

What are the predictions for a sick child?

What to expect if rheumatoid arthritis is detected in a child? The forecast, unfortunately, is not very comforting. This disease is life-long and cure it completely, forever impossible.

Exceptions include oligoarthritis, which is not accompanied by destruction of the joints.

But the most severe is the visceral form of the disease, because the number of possible complications here is much higher.

What to do if a child has this disease? Timely and correctly conducted therapy allows to slow down the processes of destruction of joints and damage to other organs.

There are cases when it was possible to achieve a long-term remission and significantly improve the quality of life of the child.

On the other hand, with frequent relapses, a serious disruption of the basic functions of the joints is possible, which leads to disability.

Are there effective methods of prevention?

Rheumatoid arthritis in a child is a chronic disease. And, unfortunately, there are no drugs or other methods of preventing the primary development of the disease in modern medicine.

Nevertheless, if the child is at risk (for example, there is a genetic predisposition, allergic disease, chronic inflammation), then the so-called nonspecific prevention is possible, which includes the following conditions:

• Regular observation by a doctor. It can be a pediatrician or a rheumatologist who will constantly examine the child, follow the analyzes, etc. Since the disease in one way or another is associated with impaired functioning of the immune system, it is not superfluous to consult an immunologist.
• It is necessary to qualitatively treat chronic foci of infection, because such an inflammatory process can provoke the development of arthritis. Depending on the nature of the diseases, consultations of the ENT, dentist, nephrologist, cardiologist, etc. are necessary.
• It is extremely important to exclude the contact of the child with infectious patients, because, again, the defeat of the organism by pathogenic microorganisms or viruses can give impetus to the development of arthritis.
• Also, doctors recommend to prevent excessive hypothermia and overheating of the body.

Observing these rules, you can reduce the likelihood of developing the disease or the occurrence of a relapse.

A source: http://.ru/article/234648/revmatoidnyiy-artrit-u-rebenka-prichinyi-simptomyi-diagnostika-i-lechenie

Rheumatoid arthritis in children. Symptoms and Treatment

It is believed that joint damage is characteristic of the adult population. Currently, joint disease can also be diagnosed in children.

This happens rarely, but it does happen. Rheumatoid arthritis in children is one of the most common diseases.

Development of the disease at a young age in the future can lead to early disability of a person.

Juvenile rheumatoid arthritis, a disease that can develop at any age.

For some strange reason, the body begins to produce antibodies to its cells, which leads to activation of the process.

It should be noted that such processes rarely pass in isolation, that is, with the loss of joints alone, can not immediately, but over time, damage occurs to other internal organs, which aggravates process. As a rule, the damage to the joints by the rheumatic process is not associated with trauma.

According to statistics, girls are more often sick than boys. The activity of the process is individual. It depends on the age of the patient when the debut of the disease occurred, on how often the child is sick, on the functioning of the immune system and many other factors.

The main causes of the disease:

1. frequent exacerbation of a viral or bacterial infection;
2. hypothermia or vice versa, prolonged exposure to the sun;
3. vaccination;
4. changes in the hormonal background especially during puberty;
5. other disorders of metabolic processes in the body;
6. hereditary predisposition;
7. stressful situations;
8. getting injured.

These reasons can act both separately and together.

If the family has relatives who have experienced similar problems in childhood, then it is necessary to monitor the condition of young children.

At the moment, it is not established why such autoimmune attacks on joints and organs occur.

Symptoms of rheumatoid arthritis in children of different ages

Before describing the symptoms, it should be noted that the JRA (or as it is right now to call chronic rheumatoid arthritis) occurs in form of the joint form, when only the joints are affected, and in the viscero-articular form, when other internal organs.

With the flow, the disease is divided:

• on the sharp;
• subacute;
• and chronic.

Depending on the form of the disease, the clinical picture changes.

If we talk about viscera-articular form, then to the forefront are signs of general intoxication of the body, which characterized by fever, general weakness, refusal to eat, decreased activity of the child, increased The lymph nodes. And against the background of such symptoms, the child begins to complain of pain in the joints.

With articular form, the activity of the process is not so aggressive and immediately characterized by a violation of joint function, in the future the process can affect other organs and systems.

