How to treat juvenile rheumatoid arthritis in children, causes. How is the diagnosis made? Infusion of corn silk

Chronic inflammatory joint disease that does not have a precise established cause, lasting more than 6 weeks. Develops in childhood(Juvenile arthritis in children) until the age of 16. Girls are more likely to get rheumatoid arthritis. Treatment of juvenile rheumatoid arthritis should be started as early as possible, as children with early illness and rheumatoid factor-positive adolescents are at risk of developing severe arthritis. All this can lead to disability due to the state of the musculoskeletal system. In children with a late onset of the disease, transformation of juvenile RA into ankylosing spondylitis is possible.

Give Special attention child, watch his gait and gestures so as not to confuse arthritis with a bruise

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

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

The history of the disease in children, when making a diagnosis, contains the following criteria:

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

An example of damage to the joints of the hands

it general classification juvenile rheumatoid arthritis. Each terminological designation does not have its own definition, or it is formed as “a chronic inflammatory disease of the joints in children that began before the age of 16”.

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

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

The nature of the course of the disease

Juvenile arthritis according to the nature of the course is distinguished:

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

According to the spread of the process, doctors in children diagnose the following forms:

• articular, predominantly affects the musculoskeletal system;
• articular-visceral, pathological process get involved and internal organs(myocardium, liver, kidneys).

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

• rapidly progressing;
• moderately progressive;
• slowly progressing.

Etiology of the disease

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

1. hypothermia and excessive insolation;
2. viral and bacterial infections;
3. heredity and improper use of drugs;
4. injury.

The main manifestation of the disease

The symptoms of juvenile (children's) rheumatoid arthritis are similar to those of SARS, so do not try to take self-treatment measures!

With symptoms of juvenile (children's) rheumatoid arthritis, damage to large and medium joints is observed (mainly). There is pain, swelling, limited movement and deformity, with an increase in local temperature. In children, a typical JRA lesion is the seizure of the maxillotemporal 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 cartilage tissue, narrowing of the joint spaces and the development of ankylosis (fusion).

Extra-articular manifestations are characterized by:

• presence high temperature body (especially in the morning);
• chills, increased pain in the joints;
• rash on the skin;
• enlarged lymph nodes, liver and spleen.

When the temperature drops in children, pouring sweat is observed, bed sheets and shirts get wet. This hectic period can last for months (in severe cases in the absence of treatment - years), and often precede serious damage to the joints. In the general blood test, an increase in ESR to 40-60 mm / h, anemia, neutrophilic leukocytosis with a shift are detected. leukocyte formula to the left, often an increase in the concentration of Ig, mainly IgG.

Acute period

Symptoms in children in the acute period of juvenile arthritis are especially severe, there is a generalized or articular-visceral (systemic) form of the disease that occurs with relapses and poor prognosis. Most often they are observed in children of preschool and younger school age, but sometimes occurs in adolescents.

Subacute period

In this case, the history of the disease in sick children looks with the presence of less pronounced 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 to be held or sit. A change in gait can be noted in a child, and after a night's sleep, children experience "morning stiffness", which is expressed in the difficulty of movement and self-service. 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 attention, and not write off on (feigning) unwillingness to go to kindergarten or school. Some doctors in pediatrics (especially those brought up in "Soviet thinking") are also inclined to argue that the child is just a malingerer. 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 deplorable.

Red eyes can be a sign of arthritis, although at first glance, the damage to the eyes and joints is in no way connected.

In girls, especially preschool age, juvenile arthritis is accompanied rheumatoid lesion eye (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 the point of complete loss), and, sometimes, in just six months. In rare cases, rheumatoid uevitis precedes the articular process, which makes it difficult to diagnose.

In subacute course, as a rule, several (2-4) joints are involved in the pathological process - an 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:

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

This form of juvenile rheumatoid arthritis has two main variants:

• Still's syndrome, more often developing in preschool children;
• and Wieseler-Fanconi syndrome, commonly seen in schoolchildren.

In the absence of treatment of juvenile rheumatoid arthritis, secondary amyloidosis may occur - 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 functions. important organs. Most often, the kidneys suffer from this - this is indicated by persistent proteinuria, as a result, chronic renal failure develops in children.

Diagnostic measures

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

• x-ray study. In juvenile arthritis, this allows you to identify the characteristic signs of the disease - osteoporosis (decrease in the density bone tissue), narrowing of the intra-articular gap and minor damage to the 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 may show - elevated level ESR and leukocytes (presence of inflammation). In addition, a blood test should be taken to determine the presence of antinuclear antibodies, the level of C-reactive protein and rheumatoid factor.

Therapy of the disease

Treatment of JRA is carried out in a complex manner, a regimen is established for children, taking into account the form of the disease and functional state joints. Diet - fortified, low-calorie, hypoallergenic, with a small amount of saturated fatty acids and high polyunsaturated fatty acids. During the period of disease activity, it is recommended hospital treatment and use pathogenetic therapy according to the form of the disease. When choosing a therapy, take into account, first of all:

1. the effect of drugs on the activity of the process;
2. local inflammatory joint syndrome;
3. nature of immunopathology;
4. state 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. Generally, modern treatment childhood rheumatoid arthritis, although it does not give complete healing, but relieves pain, inflammation and resists the further development of the disease. This enables the child to lead a full 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 lev, prescribed in the early stages of juvenile rheumatoid arthritis (methotrexate, gold, sulfazine);
• corticosteroids are prescribed only in short courses so as not to disturb the growth of the child.

If there is an infection, it is important to get treated antibacterial drugs. good effect gives plasmophoresis and is used in the immunocomplex nature of the disease. Advanced cases may require the introduction of intra-articular anti-inflammatory drugs, and surgical intervention (arthroplasty) is prescribed if conservative treatment is ineffective.

Immunotherapy

Immunoglobulin (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 ml min. Possible repetition infusion therapy every 4 weeks.

Treatment of rheumatoid uevitis

It is carried out jointly by a rheumatologist and an ophthalmologist. Locally, GCS can be used in combination with microcirculation-improving agents and mydriatics. In the absence of effect within two weeks or with the progression of the syndrome, cytostatic drugs (cyclophosphamide) are prescribed, the “point” of starting their use 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 the intake of sodium (minimum table salt) are excluded from the diet. salted cabbage, sausage, salted cheese. To restore calcium balance, you need to include dairy products, nuts and Ca preparations with vitamin D. A special exercise therapy complex that supports muscle mass and joint mobility, physiotherapy, massage and spa treatment.

