Juvenile rheumatoid arthritis: causes, diagnosis, treatment

Juvenile rheumatoid arthritis

Juvenile (juvenile) rheumatoid arthritis is a diffuse disease of connective tissue with a predominant joint damage that develops in childhood and adolescence.

Juvenile rheumatoid arthritis is the most common disease in pediatric rheumatology. According to statistics, it is diagnosed in 5, 5% of young patients all over the world.

Usually, the pathology is manifested not earlier than two years of age, while it is -2 times more common in girls.

Juvenile rheumatoid arthritis refers to invalidating rheumatic pathology, often leading to loss of ability to work already at a young age.

Causes of Juvenile Rheumatoid Arthritis

Presumably, the combination of various exogenous and endogenous damaging factors and the hypersensitivity of the organism to their effects lead to the development of juvenile rheumatoid arthritis.

Manifestations of juvenile rheumatoid arthritis can contribute to:

• transferred acute infection, (most often, viral, caused by parvovirus B19, Epstein-Barr virus, retroviruses)
• joint trauma
• insolation or supercooling
• injections of protein preparations.

Collagen proteins (types II, IX, X, XI, oligomeric matrix protein of cartilage, proteoglycans) can serve as potentially arthritogenic stimuli.

An important role is played by the family-genetic predisposition to the development of rheumatic pathology (carriage of certain sublocks of HLA antigens).

One of the leading links in the pathogenesis of juvenile rheumatoid arthritis is congenital or acquired immunodeficiency, leading to the development of autoimmune processes.

Being part of the circulating immune complexes, the RF triggers a series of chain pathological reactions that lead to damage to the synovial shell and vascular endothelium, the development in them of non-chronic chronic inflammation of exudative-alterative, and then proliferative character.

The formation of microvilli, lymphoid infiltrates, proliferation of granulation tissue (pannus) and erosion on the surface of articular cartilage, destruction of cartilage and epiphyses of bones, narrowing of the joint space, atrophy of muscle fibers.

Progressive fibrotic sclerotic involvement of joints occurs in children with a seropositive and systemic variant of juvenile rheumatoid arthritis; leads to irreversible changes in joints, development of subluxations and dislocations, contractures, fibrous and bone ankylosis, restriction of function joints.

Destruction of the connective tissue and changes in the vessels also manifest themselves in other organs and systems. Juvenile rheumatoid arthritis can also occur in the absence of rheumatoid factor.

Juvenile rheumatoid arthritis is an independent nosological unit resembling rheumatoid arthritis in adults, but differing from it in articular and extraarticular manifestations.

The classification of the American College of Rheumatology (AKP) identifies 3 variants of juvenile rheumatoid arthritis: systemic, polyarticular and oligo- (paused) articular (types I and II).

Type I oligoarthritis accounts for up to 35-40% of cases, mostly girls are ill, debut - at the age of up to 4 years. Type II oligoarthritis is noted in 10-15% of patients, mainly in boys, beginning - at the age of over 8 years.

According to immunological characteristics (presence of rheumatoid factor) juvenile rheumatoid arthritis is divided into seropositive (RF +) and seronegative (RF-). On clinical and anatomical features distinguish:

1. articular form(with uveitis or without it) in the form of polyarthritis with lesions of more than 5 joints or oligoarthritis with lesions from 1 to 4 joints;
2. articular-visceral form, including Still's syndrome, Wissler-Fanconi syndrome (allergoseptic);
3. form with limited viscerite(defeat of the heart, lungs, vasculitis and polyserositis).

The course of juvenile rheumatoid arthritis can be slow, moderately or rapidly progressive.

There are 4 degrees of activity of juvenile rheumatoid arthritis (high - III, medium - II, low - I, remission - 0) and 4 classes of disease (I-IV) depending on the degree of disruption of the function joints.

Symptoms of juvenile rheumatoid arthritis

In most cases, juvenile rheumatoid arthritis begins acutely or subacute. Acute debut is more typical for generalized articular and systemic forms of the disease with a recurring course.

With a more common articular form, mono-oligo- or polyarthritis develops, often of a symmetrical nature, with the predominant involvement of large joints limbs (knee, wrist, elbow, ankle, hip), and sometimes small joints (2nd, 3rd metacarpophalangeal, proximal interphalangeal).

There is swelling, deformity and local hyperthermia in the area of ​​affected joints, moderate soreness at rest and during movement, morning stiffness (up to 1 hour and more), restriction of mobility, change of gait.

Arthritis of small joints of the hands leads to spindle-shaped deformation of the fingers.

Juvenile rheumatoid arthritis often affects the cervical spine (pain and stiffness in the neck) and the TMJ ("bird's jaw").