Common and basic in this disease of different ages is the development of arthritis.

The process develops gradually, may not be accompanied by a rise in temperature, the lymph nodes are not changed.

The large joints are affected most often, symmetrically. But depending on the aggressiveness of the process and the work of the immune system, inflammation can spread to small joints.

The main clinical aspect is the fact that in the morning hours after awakening there is a certain stiffness in the joint movements. Objectively, parents begin to notice that in the first half the child walks slowly, can limp and gradually pass these complaints by lunchtime.

Because the disease can develop at any age, children who are not actively talking yet will not complain, and you can only suspect the damage of joints by observing their movements and actions.

Most large joints are affected (knee, ankle). When you involve small hands in the process of hand brushes, parents can notice that the child has stopped playing constructors, drawing, sculpting, dressing.

When the small joints of the feet are damaged, the baby refuses to put on shoes. Rheumatoid arthritis in a child in 2 years can be characterized by a refusal to walk. At the same time the child cries and constantly sits and can not step on his foot.

The onset of rheumatoid arthritis in a 3-year-old child is characterized by the fact that the patient refuses to ride on a bicycle or scooter, with long walks more actively complains of pain in the joints or muscles.

The articular form of rheumatoid arthritis is considered more favorable, despite the fact that over time the disease leads to changes in the shape of the joint and development of disability.

The disease with this form is not as aggressive as in the viscero-articular. The disease begins to develop with the defeat of one joint.

After a while, the opposite joint is also involved, this is another feature of this form, symmetrical joints are affected.

One of the most important and formidable symptoms in this form is eye damage. Developing uveitis, the process can result in loss of vision. Despite this, this form is the most benign, since it can occur for years with periods of exacerbation and remission.

The viscero-articular form of the disease is marked by a sharp onset of the disease.

Against the background of general intoxication, it is not immediately possible to determine the first symptoms of joint damage.

With this form of the disease, the cervical spine is affected. There is a restriction not only active, but also in passive actions. Not always, but there may be allergic rashes on the sides of the joints, on the thigh.

Methods of diagnosing the disease

In order to correctly and reliably diagnose juvenile rheumatoid arthritis in children it is necessary:

• carefully collect anamnesis;
• to conduct laboratory research methods;
• perform ultrasound;
• to make x-ray pictures of joints;
• computed tomography;
• carrying out additional instrumental examinations (electrocardiogram, examination of the fundus and others).

In most cases, rheumatoid arthritis in children 2 and 3 years of age is performed with ultrasound.

This method allows you to confirm or refute the disease immediately on a primary examination, which contributes to the prompt appointment of specific therapy.

Laboratory methods include conducting a clinical blood test, identifying all major indicators, a biochemical study that determines the presence of rheumatoid factor, ASLO, C-reactive squirrel.

X-ray examination shows changes in the articular surfaces of bones, signs of osteoporosis. If necessary, resort to such manipulation as puncture of the joint, to collect the synovial fluid, which is also examined for inflammation.

Treatment of juvenile rheumatoid arthritis in children

Treatment of the disease should begin immediately after diagnosis. Rheumatoid arthritis in a child should be treated under the supervision of the parents. Since the success of an event depends on many factors. The main goal of treatment:

1. prevention of disability and other complications;
2. preservation of full mobility of joints;
3. removal of an active inflammatory process;
4. improving the quality of life of the patient.

We must not forget that the treatment of such a disease can continue for quite a long period of time. This is due to the fact that the abatement of the activity of the process completely depends on the individual characteristics of the child's organism.

The treatment that the baby receives should include the following aspects:

• preservation of bed and half-bed regime, it depends on the severity of the condition in the acute period;
• obtaining adequate medication;
• physiotherapeutic treatment;
• a course of rehabilitation and rehabilitation measures that are aimed at the full restoration of joint mobility;
• prevention of the disease.

In the first days of the disease, when the pain syndrome is pronounced, it is necessary to ensure the child peace. If there are additional signs of intoxication with an increase in temperature, then antipyretic drugs and analgesics are used.

It is desirable to provide peace for a short period of time. If the child is active enough and can walk, then it is necessary to perform these simple actions, to prevent the development of contractures in the inflamed joint. We must exclude running, jumping, falling.