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

It is good to maintain an active lifestyle, as the disease is milder in energetic children and the complications of arthritis are less likely to occur. But children must independently regulate the degree physical activity, especially when there is pain in the area of ​​\u200b\u200binflamed joints.

At untimely treatment or with 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 usually good.

Activation of the disease begins with the initiation of humoral immunity. In the synovial membrane of the affected joint, internal microcirculation is disturbed and cells are destroyed.

In response to this, altered immunoglobulins G, which are foreign to the body, begin to be produced. Accordingly, immunocompetent cells are produced in synovial cells, namely anti-immunoglobulins G, which provide local immunity.

Also called rheumatoid factor. For the latter, the altered IgG is the antigen.

AT as a result of IgG and anti-IgG forms an immune complex, which, circulating in the joint cavity, destroys the vessels and the synovial membrane of the cartilage.

This leads to the production of a large number of cytokines of macrophage origin and even greater destruction of the joint cavity. As a result, the process extends to cartilage and bone.

Under the action of cytokines, neovascularization is activated. All these processes contribute to the maintenance of chronic inflammation in the joint.

And the synovial membrane impregnated with immunocompetent cells and immune complexes prevents the flow of nutrients and drugs to the cartilage.

Anti-IgG is carried throughout the body in the bloodstream. This explains the damage to other internal organs and the severity this disease.

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The reasons

A malfunction of the immune system is the true cause of JOHA. However, the direct provoking factor of this condition in children can be:

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

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

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

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

System. This type of juvenile arthritis is dangerous because early dates flows from total absence symptomatic manifestations. And if signs are present, they can be confused with symptoms of other diseases.

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

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

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

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

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

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

Disease types

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

• polyarthritis - characterized by damage to more than four joints;
• oligoarthritis - the pathological process affects less than three joints;
• monoarthritis - the inflammatory process is observed in only one joint.

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

• articular;
• limited - only one organ becomes inflamed;
• Still's syndrome - characterized by significant pain in the joints, the appearance of a rash, the absence of rheumatoid factor in blood tests and a rapid course. Several internal organs are involved in the process;
• allergoseptic - there is a multiple damage to organs and systems inside the body.

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

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

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

• slow;
• moderate;
• fast;
• acute;
• subacute.

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

• high;
• average;
• low;
• remission phase.

Types of Arthritis

• The disease can affect one or more symmetrical joints: in this case we are talking about oligoarthritis
• If more than 4 joints are affected, then polyarthritis is diagnosed.
• The most severe, generalized form occurs with a total lesion of all articular groups.

In 75% of cases, the symptoms of the disease in children can disappear almost completely. There comes a long remission or complete recovery.

When the prognosis is poor

Pathology has an unfavorable prognosis:

• Affecting several joints at once and continuously connecting new groups of joints to the process
• Beginning before the age of five
• Frequently relapsing
• Developing according to the seropositive variant, that is, they are added inflammatory processes in the shells of organs
• Accompanied by the presence of rheumatoid factor, elevated ESR, the level of immunoglobulin IgG and C-reactive protein in blood

This pathology most often leads to early disability of the child.

Complex symptoms in rheumatoid arthritis

The symptoms of juvenile rheumatoid arthritis are complex.

Juvenile rheumatoid arthritis is a severe chronic systemic disease whole complex symptoms, most often combined in Still's syndrome or allergic septic syndrome

The reasons for the stormy and so early development diseases are not understood until now and are explained by autoimmune and hereditary problems, which is why the disease is called idiopathic.

Still's syndrome

Still's syndrome is characterized by the following symptoms:

• Fever in the morning for 2 weeks, with subfebrile and febrile temperatures
• The appearance of an erythematous rash pink spots and papules in the area of ​​the folds of the joints, on the abdomen, chest, back, buttocks
• Enlargement of lymph nodes (lymphadenopathy)
• Enlargement of the spleen (splenomegaly) or liver (hepatomegaly)
• Joint symptoms(arthralgia, edema and deformity) appear simultaneously with extra-articular manifestations or with a slight delay in time

Still's syndrome is diagnosed quite easily, since in this form there are early symptoms polyarthritis.

In children, juvenile idiopathic arthritis with Still's syndrome often affects the cervical and temporal jaw joints. In this case, underdevelopment of the jaw can occur: the so-called bird's jaw.

Underdevelopment of the jaw is one of the symptoms of Still's syndrome

Allergoseptic form of juvenile systemic arthritis

Sometimes juvenile rheumatoid arthritis can resemble acute sepsis in symptoms. This fixes:

• Abrupt onset with a high, long-lasting temperature:
  • the temperature maximum falls mainly in the early morning hours
  • this is followed by a simultaneous decrease in temperature, with breaking through cold sweat and temporary relief
• Symptoms of intoxication: weakness, dizziness, nausea
• Lymphadenopathy
• Rash in appearance allergic and multiple
• In blood - increase in ESR, platelets and leukocytes (up to 30-40 thousand units)
• Articular syndrome can be delayed by several weeks or even months

This form of arthritis is called allergoseptic.

Due to the late onset of arthralgia and other articular manifestations, juvenile rheumatoid arthritis of the allergoseptic form is difficult to diagnose, with large quantity medical errors.

So, the disease is very easy to confuse with diseases such as toxoplasmosis, sepsis, tumors, Crohn's disease, systemic vasculitis, etc.

AT recent times to differentiate rheumatoid arthritis from other pathologies, the level of procalicitonin in the blood is determined:

With arthritis, it, unlike septic infections, remains unchanged.

Juvenile idiopathic arthritis in the allergoseptic variant of the course affects not small, but large joints:

Stages of juvenile arthritis

According to the degree of destructive bone destruction, four stages of the disease are distinguished:

• First:
  • Osteoporosis of the articular part of the bone (epiphysis)
• Second:
  • Cartilage disintegration with single erosions
  • Narrowing of the interarticular gap
• Third:
  • Destructive changes in cartilage and subchondronal bone
  • Numerous erosions in cartilage and bones
  • Articular subluxations
• Fourth:
  • The symptoms of the third stage are joined by bone or fibrous ankylosis, which is manifested by joint stiffness and muscle contractures.