The defeat of the hip joints usually develops in the late stages of the disease.

There may be subfebrile, weakness, moderate splenomegaly and lymphadenopathy, weight loss, slowing of growth, lengthening or shortening of the limbs.

The joint form of juvenile rheumatoid arthritis is often combined with rheumatoid eye disease (uveitis, iridocyclitis), a sharp drop in visual acuity.

Rheumatoid nodules are characteristic of the RF-positive polyarthritic form of the disease that occurs in children older age, having a more severe course, the risk of developing rheumatoid vasculitis and Sjogren's syndrome.

RF-negative juvenile rheumatoid arthritis occurs in any childhood, has a relatively light course with a rare formation of rheumatoid nodules.

The systemic form is characterized by pronounced extra-articular manifestations: persistent febrile fever of a hectic nature, polymorphous rash on limbs and trunk, generalized lymphadenopathy, hepatolienal syndrome, myocarditis, pericarditis, pleurisy, glomerulonephritis.

Joint damage can occur during the initial period of systemic juvenile rheumatoid arthritis or after several months, while taking a chronic recurrent course.

Still's syndrome is more common in preschool children, it is characterized by polyarthritis with lesion of small joints.

Wissler-Fanconi syndrome usually occurs at school age and proceeds with the predominance of polyarthritis of large, hip joints without pronounced deformities.

Complications of juvenile rheumatoid arthritis are secondary amyloidosis of the kidneys, liver, myocardium, intestine, macrophage activation syndrome with possible fatal outcome, cardiopulmonary insufficiency, growth retardation.

Type I oligoarthritis is accompanied by chronic iridocyclitis with a risk of vision loss, type II oligoarthritis - spondyloarthropathy.

Diagnosis of juvenile rheumatoid arthritis is based on data of anamnesis and examination of the child by a children's rheumatologist and child ophthalmologist, laboratory studies (Hb, ESR, presence of RF, antinuclear antibodies), radiography and MRI of joints, joint puncture (arthrotcentesis).

The criteria for juvenile rheumatoid arthritis are: debut up to 16 years; duration of the disease over 6 weeks; presence of at least 2-3 signs (symmetrical polyarthritis, deformities of small joints of brushes, destruction of joints, rheumatoid nodules, RF positivity, positive synovial membrane biopsy, uveitis).

X-ray stage of juvenile rheumatoid arthritis is determined by the following signs: I - epiphyseal osteoporosis; II - epiphyseal osteoporosis with narrowing of the joint slits, single edge defects (usuras); III - destruction of cartilage and bone, numerous usuras, subluxation of joints; IV - destruction of cartilage and bone with fibrous or bone ankylosis.

Differential diagnosis is performed with juvenile ankylosing spondylitis, juvenile psoriatic arthritis, reactive and infectious arthritis, Bechterew's disease, Reiter's disease, SLE, inflammatory bowel diseases (Crohn's disease, Whipple's disease), bone tumors, acute leukemia.

Treatment of juvenile rheumatoid arthritis

Treatment of juvenile rheumatoid arthritis is long and complex, begins immediately after the diagnosis is established. In the period of exacerbation, motor activity is restricted (run, jumps, active games are excluded), stay in the sun is forbidden.

In the diet restrictions apply to salt, protein, carbohydrates and fats of animal origin, sweets.

We recommend food with a high content of vegetable fats, fermented milk products with low fat content, fruits, vegetables, intake of vitamins of group B, PP, C.

Drug therapy of juvenile rheumatoid arthritis includes symptomatic (anti-inflammatory) drugs of rapid action and pathogenetic (basic) drugs.

Long-term use of basic drugs-immunosuppressants (methotrexate, sulfasalazine) allows to reduce the need for symptomatic preparations, prevent progression, prolong remission and improve the prognosis of juvenile rheumatoid arthritis.

An important component of therapy for juvenile rheumatoid arthritis is exercise therapy, massage, physiotherapy (medicinal phonophoresis, mud, paraffin, ozocerite, UV, laser therapy) and treatment natural factors.

With pronounced joint deformities and development of severe ankylosis, joint replacement is indicated.

Prognosis and prevention of juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis is a life-long diagnosis.

With adequate treatment and regular observation of a rheumatologist, a prolonged remission without pronounced deformities and loss of joint function with a satisfactory quality of life (study, work by profession). The risk of exacerbation may persist for many years.

A more unfavorable prognosis for early debut, continuously recurring course, RF + polyarthritis and systemic forms juvenile rheumatoid arthritis, leading to the development of complications, severe limitations of joint movement and disability.

To prevent exacerbations of juvenile rheumatoid arthritis, insolation, hypothermia, climatic belt, to limit contacts with infectious patients, to exclude preventive vaccinations and reception immunostimulants.