Drug therapy for the removal of the inflammatory process, non-steroidal anti-inflammatory drugs are prescribed, in more severe cases, hormones.

The main component in the treatment of this disease is the use of immunosuppressors.

These are drugs that reduce the activity of the immune system against their own cells.

Therapy with these medications is long, even in the period of remission the patient needs to take them, in order to reduce the probability of exacerbation of the disease.

We must not forget that the treatment can include not only tablets, but also necessary ointments, creams, gels, which are applied to the affected joints.

It is necessary to monitor the general well-being of the patient. Any therapy is carried out according to the doctor's prescription, self-medication is not permissible.

If the treatment of the disease is not started right away or is not carried out in full, then the exacerbation of the disease will occur more often, and the consequences will be more serious.

Physiotherapy begins at later stages of treatment. Children have such procedures:

• as treatment with mud;
• phototherapy;
• impulse currents;
• paraffin;
• electrophoresis with drugs.

What kind of therapy should be prescribed to the patient is decided by the doctor, since this depends on the age of the child, the stage of the disease and the effectiveness of the treatment. Are there any additional contraindications from the internal organs.

Recovery and rehabilitation in children with rheumatoid arthritis

Against the background of the main drug therapy, when patients take active inflammation, patients are sent to rehabilitation therapy. Its main task is to keep mobility in the joint, not to allow the formation of contractures and deformation. Restorative therapy includes:

• massage;
• therapeutic physical training;
• diet compliance;
• treatment in a sanatorium.

Massage and physiotherapy exercises are prescribed by a physician as a rehabilitator. This is necessary for the doctor to indicate the load that can be given to the child, how long it takes to occupy. Recovery always begins with light exercises, with good portability tasks are complicated.

When performing exercise therapy, balls, skipping ropes, dumbbells, bowls, sticks can be used. Treadmills with special holders, allow the child to model the mechanisms of physiological walking, thereby developing joints.

Carrying out all the recommendations of a rehabilitation physician, the normal work of not only the joint itself but also the surrounding muscles and ligaments is restored. Gymnastics, which is conducted with the child, helps to strengthen the muscular frame of the joint.

This helps improve the local circulation, which in turn increases the protective properties of the body. Parents and children should understand and do not forget that during the period of remission, general restorative activities should be conducted continuously.

The prognosis of the disease in a child is quite favorable, if the treatment was started during and was carried out in full.

Since this condition is chronic, the main goal of parents is not to allow frequent exacerbations.

In more aggressive forms of juvenile rheumatoid arthritis in children there is a gradual disability of the patient, which reduces the quality of human life.

A source: https://glavvrach.com/revmatoidnyj-artrit-u-detej/

Juvenile rheumatoid arthritis in children

Rheumatoid arthritis in children, or juvenile rheumatoid arthritis, is a chronic systemic autoimmune inflammatory disease with a predominant the defeat of peripheral joints synovial type, but in some cases, the pathological process involved and internal organs with the development of various complications.

As a rule, juvenile rheumatoid arthritis (JRA) affects children under 16 years old and differs from the course of a similar disease in adults, which served as the isolation of pathology in a separate form.

Prevalence of JRA is in the range of 2-3 cases per 1000 children. The peak incidence falls on the age of 3-5 and 12-14 years. Girls get sick almost 2 times more often than boys.

Rheumatoid arthritis (RA) ranks first among rheumatic diseases in children.

Causes

The reason for the JRA is still not established. But most researchers associate the development of the disease with infectious diseases (bacterial and viral).

If you look at modern ideas about the etiology of RA, then JRA is a multifactorial disease that develops in the prone to it children (genetic factor) after provocation, for example, viral, streptococcal infection or negative influence of the external environment.

With JRA, autoantibodies are formed in the body, which destroy the joints

Because of a certain genetic predisposition to the development of rheumatoid arthritis (associated with antigens HLA), the immune system responds to a common infection inadequately with hyperactivation and formation autoantibody.

After the destruction of all microorganisms, these antibodies begin to attack their own tissues, which leads to the development autoimmune aggression against joint components with their damage, and in some cases with damage to internal bodies.