Common symptoms of systemic juvenile arthritis

Systemic juvenile chronic arthritis of any form has some common symptoms, which include:

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

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

Symptoms

During the course of this disease, either only the joints or the joints and organs are affected. The articular form of the disease includes the following symptoms:

• feeling of stiffness after sleep. Duration is more than one hour;
• puffiness. Often, joints of medium and large sizes are exposed to the inflammatory process;
• during palpation, an increase in the temperature of the diseased joint relative to the whole body is felt;
• significant soreness - is noted not only during movement, but also at rest;
• joint deformities - observed in the later stages of the course of the disease;
• inability to fully bend or straighten the inflamed upper or lower limb.

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

Children show a number of symptoms. Doctors classify them into general and secondary. Separation is useful in diagnosing diseases, it will help to identify the degree of tissue damage. Juvenile type Arthritis is often classified according to the stage of damage, deformation of the bone tissue.

Main features:

Juvenile rheumatoid arthritis can begin acutely or subacutely. When the disease appears acute form, then the body temperature rises, swelling in the joint is noticeable, large joints suffer more.

Also often affected cervical vertebrae, they become sensitive, painful and swollen.

An exacerbation is inherent in severe varieties of the disease; according to statistics, this type is common in young children.

Subacute onset resolves with less complex symptoms. In many cases, arthritis starts in one joint.

First, the joint itself swells, then it ceases to perform its functions. The child begins to walk differently, if not 2 years old, then the baby may stop walking on his own.

In the morning, there is noticeable tightness in the joints, it is difficult to get up and walk briskly. This state can last for several minutes or several hours.

This disease often affects the eyes, vision deteriorates, it is possible total loss vision.

Articular-visceral form. She has several features allergic rash, arthritis. The form is divided into several types - Still's syndrome and Wieseler-Fanconi syndrome.

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

Children may complain about:

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

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

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

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

These include:

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

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

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

Deformation of the small joints of the hands;

Symmetric polyarthritis of the joints of the arms and legs;

The formation of rheumatoid nodules;

The presence of destructive arthritis.

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

Diagnostics

Juvenile arthritis is diagnosed on the basis of instrumental and laboratory studies.

To instrumental research relate:

• radiological;
• electrocardiography;
• CT scan;
• examination of internal organs.

Laboratory research methods include biochemical, immunological and general blood tests.

Diagnostic measures for juvenile rheumatoid arthritis are carried out by a pediatrician who needs to perform a number of measures:

Proper clinical examination plays a decisive role in the diagnosis of juvenile arthritis. What characteristic symptoms and signs will indicate JRA:

• Inflammation of one or more joints that lasts for several months.
• The defeat of the hands and feet, which is symmetrical in nature.
• Inflammation of the synovial articular membrane and bursa (synovitis, bursitis).
• Limited mobility in the affected limbs.
• Amyotrophy.
• Stiffness in the morning.
• Systemic manifestations (uveitis, iridocyclitis, myocarditis, pneumonitis, alveolitis, vasculitis, hepatosplenomegaly, etc.).

Laboratory diagnostics is of decisive importance in making a diagnosis. The main indicator that interests the attending physician is the presence or absence of rheumatoid factor.

Also taken into account are clinical and biochemical analyzes blood, indicating the development of inflammation in the body (leukocytes, neutrophils, erythrocyte sedimentation rate, C-reactive protein, etc.).

In the absence of contraindications, an X-ray examination is performed, which allows detecting periarticular osteoporosis, a violation of the bone structure, a decrease in the joint space, ankylosis, and pathological changes in the spinal column.

For a detailed assessment of the state of intra- and periarticular structures, ultrasound examination, computer and magnetic resonance imaging are used.

It is worth noting that in most cases the diagnosis of juvenile arthritis in children is made collectively with the involvement of additional specialists, such as an orthopedist, ophthalmologist, endocrinologist, phthisiatrician, hematologists, etc.

Only a highly qualified specialist can determine whether a child has arthritis - juvenile rheumatoid, reactive, infectious, rheumatic or psoriatic.

Examinations, analyzes

If there is a suspicion of a rheumatoid type of cartilage damage in a patient, the doctor will prescribe examinations. They are simple, will help to identify the presence of signs, to diagnose juvenile arthritis.

Children have comprehensive examination. The rheumatologist will make the initial diagnosis based on the patient's complaints.

Treatment is prescribed after analyzing the results of the examination. observed:.

Treatment

The mainstay of treatment for juvenile rheumatoid arthritis is the suppression of severe inflammatory response in the joints, elimination systemic manifestations and minimizing the consequences of the disease.

An important aspect in the treatment is the observance of the correct mode of physical activity of the child. It is impossible to use complete immobilization of the joints, as this will lead to an aggravation of the process and the development of persistent contractures.

With a far advanced pathological process and changes articular surfaces bones, special physiotherapy exercises are recommended under the supervision of a doctor or instructor.

You should also use immobilization orthoses, corsets, crutches.

With an exacerbation of the disease, it is necessary to avoid exposure to solar radiation, hypothermia, and stress.

Drug therapy is prescribed immediately after the diagnosis is established. Treatment must be carried out in a hospital.

Drugs are used primarily NSAID groups who are filming pain and inflammation. These drugs are taken orally.

The dose is calculated depending on the available body weight of the child.

Almost always with complicated and malignant course JRA resort to intra-articular administration of glucocorticosteroids, which act quickly and quite effectively. However, these drugs should be treated with caution, given the children's age of patients.

Immunosuppressive therapy (methotrexate, sulfosalazine) is used to influence the cause of the development of the disease - the activity of pathological humoral immunity.

It is also toxic, therefore, during treatment, it is necessary to monitor the main blood parameters and evaluate the effect on the bone marrow.

Surgical treatment is resorted to in the presence of pronounced changes in joints that limit mobility and significantly impair the quality of life of patients. The essence of the operation is to remove contractures and prosthetics.

Traditional Methods

Treatment is a set of activities that includes drug treatment, physiotherapy methods, special diet and exercise therapy.

• Medication includes the use of non-steroidal anti-inflammatory drugs and glucocorticoids. The doctor selects the dosage of these medicines depending on the age and weight of the child.
• Immunosuppressive drugs are used to stop progressive cartilage damage. They are prescribed both in the acute period and in remission, to prevent exacerbation.
• Physiotherapy treatment is aimed at improving the physical activity of the child. Physiotherapeutic methods of treatment include applications with paraffin, electrophoresis, magnet therapy, infrared radiation, cryotherapy.
• Physical exercises are used with caution and depending on the period of the disease. Effective swimming and cycling.