A source: http://www.krasotaimedicina.ru/diseases/rheumatology/juvenile-rheumatoid-arthritis

Characteristics of the disease with juvenile rheumatoid arthritis

In the course of the disease, only joints (articular form) or joints and internal organs (joint-visceral form) can be affected.

Lesion of joints.

• Symmetrical joint damage. The most common pathological process involves middle and large joints (knee, ankle, wrist, ulnar, hip), less often small joints of the hand, jaw joints, joints of the cervical segment the spine.
• Morning stiffness lasting more than 1 hour. The patient, after a night's sleep, feels a bit of difficulty while moving in the joints and self-service.
• Swelling of the joints.
• Local increase in temperature of the affected joint.
• Soreness of the joints during movement and at rest. The most intense pains appear in the second half of the night or in the morning.
• The color of the skin above the joint does not change.
• In the later stages, due to the significant destruction of intraarticular elements and the transition of inflammation to the periarticular tissues, subluxations and coarse disfiguring deformities that cause loss of joint function (patients are not able to hold a mug in their hands, fasten their buttons, to be washed).
• The appearance of contractures (a condition in which the limb can not be fully bent or unbent in one or more joints), subluxation (violation of the normal articulation of articular surfaces, in which their partial contact is preserved).

Extra-articular manifestations.

1. Increased body temperature. The highest temperature is usually observed in the evening (38-39 ° C or higher), later it quickly returns to normal.
2. Digital arteritis is small brown foci on the skin near the nails. They are the result of necrosis of small vessels due to rheumatoid vasculitis (inflammation of the walls of small blood vessels).
3. Rheumatoid nodules - formations under the skin of a size from, cm to 2, Often they are localized in the area of ​​elbows. Nodules are painless, mobile, as they are not soldered to surrounding tissues.
4. Inflammation of the heart (myocarditis, pericarditis). When myocarditis is concerned about pain in the heart, dyspnea (feeling of lack of air), cyanosis of the skin (bluish staining), lowering of blood pressure, arrhythmia. The pulse changes: it becomes more frequent (tachycardia) or is cut (bradycardia). With pericarditis, clinical symptoms are similar to those of myocarditis. With the accumulation of a significant volume of fluid in the pericardial bag, there appear: puffiness (swelling) of the patient's face, swelling of the cervical veins, forced semi-sitting position in the bed (orthopnea).

Significantly less often with chronic rheumatoid arthritis occur:

• Pleuritis (inflammation of the serous membrane covering the lungs);
• interstitial lung fibrosis - inflammation of the interstitial lung tissue followed by a transition to fibrosis (proliferation coarse fibrous connective tissue, compaction of the lung tissue with the formation of a functional inferiority);
• pulmonary hypertension;
• enlargement of the liver and spleen;
• increased peripheral lymph nodes;
• rheumatoid uveitis (inflammation of the choroid of the eye).

Isolate syndrome Still and Allergosepsis Wiesler-Fanconi.

Still's syndromehas a subacute start. It is characterized by:

1. an increase in peripheral lymph nodes (lymphadenopathy);
2. increase in body temperature to 39-40 ° C;
3. allergic rash and inflammation of the serous membranes of internal organs (polyserosite).

Allergosepsis Wiesler-Fanconi:

• body temperature reaches 40 ° C and more (hectic fever);
• rashes on the skin in the form of spots;
• inflammation of serous membranes of internal organs (polyserositis);
• carditis (inflammatory process in the heart);
• interstitial lung fibrosis - inflammation of the interstitial lung tissue followed by a transition to fibrosis (proliferation coarse fibrous connective tissue, compaction of the lung tissue with the formation of a functional inferiority).

Articular syndromeis limited to joint pain (arthralgia) or limited coming exudative arthritis (inflammation of the joint with the presence of exudation - a fluid that has escaped from the vessels into inflamed tissues). There is a threat to the life of the child due to severe lesions.

Clinical and anatomical characteristics.

1. Rheumatoid arthritis with predominant joint damage (articular form):
   • polyarthritis - inflammation of a large number of joints (more than three);
   • oligoarthritis - inflammation of 2-3 joints;
   • monoarthritis - lesion of one joint.
2. Rheumatoid arthritis with involvement of joints and internal organs (joint-visceral form).
   • With limited viscera (inflammation of the internal organs).
   • Still's syndrome - characterized by high body temperature, inflammation of the joints, spotted or nodular-like rash, lack of in the blood of the rheumatoid factor, enlarged lymph nodes and spleen, rapid involvement of various internal bodies.
   • Allergoseptic syndrome (Wisler-Fanconi syndrome):
     • body temperature reaches 40 ° C and more (hectic fever);
     • rashes on the skin in the form of spots;
     • inflammation of serous membranes of internal organs (polyserositis);
     • carditis (inflammatory process in the heart);
     • interstitial lung fibrosis - inflammation of the interstitial lung tissue followed by a transition to fibrosis (proliferation coarse fibrous connective tissue, compaction of the lung tissue with the formation of a functional inferiority).