Factors that can provoke the development of JRA:

• viral diseases (influenza, MS virus, rubella, chicken pox, adenovirus, herpetic infection);
• bacterial lesions (streptococcal: angina, pharyngitis, otitis media, pneumonia, bronchitis, intestinal infections);
• traumatic joint damage;
• general overheating or hypothermia of the body;
• increased insolation;
• climate change;
• hormonal disorders;
• introduction of vaccines.

Symptoms

Symptoms of rheumatoid arthritis in children depend on which clinical form of the disease develops in a particular case and the rate of debility of the pathology. Distinguish the acute and subacute beginning of RA in children.

The acute onset of rheumatoid arthritis is more common in preschool and primary school children.

This is an unfavorable variant of the course characterized by the rapid development of pathological symptoms of severe forms disease: generalized articular with the defeat of a large number of joints and visceral with damage to the internal bodies.

Subacute onset of rheumatoid arthritis is observed in most cases.

It is characterized by a gradual onset of pathological symptoms, a prolonged chronic course of the disease.

With rheumatoid arthritis all joints of the body can be affected

Consider 2 main forms of rheumatoid arthritis in children.

Articular form

The articular form begins subacute and can occur in 3 versions:

1. Monoarthritis - occurs in 10-30% of cases of the joint form, with 1 large joint - ankle or knee - suffering. The affected joint becomes inflamed, swollen, there is a pronounced pain syndrome, which often leads to a restriction of movement or complete loss of the patient's limb function. This variant of the disease course is not typical for adults and resembles rheumatoid arthritis. A distinctive feature can be considered stiffness in the joint in the morning, which disappears after some time after getting up from bed.
2. Oligoarthritis - occurs in 45-50% of cases of the joint form of the disease. In this case, 2-4 joints (knee, wrist, ankle, elbow, hip, interphalangeal joints of the hands) are involved in the pathological process. Unlike adults, inflammation of the joints is asymmetric.
3. Polyarthritis - occurs in 20-30% of cases and corresponds to the generalized joint form of the disease, which often begins acutely and proceeds severely. In this case, more than 5 different joints are affected. In the pathological process, any joints of the extremities can be drawn in, also the joints of the cervical spine, temporomandibular, sternoclavicular joint can be affected. Arthritis is asymmetric, accompanied by a sense of morning stiffness and external signs of inflammation.

As a rule, monoarthritis and oligoarthritis are not accompanied by extra-articular manifestations and the general condition of the child is not violated. It is possible that the temperature rises to subfebrile numbers with a moderate increase in peripheral lymph nodes.

The generalized articular form always proceeds with a pronounced extraarticular symptomatology:

• fever;
• peripheral lymphadenopathy;
• the appearance of subcutaneous rheumatic nodules;
• decreased body weight;
• atrophy of certain muscle groups;
• muscle pain;
• defeat of the eyes (uveitis, iridocyclitis, cataract).

Inflammation of the knee in rheumatoid arthritis in children

The joint form of the disease is considered benign, as it slowly progresses and is not accompanied by severe lesions of the internal organs.

But with the progression of pathology in joints, there are persistent changes that manifest themselves in the form of various persistent deformations, muscle atrophy, dislocations and subluxations, changes in ligaments.

All this can cause disability of the child.

Articular-visceral form

In some cases, children's rheumatoid arthritis can flow through the joint-visceral type.

This is a serious variant of the disease, which begins acutely and proceeds with lesions of the internal organs, which in some cases can lead to death.

This form of the disease exists in 2 versions:

• Still's syndrome;
• allergoseptic syndrome.

Still's syndrome begins acutely with a violation of the general condition of the patient, fever, the appearance of rash allergic character, generalized enlargement of the lymph nodes, enlargement of the liver and spleen, pain and inflammation in joints.

The defeat of the joints in the syndrome of the Still resembles a generalized joint form. Very quickly develop joint deformities and muscle contractures, which leads to severe functional insufficiency and disability of the child.

Liver enlargement is a sign of Still's syndrome

Along with articular manifestations, lesions of internal organs develop:

• heart - myocarditis, endocarditis, pericarditis, which can lead to the formation of heart disease;
• kidneys - glomerulonephritis, amyloidosis of kidneys with gradual development of renal failure;
• lungs - pneumonitis;
• blood vessels - vasculitis;
• blood - anemia;
• amyloidosis of the liver, adrenals.