Folk methods of treatment

Alternative methods of treatment include the use of both internal and external remedies. Herbs can be used together with drugs, but there are a number of contraindications. Therefore, before use, you should consult with your doctor.

• Cranberries have anti-inflammatory, antimicrobial and soothing properties. For treatment, a decoction of cranberries is used, which is added to the bath.
• Thistle is used for compresses and lotions. To do this, take 2 tablespoons of herbs and pour 400 ml of them hot water. It can also be used orally, 1 tablespoon of decoction 3 times a day.

The main goal of therapy for such a disease is to freeze the process of destruction of joints and cartilage. That is why treatment must be carried out until the remission of the disease. Elimination of the disease is carried out in several ways. The first of them is the use of drugs - anti-inflammatory, glucocorticosteroids, anticoagulants. The second is the implementation of physiotherapy procedures:

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

During periods of subsidence of the symptoms of this disease in children, it is recommended to perform exercise therapy exercises and taking courses therapeutic massage. It is best if the treatment will take place in a sanatorium-resort environment.

Surgical intervention is addressed in cases where joint deformities are pronounced - their prosthetics are carried out. At adequate therapy the prognosis of the disease is quite favorable, especially considering that it is lifelong.

The success of treatment is considered to be a long course of the remission stage.

There is no specific prevention of such a disorder, it is only necessary to be examined by a rheumatologist twice a year, and also to limit yourself from hypothermia or overheating of the body.

1. If the rheumatoid type of tissue inflammation is not characterized by the presence of a large number of lesions, conservative treatment is possible. In the initial stage, for children with the disease, the use of non-steroidal anesthetics that have an anti-inflammatory nature is acceptable. Treat juvenile arthritis with ibuprofen.
2. For children who are concerned about the rheumatoid type of damage with bright signs suitable drugs of a different nature. Corticosteroids are often used. They will help relieve severe pain, have an anti-inflammatory effect. In this case, it will take a long time to treat juvenile arthritis.
3. Drugs that affect the patient's immunity are used - immunomodulators that have antirheumatic effects. Juvenile arthritis treated with drugs plant origin- supportive therapy.
4. For the treatment of children, physiotherapy, physiotherapy exercises are used. Along with conservative treatment LFK shows results. The effect can be achieved if juvenile arthritis is treated by combining several methods at the same time. For example, perform a set of specially selected exercises and take medications.

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

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

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

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

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

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

The most commonly prescribed medications for juvenile arthritis are:

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

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

Complementary therapies

Daily activities physical therapy help improve activity levels little patient. However, adults should help the child with the exercises and monitor their correctness. It is very good if the child will go swimming and ride a bike.

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

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

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

Diagnosis of the disease

Effective early treatment disease is possible only with high-quality diagnostics, sometimes including a wide variety of examinations, the purpose of which is to exclude the likelihood of other diseases

• General blood tests and for the presence of antibodies - rheumatoid factor
• Bacteriological cultures for suspected infections
• X-ray of joints and chest
• Electrocardiogram
• CT or MRI of the brain, chest and abdomen
• endoscopy
• Procalcitonin test
• Biopsy of the synovium
• Examination by an ophthalmologist, etc.

Juvenile rheumatoid arthritis is difficult to treat with standard nonsteroidal and steroidal agents.

Attention:

The use of aspirin for the treatment of childhood arthritis is generally unacceptable, as there is a risk of Reye's syndrome, leading to inflammation of the brain and fatty hepatosis. Especially dangerous is the use of aspirin by children and adolescents during periods of influenza and chicken pox.

A relatively safe substitute for aspirin among NSAIDs is naproxen

The standard treatment regimen and its disadvantages

Standard scheme complex treatment juvenile rheumatoid arthritis usually includes:

AT standard scheme NSAIDs, glucocorticoids, immunoglobulin and immunosuppressants are used for treatment

• Taking NSAIDs and parenteral glucocorticoids (for example, methylprednisolone), which can stop the anti-inflammatory process, deactivate macrophages and prevent the development of visceral pathologies
• The combination of intravenous immunoglobulin with immunosuppressive drugs, that is, immunosuppressive treatment.
  • Methotrexate is used as an immunosuppressant.

However, systemic juvenile idiopathic arthritis does not respond well to such treatment:

• Therapy with methylprednisolone led to a temporary result and did not stop the development of the disease.
• In addition, the abuse of glucocorticosteroids led to:
  • to obesity
  • growth retardation
  • the development of Itsenko-Cushing's syndrome, the phenomenon of osteoporosis and arterial hypertension
• Intravenous immunoglobulin was effective in early detection of the disease
• The effect of methotrexate in the systemic form was also insufficient.

New drugs of genetically engineered medicine

Doctors today came to the aid of genetically engineered medicine, which developed a new generation of drugs.

• So, for the treatment of rheumatoid arthritis with Still's syndrome, biological preparations - inhibitors of the pathogenesis factor TNF-α are successfully used.
• However, juvenile rheumatoid arthritis of the allergoseptic form with extra-articular manifestations is treated with drugs that suppress IL-6 receptors.
  • Such a drug is the monoclonal drug Actemra (tocilizumab), which has proven its effectiveness over a 5-year study.
  • Tocilizumab at intravenous administration once every two weeks during the year it stops the fever, reduces the rash and significantly improves the blood formula.

The drug of genetically engineered medicine - Actemra (tocilizumab)

Other methods of non-drug treatment

• Exercise therapy is very important in the treatment of juvenile arthritis. They allow:
  • maintain joint mobility
  • prevent the development of contractures
  • prevent the development of muscle atrophy
• Also, due to destructive changes in the joints and bones, it is very important to constantly carry out orthopedic correction with the help of special splints and orthoses.
• Favorably affects the condition of the child and significantly lengthens the periods of remission annual sanatorium treatment.

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

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

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

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

Basic treatment includes the use of such drugs:

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

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

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

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

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

Complex- individual approach is a priority in the treatment of juvenile rheumatoid arthritis in children. What does the attending physician expect to achieve when prescribing a course of therapy:

• Suppress the inflammatory process.
• Save the child from damage to the joints and systemic manifestations of the disease.
• Restore the functionality of the joints.
• Prevent or at least slow down the destructive processes in the joints.
• Avoid premature disability.
• Achieve more or less stable remission.
• Improving the quality of life of the child.