Immunological characteristics:

1. rheumatoid arthritis seropositive- if there is a rheumatoid factor in the blood, a special immunological marker that testifies in favor of rheumatoid arthritis. It was found that the presence of rheumatoid factor in the blood causes more aggressive course and unfavorable prognosis of the disease;
2. rheumatoid arthritis seronegative- in the absence of rheumatoid factor in the blood.

Degrees of activity of the process:

• high;
• moderate;
• low;
• remission (the period of the course of a chronic illness, which is manifested by the disappearance of her symptoms). They are set by the doctor on the basis of calculation of painful and swollen joints and laboratory data.

The reasons are unknown.

It is believed that the underlying disease is a genetic predisposition, which is realized in the disease under the influence of environmental factors:

1. viruses (influenza, Coxsackie virus, Epstein-Barr virus);
2. bacterial infection (group B streptococcus, mycoplasma, chlamydia);
3. injury of the joint;
4. hypothermia of the body;
5. stressful situations;
6. Inoculations performed on the background or immediately after the acute respiratory viral infection or bacterial infection;
7. insolation (exposure to sunlight).

We remind you that the sooner you seek help from a specialist, the more chances to keep health and reduce the risk of complications:

• Analysis of complaints and anamnesis of the disease:
  • symmetrical pain in the joints during movement and at rest;
  • morning stiffness lasting more than 1 hour;
  • swelling of the joints;
  • increased temperature of the joint;
  • the appearance of nodules under the skin more often in the region of the elbows;
  • pain in the heart.
• Analysis of anamnesis of a child's life:
  • transferred infectious diseases (for example, frequent otitis (ear inflammation), intestinal infections);
  • the presence of allergic reactions in the past.
• Hereditary anamnesis: the presence of relatives with rheumatic diseases or with other autoimmune diseases.
• General inspection:
  • swelling of the affected joints;
  • change in the shape of the joints: ulnar deviation (the brush resembles the fin of the walrus).
• Laboratory examinations:
  • general blood test: acceleration of ESR (sedimentation rate of erythrocytes);
  • Immunological examination of blood: positive rheumatoid factor (specific protein in rheumatoid arthritis);
  • ACPC (antibodies to cyclic citrulline peptide) is the most reliable marker of rheumatoid arthritis.
• Instrumental research methods:
  • ECG;
  • Ultrasound of the heart, abdominal organs, kidneys;
  • X-ray of the organs of the thoracic cavity, affected joints, spine.
• It is also possible to consult a children's rheumatologist.

Treatment of rheumatoid arthritis should be performed before remission (no clinical and laboratory manifestations of the disease). This pursues the main goal - to slow down the process of joint destruction.

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) - have analgesic and anti-inflammatory effects, however, are not able to slow down the destruction of joints.
2. Glucocorticosteroids inside or intra-articularly - suppress inflammation, but slightly slow down the destruction of joints.
3. Basic anti-inflammatory drugs (sulfasalazine, leflunomide, aminoquinoline preparations, cytostatics) - suppress inflammation and slow down the destruction of joints. These drugs have serious side effects (they depress hemopoiesis, disrupt liver function), especially cytostatics, however, only they can slow down the destructive inflammatory process, so they must be taken continuously under the control of a general analysis of blood and liver enzymes. Great hopes are placed on biological genetically engineered drugs that affect the damaged immune processes. They are also basic and slow the progression of the disease.
4. Local therapy includes: physiotherapeutic methods of treatment (for example, magnetotherapy - a method of treatment based on the effect on the human body with magnetic fields, electrophoresis - the method of electrotherapy, which includes a combined effect on the body direct current and drugs administered with it), when the inflammatory process subsides, therapeutic exercise is prescribed and massage.
5. The development of contractures (restriction of passive movements in the joint, that is, a state in which the limb can not be completely bent or unbent in one or more joints due to a lesion) and ankylosis (complete loss of movement in joint).
6. Complete loss of vision on the background of uveitis (inflammation of the choroid of the eye).
7. Chronic renal failure as a result of amyloidosis (deposition of amyloid protein in internal organs with further disruption of their functions) of the kidneys. Its main signs: in the early days there is a loss of appetite, nausea, vomiting. Somewhat later there are muscle twitchings, drowsiness, a blocking of consciousness, there is a sense of lack air, heart rate is increased, heart boundaries expand, pressure is increased, rhythm is disturbed heart. There are pains in the abdomen, the liver is enlarged, diuresis (volume of urine) decreases.
8. Invalidization.
9. Osteoporosis and fractures associated with it.
10. Primary prevention (aimed at preventing the development of the disease) does not exist.
11. Only secondary prevention is possible (aimed at preventing relapses of juvenile rheumatoid arthritis). It is necessary to constantly monitor the rheumatologist. In the presence of signs of a beginning exacerbation, it is necessary to strengthen medical therapy, reduce physical stress (study at home for schoolchildren), or send a patient to inpatient treatment.