Allergoseptic syndrome (Wissler-Fanconi syndrome) begins acutely, accompanied by a severe condition of the child with febrile fever, which persists for a long time (2 weeks - 3 months). On the body appears a polymorphic rash of an allergic nature.

Lymph nodes are enlarged all over the body, internal organs are affected - pericarditis, pleurisy, myocarditis. The liver and spleen are enlarged. At the beginning of the disease, joint damage is manifested only by pain syndrome.

Arthritis develops 2-3 months after the onset of pathological symptoms.

Diagnostics

The diagnosis of rheumatoid arthritis, especially at an early stage, is a very difficult task, since there are no specific methods that allow you to establish a diagnosis with 100% accuracy.

In most cases, this is a clinical diagnosis.

At this time, juvenile rheumatoid arthritis is diagnosed with clinical Eastern European criteria, which include a set of symptoms, radiologic signs and laboratory.

And still we advise reading:Treatment of rheumatoid arthritis with methotrexate

Clinical criteria of JRA:

• arthritis lasts more than 3 months;
• after the defeat of the first joint, the second is inflamed no later than 3 months;
• if the small joints of the hand are affected, the inflammation is symmetrical;
• signs of synovitis (effusion in the joint cavity);
• development of joint contracture;
• development of bursitis or tendovaginitis of any localization;
• amyotrophy;
• morning stiffness in the joints;
• inflammation of the eyes;
• subcutaneous rheumatoid nodules.

X-ray radiologic criteria:

1. osteoporosis according to roentgenograms;
2. reduction of the joint gap, marginal bone defects, joint ankylosis;
3. dysplasia of bones;
4. signs of damage to the cervical spine.

Radiography of damaged joints is an integral part of the diagnosis of JRA

Laboratory criteria of JRA:

• increased ESR;
• rheumatoid factor in blood serum;
• morphological study of the biopsy of the joint membrane.

If the child has 3 of the above criteria, then a diagnosis is possible; If 4, then there is no doubt, and arthritis should be mandatory; if there are 8, then the classic variant of rheumatoid arthritis is diagnosed child.

Principles of treatment

Treatment of juvenile rheumatoid arthritis is a very important and complex process. However, adequate and timely initiation of therapy can stop the progression of the disease, reduce the risk of complications and improve the prognosis of the disease.

The main tasks of treating rheumatoid arthritis in a child:

1. elimination of active inflammation;
2. elimination of symptoms of arthritis and pain;
3. saving the function of the joints, their mobility;
4. prevention of functional limitations and disabilities;
5. achievement of persistent remission;
6. improving the quality of life of a sick child, for example, prosthetics in case of severe limb injury;
7. prevention of side effects from medications.

The basis of treatment is medication permanent therapy, which is appointed to eliminate symptoms (symptomatic) and stopping the autoimmune process (basic anti-inflammatory therapy).

Drug therapy is the basis of RA treatment

Apply medicines from the following groups:

• NSAIDs (diclofenac, ibuprofen, meloxicam) - these drugs do not affect the course of the disease, but only eliminate its symptoms, so for monotherapy they are not used, but only in a complex. All these drugs negatively affect the gastrointestinal tract, can cause an exacerbation of gastritis and bleeding.
• Glucocorticoid hormones (prednisolone, methylprednisolone) - prescribed with ineffectiveness of other symptomatic agents. Medication is prescribed by a short course (pulse therapy) with exacerbations or very severe forms of the disease with damage to the internal organs. Permanent intake of GCS for children is prescribed rarely (only in extremely severe cases).
• Cytostatics (drugs from various groups) that affect the course of the disease and are used as a basic therapy. These drugs suppress autoimmune aggression and inhibit the progression of pathology.
• Targeted therapy is a modern, highly effective and costly method of treatment when applied Special biological preparations that block the production of autoantibodies and further damage joints.

In severe cases, extracorporeal methods of purifying blood from antibodies are used. With the development of complications (contractures, deformations) apply functional therapy, prosthetics, surgical orthopedic care.

A source: http://MoyaSpina.ru/bolezni/yuvenalnyy-revmatoidnyy-artrit-detey