There is no primary prevention for juvenile chronic arthritis.

Complications

The consequences and prognosis for life of juvenile arthritis depend on timely treatment. If treatment is started on time, the prognosis is favorable. The child then feels well and leads a normal life. If treatment is not started and time is lost, complications may develop up to disability.

Complications of juvenile arthritis are:

The rheumatoid type of the disease in children is diagnosed simply, in the absence of timely treatment disease leads to serious complications. Until the disease progresses to chronic form, it is necessary to address to the rheumatologist.

If the inflammatory process lasts a long time, it will cause serious harm the patient's health. Possible complications in children:

• Severe anemia.
• Uneven growth of the limbs - arms, legs are inadequately developed.
• Complete, partial loss of vision.
• Diseases of cardio-vascular system such as pericarditis.
• Slow growth of the bone skeleton.
• Severe, persistent pain in the joints.

Still's syndrome is a disease against which there are no methods of preventive treatment. This means that it is impossible to prevent the onset of the disease in children.

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

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

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

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

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

Preventive actions

To prevent juvenile arthritis, the child should be protected from hypothermia and prolonged insolation. Take measures to protect the child from infectious diseases, treat them in a timely manner.

Do not overload it with physical exercises and keep a balanced balanced diet.
.

Sabzalieva Anna Vagifovna

megan92 () 2 weeks ago

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

Daria () 2 weeks ago

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

megan92 () 13 days ago

Daria () 12 days ago

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

Sonya 10 days ago

Isn't this a divorce? Why sell online?

Yulek26 (Tver) 10 days ago

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

Editorial response 10 days ago

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

Sonya 10 days ago

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

Margo (Ulyanovsk) 8 days ago

Has anyone tried folk methods joint treatment? Grandmother does not trust pills, the poor woman suffers from pain ...

Andrew a week ago

What only folk remedies I didn't try, nothing helped...

Ekaterina a week ago

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 a disease

So, the disease develops in children under 16 years of age, which is why it has such a name. Among all occupies one of the first places. There are only 1% of children in the world 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. The exact cause of its occurrence, experts also cannot yet determine. However, it is already possible to 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 does juvenile rheumatoid arthritis develop?

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

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

Through the circulatory and lymphatic systems, 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. Pathology treatment should begin immediately - immediately after the patient's symptoms are described and differential treatment is carried out.

Naturally, one should also consider what types of diseases exist:

By type of injury:

1. 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.
2. System. 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.

According to the spread of the lesion:

1. 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 older than 1 year. This form of the disease can also be limited to only a few joints, but in some cases it progresses and spreads.
2. Juvenile. Here the pathology affects the upper and lower limbs. The number of diseased joints is more than 5. In this case, the neck and jaw joints can also be affected. Most often, such juvenile arthritis occurs in girls. Treatment of the disease is mainly carried out in a hospital.

By progression rate:

1. Slow.
2. Moderate.
3. Quick.

Learn more about the disease in this video:

On an immunological basis:

1. Juvenile seronegative rheumatoid arthritis. Its feature is that it is not found in the blood.
2. Juvenile seropositive rheumatoid arthritis. This type of disease is more severe. At the same time, it can be detected using the presence of a rheumatological marker in the blood.

By the nature of the flow:

1. (spicy). it malignant form a disease that progresses rapidly. The prognosis in this case is unfavorable.
2. Subacute. It is characterized by slow development and course. It 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 present in a variety of ways. However, in any case, its treatment is necessary, complex and lifelong.

What factors provoke the disease

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

1. Late vaccinations.
2. Joint injury.
3. hereditary predisposition.
4. Viral or bacterial infection.
5. General hypothermia of the body.
6. Prolonged exposure to direct sunlight.

Symptoms of pathology

Juvenile rheumatoid arthritis presents in a variety of ways. It all depends on its type. The following symptoms of this joint disease can be distinguished:

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

These symptoms are basic and common to all forms of pathology. However, for each type of disease, additional signs are characteristic:

Reactive juvenile arthritis manifests as:

1. Increase in overall temperature.
2. Specific allergic rash.
3. Enlargement of the spleen and liver, as well as regional lymph nodes.
4. The symptoms of this disease are bilateral.

Subacute juvenile arthritis in children has the following clinical features:

1. Pain sensations are characterized by low intensity.
2. Swelling appears in the joint area, and its functionality is seriously impaired.
3. In the mornings, the child, just like adults, feels stiffness in movements.
4. A slight increase in body temperature, which appears extremely rarely.
5. A slight increase in lymph nodes, while the spleen and liver practically do not change their size.

Oligoarticular juvenile arthritis has the following clinical symptoms:

1. One-sided character.
2. Child growth retardation.
3. Inflammation of the inner membranes of the eyeballs.
4. Asymmetric arrangement of limbs.
5. Cataract.

In addition, juvenile rheumatoid arthritis is accompanied by severe muscle weakness, anemia, and pale skin. It is the systemic form of the disease that is of particular danger.

Diagnosis of the disease

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

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

Since juvenile chronic arthritis has non-specific symptoms, then only differential diagnosis can determine it. The effectiveness of treatment largely depends on its quality.

About the features of the treatment of the disease without pills, see the video below:

Features of treatment

Rheumatoid juvenile idiopathic arthritis is complex disease which requires an integrated approach. The therapy is designed not only to relieve the pain syndrome and manifestations of the inflammatory reaction of the joints, but also to minimize the consequences of the 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 the disease. Complete immobilization of the joints in children cannot be allowed, as this will only aggravate his condition and provoke fast development pathology.

That is, the baby needs to move, but in moderation. For example, walking on a flat road, cycling without extra load, swimming. You can not jump, run and fall. If the phase of exacerbation of rheumatoid arthritis has come, then the child should try to stay away from direct sunlight, not to overcool.