A source: https://lookmedbook.ru/disease/yuvenilnyy-revmatoidnyy-artrit

Juvenile rheumatoid arthritis: the causes of the diagnosis, symptoms and treatment in children

Juvenile rheumatoid arthritis is a chronic joint disease, the origin of which has not been established so far.

It is noted only that the inflammatory process in the joints always lasts at least 6 weeks and develops in children and adolescents under the age of 16 years.

Mostly girls suffer.

Juvenile rheumatoid arthritis (or abbreviated Jurassic) can be converted to arthritis of severe forms or ankylosing spondylitis.

All these diseases have serious consequences and can lead to disability of the child.

Therefore, the treatment of juvenile rheumatoid arthritis should be carried out as early as possible.

Advice: parents should always closely monitor the child, if he has a positive rheumatoid factor, then juvenile rheumatoid arthritis may There is the slightest change in gait, gestures, coordination of movements - an occasion for examining a rheumatologist for confirmation or denial Yura.

Classification of the Jurassic

A juvenile type of arthritis is a collective term, which means all rheumatoid diseases in children. There is an official classification of the Jurassic:

• JURA M 08.0 - juvenile rheumatoid arthritis;
• Juana - juvenile psoriatic arthritis;
• Juha - juvenile chronic arthritis (seronegative polyarthritis M 08.3);
• USA M 08.1 - juvenile ankylosing spondylitis;
• M 08.2 - juvenile arthritis with systemic onset;
• M 08.4 - juvenile arthritis with pausiarticular origin;
• M 08 8 - juvenile arthritis of other types;
• M 08.9 - juvenile arthritis as an accompanying disease in other pathologies.

The diagnosis is made if the clinical picture of the child's illness is as follows:

1. The disease lasts more than three months.
2. The child is not older than 16 years.
3. Articular inflammation arose for the first time and does not belong to other nosological forms.

Symptoms of the Jurassic

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

Deformation of small joints of hands;

Symmetrical polyarthritis of the joints of the hands and feet;

Formation of rheumatoid nodules;

Presence of destructive arthritis.

Based on the results of the survey, seropositivity is observed in the Russian Federation

How Juvenile Arthritis Works in Children

By the nature of the current, there are two forms of the Jurassic:

1. Acute - the symptoms are very severe, there are frequent relapses, the forecast is unfavorable.
2. Subacute - the same symptoms, but less pronounced, treatable better.

Localization of Jurassic:

• Articular, affecting mainly ligaments, joints and muscles;
• Articular-visceral, when other internal organs are affected - heart muscle, liver and kidneys.

Causes of the Jurassic

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

1. Severe hypothermia.
2. Hereditary predisposition.
3. Injuries of joints and ligaments.
4. Inadequate drug therapy.
5. Infection of a viral or bacterial nature.

In some cases, excessive sun exposure causes illness.

How to recognize juvenile arthritis

Juvenile rheumatoid arthritis affects mostly large and small joints. At the same time they are swollen, deformed, the skin feels hot, the child complains of burning pain and stiffness in movements.

Typical localization for the Jurassic is the maxillo-temporal junctions and the cervical spine. Sometimes it is similar to the periarthritis of the shoulder, so it is important to correctly diagnose.

Such lesions are always accompanied by inflammation, the gradual destruction of cartilaginous tissues and the fusion of the joint elements.

The extraarticular signs of the disease include:

• febrile condition with fever;
• pain in the joints, intensifying in the morning;
• rashes on the skin;
• hypertrophy of lymph nodes, liver and spleen.

If the temperature falls, the child literally sweats later, his underwear and bed linen soak through. This stage of the Jurassic can last from several months to several years, if no diagnosis has been made and no treatment has been initiated. And only then there will be lesions of the joints.

Acute form of the disease

Juvenile rheumatoid arthritis of acute form is very difficult. All symptoms are manifested, the nature of the disease is systemic. There are often relapses, treatment is ineffective.

Subacute form of the Jurassic

Arthritis in children in this form has the same symptoms as in acute, but they are not so strong and often manifest.