The basis of treatment is drug therapy:

1. Non-steroidal anti-inflammatory drugs - Piroxicam, Indomethacin, Naproxen, Ibuprofen. These drugs should be taken after meals. If you need 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 destruction of the joint, they only relieve pain and other unpleasant symptoms.
2. - Prednisolone, Betamethasone. Since juvenile idiopathic arthritis is characterized by severe pain, for rapid achievement anti-inflammatory effect, these drugs are used. In this case, the drug is quickly excreted from the body. However, corticosteroids have a large number side effects. That's why long time they cannot be used.
3. Immunosuppressive drugs -, Cyclosporine, Leflunomide. These drugs inhibit the work of the body's defense system, so their main focus is to protect the joints from destruction. It takes a long time to take these drugs for juvenile rheumatoid arthritis, which is what they are designed for. However, their frequency of use is low. The child will need to drink such medicines no more than 3 times a week. In this case, drugs are prescribed taking into account the characteristics of the body and the development of pathology.

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

1. exercise therapy. It is of great importance for improving the motor activity of the 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 chronic rheumatoid arthritis in children is best done by cycling on a flat road, as well as by swimming.
2. Physiotherapy treatment. Pediatrics in this case focuses on such therapy, as it improves the effect medications. The recommendations of doctors 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 such methods, then the prognosis can be good. Decreased intensity of symptoms immune status, muscles relax, as a result of which the joints return to their full functionality. Some procedures help to reduce the inflammatory process.
3. 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. Massage can only be used during remission. This procedure is useful in that it allows you to restore normal blood circulation in the muscles and joints. In this case, all movements must be such as not to exert any load on the joint.

In some cases, rheumatoid juvenile chronic arthritis is treated with surgery. The operation only applies to 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.

Rheumatoid arthritis can develop in childhood and adolescence - up to 16 years. In this case, it is called juvenile. Juvenile arthritis has its own specific symptoms and characteristics. Forms of the course of juvenile and its treatment are diverse and are determined by a number of factors..

Types of Arthritis

• The disease can affect one or more symmetrical joints: in this case we are talking about oligoarthritis
• If more than 4 joints are affected, then polyarthritis is diagnosed.
• The most severe, generalized form occurs with a total lesion of all articular groups.

In 75% of cases, the symptoms of the disease in children can disappear almost completely. There comes a long remission or complete recovery.

When the prognosis is poor

Pathology has an unfavorable prognosis:

• Affecting several joints at once and continuously connecting new groups of joints to the process
• Beginning before the age of five
• Frequently relapsing
• Developing according to a seropositive variant, that is, inflammatory processes are added in the membranes of organs
• Accompanied by the presence of rheumatoid factor, elevated ESR, the level of immunoglobulin IgG and C-reactive protein in the blood

This pathology most often leads to early disability of the child.

Complex symptoms in rheumatoid arthritis

Juvenile rheumatoid arthritis is a severe chronic systemic disease that has a range of symptoms, most often combined in Still's syndrome or allergic septic syndrome.

The reasons for the rapid and so early development of the disease are not clear to this day and are explained by autoimmune and hereditary problems, which is why the disease is called idiopathic.

Still's syndrome

Still's syndrome is characterized by the following symptoms:

• Fever in the morning for 2 weeks, with subfebrile and febrile temperatures
• The appearance of an erythematous rash in the form of pink spots and papules in the area of ​​\u200b\u200bthe folds of the joints, on the abdomen, chest, back, buttocks
• Enlargement of lymph nodes (lymphadenopathy)
• Enlargement of the spleen (splenomegaly) or liver (hepatomegaly)
• Articular symptoms (, swelling and deformity) appear simultaneously with extra-articular manifestations or with a slight delay in time

Still's syndrome is diagnosed quite easily, since this form has early symptoms of polyarthritis.

In children, juvenile idiopathic arthritis with Still's syndrome often affects the cervical and temporomandibular joints. In this case, underdevelopment of the jaw can occur: the so-called bird's jaw.

Allergoseptic form of juvenile systemic arthritis

Sometimes juvenile rheumatoid arthritis can resemble acute sepsis in symptoms. This fixes:

• Abrupt onset with a high, long-lasting temperature:
  • the temperature maximum falls mainly in the early morning hours
  • this is followed by a simultaneous decrease in temperature, with breaking through cold sweat and temporary relief
• Symptoms of intoxication: weakness, dizziness, nausea
• Lymphadenopathy
• Rash in appearance allergic and multiple
• In the blood - an increase in ESR, platelets and leukocytes (up to 30-40 thousand units)
• Articular syndrome can be delayed by several weeks or even months

This form of arthritis is called allergic arthritis..

Due to the late manifestation of arthralgia and other articular manifestations, juvenile rheumatoid arthritis of the allergoseptic form is difficult to diagnose, with a large number of medical errors. So, the disease is very easy to confuse with diseases such as toxoplasmosis, sepsis, tumors, Crohn's disease, systemic vasculitis, etc.

Recently, to differentiate rheumatoid arthritis from other pathologies, the level of procalicitonin in the blood is determined:

With arthritis, it, unlike septic infections, remains unchanged.

Juvenile idiopathic arthritis in the allergoseptic variant of the course affects not small, but large joints:

• Most common knee and hip
• Less often - joints of the ankle, foot and hands

Stages of juvenile arthritis

According to the degree of destructive bone destruction, four stages of the disease are distinguished:

• First:
  • Osteoporosis of the articular part of the bone (epiphysis)
• Second:
  • Cartilage disintegration with single erosions
  • Narrowing of the interarticular gap
• Third:
  • Destructive changes in cartilage and subchondronal bone
  • Numerous erosions in cartilage and bones
  • Articular subluxations
• Fourth:
  • The symptoms of the third stage are joined by bone or fibrous ankylosis, which is manifested by joint stiffness and muscle contractures.

Common symptoms of systemic juvenile arthritis

Systemic juvenile chronic arthritis of any form has some common symptoms, which include:

Complications of chronic arthritis

Systemic juvenile chronic arthritis is fraught with very serious complications and can lead to:

• to cardiopulmonary failure
• Deposition in tissues of amyloids - protein-polysaccharide complexes
• Generalized viral and bacterial infections
• Malignant form of the course of the disease, expressed in hemaphagocytic syndrome:
  • increase in the number of macrophages and the level of fibrinogen
  • blood clotting disorders
  • leukopenia and thrombocytopenia
  • disturbed confused consciousness
  • danger of coma and death

Comprehensive treatment of juvenile arthritis

Diagnosis of the disease

Effective early treatment of the disease is possible only with high-quality diagnostics, sometimes including a wide variety of examinations, the purpose of which is to exclude the possibility of other diseases.

• General blood tests and for the presence of antibodies - rheumatoid factor
• Bacteriological cultures for suspected infections
• X-ray of joints and chest
• Electrocardiogram
• CT or MRI of the brain, chest and abdomen
• endoscopy
• Procalcitonin test
• Biopsy of the synovium
• Examination by an ophthalmologist, etc.

Juvenile rheumatoid arthritis is difficult to treat with standard nonsteroidal and steroidal agents..

Attention:

The use of aspirin for the treatment of childhood arthritis is generally unacceptable, since there is a risk of Reye's syndrome, leading to inflammation of the brain and fatty liver. Especially dangerous is the use of aspirin by children and adolescents during periods of influenza and chicken pox.

A relatively safe substitute for aspirin among NSAIDs is naproxen.

The standard treatment regimen and its disadvantages

The standard scheme of complex treatment of juvenile rheumatoid arthritis usually includes:

• Taking NSAIDs and parenteral glucocorticoids (for example, methylprednisolone), which can stop the anti-inflammatory process, deactivate macrophages and prevent the development of visceral pathologies
• The combination of intravenous immunoglobulin with immunosuppressive drugs, that is, immunosuppressive treatment.
  • Methotrexate is used as an immunosuppressant.

However, systemic juvenile idiopathic arthritis does not respond well to such treatment:

• Therapy with methylprednisolone led to a temporary result and did not stop the development of the disease.
• In addition, the abuse of glucocorticosteroids led to:
  • to obesity
  • growth retardation
  • the development of Itsenko-Cushing's syndrome, the phenomenon of osteoporosis and arterial hypertension
• Intravenous immunoglobulin was effective in early detection of the disease
• The effect of methotrexate in the systemic form was also insufficient.

New drugs of genetically engineered medicine

Genetic engineering medicine has come to the aid of doctors today, developing new generation drugs.

• So, for the treatment of rheumatoid arthritis with Still's syndrome, biological preparations - inhibitors of the pathogenesis factor TNF-α are successfully used.
• However, juvenile rheumatoid arthritis of the allergoseptic form with extra-articular manifestations is treated with drugs that suppress IL-6 receptors.
  • Such a drug is the monoclonal drug Actemra (tocilizumab), which has proven its effectiveness over a 5-year study.
  • Tocilizumab, given intravenously once every two weeks for a year, relieves fever, reduces rash, and markedly improves blood counts.

From 2 to 16 children fall ill per 100,000 children in the JCA population.

The cause of arthritis is also can be:

• vaccination (more often after DTP);
• joint injury;
• hypothermia;
• excessive insolation (stay in the sun);
• hereditary predisposition.

Juvenile rheumatoid arthritis often affects girls.

To understand the essence and classification of Juha, let's look at what the joint consists of.

A joint is a joint of the bones of the skeleton, immersed in the joint capsule, or bag. Thanks to them, a person can show any physical activity.

The articular bag consists of outer and inner layers. The inner layer or synovial membrane is a kind of nutrition for the joint.

In children, the joints are abundantly supplied with a vascular network.

With JXA, inflammation occurs in the synovial membrane, hence the trophism (nutrition through the blood supply) of the joint is disturbed and further changes.

Juvenile arthritis in children and its classification

Number of affected joints arthritis is classified into:

• monoarthritis - one joint is affected;
• oligoarthritis - when no more than four joints are involved;
• systemic variant - damage to organs and tissues is added to the damage to the joints;
• polyarthritis - more than four joints are damaged.

By detecting rheumatoid factor in the patient's blood:

• seropositive;
• seronegative.

According to the development of complications:

• infectious complications;
• macrophage activation syndrome;
• pain joint syndrome in a child;
• pulmonary heart failure;
• growth retardation.

Painful joint syndrome in a child

Pain is the most common complaint of rheumatoid arthritis in children, so if arthritis is suspected, the mother should pay attention to the following factors:

• redness and swelling of the joint;
• the skin over the joint is hot to the touch;
• the child spares the joint, limiting movement in it;
• pain during flexion, extension of the affected limb;
• in the morning, stiffness in the joint, that is, the inability to get out of bed or brush your teeth on your own due to limited mobility in the joint.

Juvenile rheumatoid arthritis, seropositive

The prevalence is about 10%. They are more common in girls between the ages of 8 and 15.

Joint pain occurs symmetrically. The knee, wrist and ankle joints are most commonly affected.

This type is not the most the best option course of the disease, as it leads to destructive (destructive) changes in the joint already in the first six months of the disease. The child's function of flexion/extension of the joint is impaired, followed by disability.

Complications:

• growth retardation;
• severe disability;
• contractures (lack of mobility) in the joints.

Such severe course and complications are associated with the presence of rheumatoid factor in the blood, which is quite aggressive to the synovial membrane of the joint and leads to irreversible consequences without adequate treatment.

Juvenile arthritis, seronegative

Distributed in 20 - 30%. Again, the female sex from 1 to 15 years old suffers more often, the age range is wider than that of the seronegative.

The course of this disease is benign.

Joints affected:

• knee;
• elbow;
• temporomandibular joints;
• cervical spine.

Also, with this form of JOHA, mothers may notice an increase in temperature and an increase in lymph nodes in a child.

comparison table

Oligoarthritis

Occurs in 50% of all cases.

Several joints are affected:

1. Knees.
2. Ankle.
3. Elbow.
4. Wrist.

The course of this form of the disease is quite aggressive, as it develops inflammatory changes in the shells of the eye.

Systemic variant of rheumatoid arthritis

Clinical manifestations:

• rash;
• enlargement of the liver, spleen;
• temperature rise;
• pain in the joints;
• inflammatory changes in organs.

1. Eye damage. In children with juvenile arthritis, inflammatory changes in the membranes of the eye may occur.

As a rule, this happens asymptomatically, and the child does not feel pain in the eyes at all, which is fraught with the threat of loss of vision without proper control of the ophthalmologist.

With juvenile arthritis, iritis or iridocyclitis, an inflammation of the iris, often occurs.

Complications of eye diseases:

• cataract - clouding of the lens;
• glaucoma - increased intraocular pressure;
• as the most unfavorable outcome - blindness.

Your attending rheumatologist is obliged to send the child for a check-up to an ophthalmologist 2 times a year.

The optometrist should examine such babies only with a slit lamp. Without it, the inspection will be incorrect. As a result, a doctor may miss an eye problem in juvenile arthritis.