At the development stage, one joint, most often the knee or ankle, is affected first.

If the child is very small, he becomes capricious, refuses to get up on his feet, all the time either asks for his hands or sits.

Older children complain about "morning stiffness". A child can not get out of bed and do homework on his own.

The gait changes: it becomes very slow, as if every step causes pain.

In this condition, he can stay for up to an hour until the joints are developed.

Often parents and doctors take for this reason the disease for the simulation, explaining this by the fact that the child simply does not want to go to school or to a kindergarten. If the pediatrician claims that the child is pretending - it makes sense to go to another, more attentive and qualified physician.

Girls of preschool and primary school age often have a Jurassic rheumatoid eye disease.

The disease is calledrheumatoid uvitis, one- or two-sided.

When subacute rheumatoid arthritis affects from 2 to 4 joints, this form of the disease is called oligoarticular.

Juvenile rheumatoid arthritis systemic form

In this case, the disease is recognized by such signs:

1. A strong fever that can not be appeased;
2. Hypertrophy of lymph nodes;
3. Hepatolienal syndrome - liver dysfunction;
4. Allergic rashpolimorfnogo nature;
5. Different arthralgia.

If treatment has not been started, secondary amyloidosis can occur, caused by the constant presence of immune complexes in the blood.

Begins deposition of amyloids on the walls of blood vessels and arteries, in the liver, kidneys, intestines and myocardium. As a result, the work of these vital organs is violated.

The kidneys suffer most of all, a large number of proteins are found in the urine. Because, as a rule, children with rheumatoid arthritis suffer from kidney failure first of all.

How is the diagnosis made?

In order to accurately diagnose a disease, a doctor can prescribe such examinations and tests:

1. Radiography. In the pictures you can find osteoporosis (bone tissue lose density), bone erosion, reduced lumens between joints.
2. MRI, CT and NRT. With the help of these diagnostic methods, the doctor can determine how badly the cartilage tissues and bones are damaged.
3. Laboratory tests of urine and blood. The results show the level of ESR, leukocytes in the blood, which indicates the presence of an inflammatory process, as well as the level of protein in the urine. In addition, it is necessary to donate blood for the presence of rheumatoid factor (RF), antinuclear bodies, determination of the level of C-reactive protein.

Based on the results of tests and examinations, complex therapy is prescribed.

How is the Jura treated?

The program of treatment for children is made depending on the form of the disease and the condition of the joints. In the "quiet" period, it is necessary to follow a diet.

Food should be low-calorie, rich in vitamins and polyunsaturated fatty acids.

Saturated fatty acids and allergen products should be completely eliminated.

During an exacerbation, it is recommended that the child be hospitalized. Complex therapy will be performed at the hospital, taking into account the characteristics of the disease. In this case, the doctor will observe such moments during treatment:

• The effect of various medications on the patient's condition;
• The nature of immunopathology;
• Character and development of bone-cartilage destruction.

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

Basic treatment includes the use of such drugs:

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

If the disease is provoked by an infection, it is necessary to conduct a course of antibiotic therapy. If the disease has an immunocomplex etiology, plasmaphoresis is used. For very severe pain medications are administered intra-articularly.

In some cases, immunotherapy gives a positive result. Intravenously, a drop of immunoglobulin is injected.

It is important to observe the technique of drug administration. In the first 15 minutes, every 10-20 drops of the drug are injected every minute, then the rate increases. You can repeat the procedure every month.

In severe forms of the disease and neglected cases, when conservative methods of treatment proved to be ineffective, a surgical operation is performed - arthroplasty.

As for the treatment of rheumatoid uivitis, this complication is treated together by a rheumatologist and an ophthalmologist.

For local treatment, a combination of GCS and mydriatic is used.

If after a two-week course of such therapy the results are not observed or the pathology progresses, cytostatics are prescribed.

To apply them begin after confirmation in the child of acute or seropositive form of rheumatoid arthritis.

Features of treatment, complications and consequences of the disease

In the fight against the symptoms of the disease, it is very important to eat the baby properly. Minimize the use of salt.

This means that the diet should not be sausages, hard cheeses, pickles, homemade food should also be salted very moderately.

Thus, the intake of sodium into the body decreases.

To maintain a balance of calcium in the menu you need to include nuts, dairy products, additionally recommended supplements with calcium and vitamin D.

Advice: it is not necessary to limit the child if he is diagnosed with this in communication with peers and sports. He can quite attend various sections and take part in mobile games. Then, in case of an exacerbation of the disease, complications and consequences will be minimized.

It is noted that the disease proceeds in a lighter, milder form, if the child leads an active lifestyle. In weak, flaccid children, the symptomatology, on the contrary, is always expressed more vividly.

But: while it is strictly forbidden to force the child to move, perform exercises, etc.

He himself must regulate the intensity of physical exertion.

If physical discomfort and pain occur during physical activity, then it is necessary to revise and adjust exercises of exercise therapy and other sports.

If the treatment was started late, was conducted in bad faith or was absent altogether - what then threatens the juvenile rheumatoid arthritis? In the first place, the fusion of the joint elements will progress. And this leads to their complete dysfunction, immobility, as a consequence - the disability of the child.

Influence on the kidneys, liver and heart lead to the development of chronic pathologies of these organs, which also negatively affects the general condition of children.

When a rheumatoid cancer occurs, the child may completely become blind. It should be remembered that the destroyed articular tissues are not restored.

And the operation is not always possible.

A source: http://sustav.info/bolezni/arthritis/yuvenilnyj-revmatoidnyj-artrit.html

Juvenile Rheumatoid Arthritis: Diagnosis and Symptoms

Category: Children's diseases 4668

Juvenile rheumatoid arthritis is a systemic autoimmune disease that affects children under the age of sixteen. Girls are sick several times more often than boys.

The autoimmune nature of the disease suggests that the body, by unknown factors, begins to recognize its cells as pathological and actively develops antibodies against them.

It is systemic, because not only the joints, but also several internal organs and systems are involved in the pathogenic course.

During such a disease, the inflammatory process first attacks the joints, which leads to a slow violation of the integrity of the cartilage and deformation of the bones. Similar development in the internal organs leads to a violation of their normal functioning.

The articular form of the disease is manifested by such symptoms as puffiness and visible deformation of the affected part of the body, and systemic - an increase in body temperature to critical indicators, the occurrence of rashes, as well as the defeat of organs such as the heart, lungs and kidney.

Diagnosis is the implementation of a complete hardware examination of the child and puncture of the joints. Most often, this ailment can be diagnosed at the age of up to two years.

If this is not done in time, then such a pathology can lead to disability and loss of efficiency. The treatment of the disease is aimed at taking medications, performing physiotherapy and therapeutic massage courses.

Because rheumatoid arthritis in children is a lifelong disease, the prognosis depends on the proper diagnosis and tactics of therapy.

Etiology

To date, medicine does not know the cause of the progression of juvenile rheumatoid arthritis, but physicians converge in the opinion that the basis of this disease in children is a combination of external and internal factors, such as:

• genetic predisposition;
• severe course of viral diseases;
• bacterial infections;
• a wide range of joint injuries;
• prolonged exposure to cold or sunlight;
• complications after preventive vaccinations, which may have been performed during or immediately after recovery from ARVI;
• injections of protein drugs;
• congenital or acquired immunity disorders.

Such a disease occurs infrequently, but leads to irreversible changes in the affected joints, internal organs and systems. The main difference from rheumatoid arthritis in adults is that in children it affects not only the joints.

Varieties

Depending on the number of affected joints, juvenile rheumatoid arthritis is divided into:

1. polyarthritis - characterized by the defeat of more than four joints;
2. oligoarthritis - pathological process affects less than three joints;
3. monoarthritis - an inflammatory process is observed only in one joint.

As the internal lesions proceed, as well as the manifestation of symptoms, the disease can be:

• articular;
• limited - only one organ becomes inflamed;
• the syndrome of Still - differs considerable soreness in the joints, the appearance of a rash, the absence of a rheumatoid factor in blood tests and rapid leakage. Several internal organs are involved in the process;
• allergoseptic - multiple damage to organs and systems within the body is observed.

Depending on the presence of rheumatoid factor in the blood, such an ailment occurs:

1. seropositive - is characterized by an aggressive and rapid course, as well as a disappointing prognosis;
2. seronegative.

The flow of juvenile rheumatoid arthritis is divided into several stages:

• slow;
• moderate;
• fast;
• sharp;
• subacute.

According to the degree of activity of the inflammatory process, the disease in children is divided into phases:

1. high;
2. average;
3. low;
4. phase of remission.

Symptoms

Juvenile rheumatoid arthritis

During the course of this disease, only joints or joints and organs are affected. The following symptoms refer to the joint form of the disease:

• feeling of restraint after sleep. Duration is more than one hour;
• swelling. Often, the inflammatory process is affected by joints of medium and large size;
• During palpation, the temperature of the affected joint is felt in relation to the whole body;
• significant soreness - it is noted not only at movement, but also at rest;
• joint deformities - are observed in the late stages of the course of the disease;
• The inability to fully bend or unbend the inflamed upper or lower limb.