If the doctor has identified the onset of inflammatory changes in the eye, treatment will be prescribed. They will be treated with eye drops, which are based on a hormonal component to reduce dryness, swelling and inflammation.

Also, eye treatment is possible by introducing an injectable preparation into the eyeball. This significantly increases the effectiveness of the treatment of the underlying disease.

2. Damage to organs and systems. Juvenile rheumatoid arthritis is a disease that affects not only the joints, but also the internal organs. The disease affects connective tissue, which is present in many organs, and blood vessels.

Main targets for arthritis:

1. Heart.
2. Lungs.
3. Kidneys.
4. Nervous system.

Inflammatory changes in the membranes of the heart are called carditis. They can also develop as complications after other diseases. For example, after the transfer streptococcal tonsillitis or scarlet fever, which are more characterized by damage to the heart valve system. In juvenile arthritis, changes in the myocardium and pericardium are more common. Carditis may be asymptomatic.

Changes in the lungs concern the lung tissue itself and the pleura. The bronchi and bronchioles themselves are affected less frequently. As complications in the pleural cavity, adhesions occur and fluid accumulates.

Pain in the arms, legs - a consequence of rheumatic damage to the nerve endings. Movement disorders may also occur.

Kidney damage occurs in the form of glomerulonephritis (inflammation of the tissues of the kidney). Moreover, glomerulonephritis occurs with high activity of arthritis. Violation of the kidneys does not occur, usually there are minimal changes in the urine.

1. If your child began to complain of pain in the joints, then immediately follow to pediatrician cardiorheumatologist or pediatric rheumatologist.

2. On initial stage examinations for a child should be submitted:

• general blood analysis;
• general urine analysis;
• biochemical blood test (liver enzymes, creatinine, total protein, blood sugar, C – reactive protein);
• blood for the presence of rheumatoid factor;
• blood for the study of antistreptolysin O titer (if there is a history of frequent sore throats), which indicates the presence of streptococcus in the body;
• blood test for immunological parameters (antinuclear factor, circulating immune complexes, concentration of immunoglobulins).

3. Then the doctor will direct the baby to instrumental examinations:

• Ultrasound of the affected joints;
• x-ray examination;
• Ultrasound of the abdominal cavity;
• Ultrasound of the heart (with suspicion of carditis);
• Ultrasound of the kidneys.

4. Expert advice. An oculist, an ENT doctor, a neurologist must examine the child if there are relevant complaints.

Only after the examinations passed above, the doctor should confirm or refute the diagnosis.

Mode moments in treatment

1. With active arthritis, bed rest or significant limitation of physical activity is indicated. Jumping, running, squatting are prohibited.

   Juha is always treated in a hospital setting.

2. Minimal dosed gymnastics for the joints is required. Joints are made for movement. Gymnastics should be carried out with an exercise therapy instructor. An individual approach to each child is important, taking into account his functional abilities and pain sensations.
3. With juvenile arthritis, you can not gypsum, apply splints, bandages on the affected joint.
4. A medical exemption from vaccinations is required.
5. Exclusion of hypothermia.
6. Sun exposure is allowed only with the use of sunscreen and hats.
7. A calcium-fortified diet, complete balanced meals are recommended.
8. Psychological support and the right attitude from the parents, as the treatment of JCA can last for years.

Essential drugs for treatment

In this matter, it should be noted two areas of treatment:

1. symptomatic treatment. These are non-steroidal anti-inflammatory drugs and glucocorticosteroids.
2. Immunosuppressive therapy, which suppresses the activity of the immune system.

Non-steroidal anti-inflammatory drugs (NSAIDs)

These drugs relieve pain quite well, but not so well eliminate inflammatory changes in juvenile arthritis.

These include:

• ibuprofen;
• Diclofenac;
• Meloxicam.

In rheumatology, Nise, or Nimesulide, is often and widely used. It has been proven that of all non-steroids, it has the mildest effect on the children's body and has fewer manifestations of side effects.

Anti-inflammatory drugs of a hormonal nature

In the presence of systemic arthritis with organ damage, the so-called pulse therapy is prescribed.

Pulse therapy is an intravenous infusion hormonal drugs(Prednisolone) in sufficiently high doses. Not recommended for children under 3 years of age as it may cause growth retardation.

Immunosuppressants

Hormonal drugs give a quick, but short-lived effect.

Therefore, with inefficiency and high activity of the disease, as well as with a systemic variant, immunosuppressants are prescribed.

Methotrexate is the main drug for the treatment of rheumatoid arthritis. Immunosuppressive therapy should be long-term age dosages, without spontaneous cancellation.

Quite often it happens that during the treatment with methotrexate, the child has a remission, all the symptoms go away and the parents decide to stop the drug without the consent of the doctor. As a result, there is a sharp exacerbation of the disease and, possibly, with a more aggressive course.

Cancellation of Methotrexate is carried out only in a hospital setting and, at least, after a 2-year remission.

Methotrexate has a fairly high efficiency, is well tolerated in most cases. Possible nausea, vomiting, but this is at the initial stage of treatment.

The dosage of Methotrexate is selected in a hospital setting, calculated by weight, height. It happens both in tablet form and injectable, it is taken 1 time in 1 - 2 weeks as prescribed by a doctor.

Juha is a disease in which the child must be given the status of a disabled person. This entitles you to free receipt medicines. But, unfortunately, the commission does not always award disability to such children, and therefore they have to be treated at their own expense.

Recently, for the treatment of juvenile arthritis began to be used preparations - biological agents:

• Humira;
• Orencia;
• Remicade.

These drugs are proteins that bind to immune cells and suppress their activity. Treatment with these drugs is expensive and not available in all clinics.

1 ampoule of such a drug can reach a price of up to 70,000 rubles. Such treatment is possible at the expense of the MHIF budget.

How to achieve long-term remission?

Remission is considered:

• lack of joints with active arthritis;
• lack of systemic manifestations;
• normal blood and urine counts, negative C-reactive protein and rheumatoid factor;
• complete absence of complaints in the child;
• morning stiffness no more than 15 minutes.

If within six months the child meets these criteria, then we can safely talk about remission.

In general, the treatment of arthritis is a complex, and, most importantly, lengthy process. May take years. Of course, the child's quality of life suffers. An important role is played by how the immune system responds to treatment, whether the dosage is correctly selected, and whether the patient receives it.

Juvenile rheumatoid arthritis can be cured only through the coordinated work of the doctor and parents.