The main symptoms of extra-articular manifestations of the disease are:

1. a significant increase in the temperature of the entire body, up to a fever;
2. the appearance of brown spots on the skin in the nail area;
3. formation of rheumatoid nodules under the skin;
4. soreness in the heart;
5. decrease in blood pressure;
6. dyspnea;
7. significant reduction in body weight;
8. fast fatiguability;
9. formation on the skin of rashes of an allergic nature, which carry a lot of uncomfortable sensations;
10. disturbances of a warm rhythm.

Internal symptoms that can be observed only in the diagnosis of this ailment in children:

• inflammatory process in the mucous membrane of the lungs;
• reddening of the protein coat of the eyes - can be either one-sided or spread to both eyes;
• fibrosis;
• pulmonary hypertension;
• an increase in the volume of organs such as the liver, spleen, regional lymph nodes.

Complications

If untimely referral to a specialist for adequate care, there are many complications that may pose a threat to the life of the child. Among them:

1. slight or complete loss of movement;
2. blindness;
3. amyloidosis of organs such as the kidneys, liver, intestines and myocardium;
4. renal, cardiac and pulmonary insufficiency of a chronic nature;
5. violation of the structural structure of the bones of the skeleton and related fractures;
6. complete loss of efficiency by the child.

Diagnostics

Diagnostic measures of juvenile rheumatoid arthritis are performed by a pediatrician, who needs to perform a number of activities:

• analysis of the medical history of children and close relatives - is carried out to exclude or confirm the hereditary nature of the disorder;
• elucidation of the first time and intensity of symptoms;
• thorough general examination of the patient.

If necessary, the specialist appoints several auxiliary surveys:

1. laboratory - a general and biochemical blood test for the detection of specific proteins and antibodies. In addition, the puncture of the affected joints is performed;
2. hardware - ultrasound of the thorax, abdomen and kidneys, ECG and radiography of the joints and spine;
3. consultations of such specialists as a children's rheumatologist and ophthalmologist.

After studying all the results of the examinations, the attending physician prescribes the most effective treatment of juvenile rheumatoid arthritis. The success of therapy will depend on the prognosis for the patient.

Treatment

The main goal of therapy of this disease is to freeze the process of destruction of joints and cartilage. That is why the treatment must be carried out before the remission of the disease.

Elimination of the disease is carried out in several ways. The first of these is the use of medications - anti-inflammatory, glucocorticosteroids, anticoagulants.

The second is the performance of physiotherapy procedures:

• acupuncture;
• treatment by current, ultrasound, magnetic field and infrared radiation;
• electrophoresis.

During the periods when the symptoms of this disease subsided, the exercise of exercise therapy and the course of therapeutic massage are recommended in children. It is best if the treatment is performed in a sanatorium-resort setting.

To surgical intervention apply in those cases when pronounced deformations of joints - their prosthesis is carried out.

With adequate therapy, the prognosis of the disease is quite favorable, especially when it is considered that it is life-long.

Successful treatment is considered to be a prolonged course of remission.

Diseases with similar symptoms:

Myeloid leukemia (myeloid leukemia) (concurrent symptoms: 7 of 20)

Myeloid leukemia or myeloid leukemia is a dangerous oncological disease of the hematopoiesis system, in which the stem cells of the bone marrow are affected. In the people, leukemia is often referred to as "blood-belly." As a consequence, they completely cease to perform their functions and begin to multiply rapidly.

... Still's disease(concurrent symptoms: 7 of 20)

Illness of Still (syn. juvenile rheumatoid arthritis, juvenile rheumatoid arthritis) is an autoimmune disease that is often diagnosed in people under 16 years old. Pathology belongs to the category of systemic diseases, i.e., can affect internal organs.

... Rheumatic carditis(concurrent symptoms: 6 of 20)

Cardiac rheumatic heart disease is the most common complication after various infectious diseases. Most often he begins to progress due to incompletely treated angina.

When the disease affects all layers of the walls and shells of the heart - from the endocardium and ending with the pericardium.

With timely diagnosis and proper treatment, it is possible to avoid the spread of the whole-heart attack process and stop it at the level of changing the structure of the organ's cells.

... Interstitial pneumonia(concurrent symptoms: 6 of 20)

About interstitial pneumonia, doctors say when a person's inflammation in the lungs affects interstitium, located in the septa between the blood vessels and the alveoli.

As a result of the inflammatory process and edema, gas exchange in the affected organ is disturbed, which causes severe symptoms.

Idiopathic interstitial pneumonia is not one disease, but a group of pathologies in which diffuse changes in interstitial tissue develop.

... Rheumatism in children(concurrent symptoms: 6 of 20)

A source: http://SimptoMer.ru/bolezni/detskie-zabolevaniya/1876-yuvenilnyy-revmatoidnyy-artrit-simptomy