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Juvenile rheumatoid arthritis in children

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What is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis (JRA) is a systemic disease characterized by inflammatory lesions of the joints. The diagnosis of JRA is made with long current arthritis (over 1.5 months) and no other identified pathology of the joints in children under the age of 16. The JURA is quite a rare disease.

Etiology it is now quite nesochen. It is assumed that an important role in the occurrence of this disease is played by genetic predisposition and features of the immune system. Not excluded and the effect of viruses on immunity.

According to statistics, more susceptible to the disease girls. Noted that the later occurred disease is, the harder it is for. Development and malignant pathological process without adequate treatment often leads to disability and even death.

International classification of juvenile rheumatoid arthritis include several aspects:

  • The type of lesion is systemic arthritis oligoarthritis (persistent and widespread); the arthritis.

  • Depending on the nature of the current juvenile arthritis is divided into acute (reactive) and subacute.
  • On localization distinguish visceral and articular-articular forms (along with joints, affects internal organs).
  • The flow of juvenile rheumatoid arthritis is divided into slowly progressing, moderately progressing, and rapidly progressive.

The pathogenesis of the disease

Activation of the disease begins with the initiation of humoral immunity. In the synovial membrane of the affected joint is a violation of the internal microcirculation and destruction of cells. In response, it begins to produce the modified immunoglobulins G, which are foreign to the body. Accordingly, in the cells of synovitis produced by immunocompetent cells, namely anti-immunoglobulin G,which provide local immunity. They are also called rheumatoid factor. For last modified IgG is an antigen. The result of IgG and anti-IgG forms an immune complex which circulates in the joint cavity, destroys the blood vessels and synovium cartilage.

This leads to the generation of large quantities of cytokines of macrophage origin and further destruction of the articular cavity. Eventually, the process extends the cartilage and bone. Under the action of cytokines is activated neovascularization. All these processes contribute to the maintenance of chronic inflammation in the joint. And soaked immunocompetent cells and immune complexes synovial sheath prevents the flow of nutrients and drugs to the cartilage.

Anti-IgG with blood flow spreads throughout the body. This explains the defeat of other internal organs, and the severity of the disease.

The clinical picture of juvenile rheumatoid arthritis

Symptoms of juvenile arthritis are quite varied as its forms. But the common symptom for all is arthritis. First, there is stiffness and soreness around the joint, then swelling and redness and local hyperthermia. Most often in childhood affects the major and smaller joints. Characteristic of juvenile rheumatoid arthritis is considered to be the defeat of the joints of the cervical spine and nijnecheljustny-temporal joints. This further leads to the occurrence of severe deformities and impaired development, as the child is still growing.

The acute course of the disease is typical for preschoolers and primary school students. Along with the emergence of arthritis, increases overall body temperature to febrile digits high, it may be allergic rash on the body. Often increase of regional lymph nodes, liver and spleen. In this form of disease, joint involvement is usually bilateral. Sometimes clinical manifestations first, more pronounced on one side only, and can mistakenly assume that the process is one-sided. The acute course of the JURA malignant, rapidly progressive and poor prognosis.

A subacute course is characterized by slow onset and progression of the disease. The process usually begins with one hand.Other joints are involved much later. Severe pain may not be. Revealed a swelling in the joint, disturbance of its functions. The child appears morning stiffness that may persist for hours. The child sedentary and walks with difficulty. Children up to two years even longer to walk. The increase of the General temperature of the body is rare and only to subfebrile figures. Lymph vessels slightly enlarged. The liver and spleen are unchanged. Subacute course of the JURA is characterized by a more favorable prognosis and better treatment.

Systemic rheumatoid arthritis

This form of the disease is manifested by a combination of arthritis with symptoms of internal organ. One of these symptoms is a fever, mostly in the morning. Often at the height of hyperthermia observed the appearance of a rash that is papular in nature. Disappears on its own, not itchy. The usual localization of the rash, the joints, the face, the side surface of the buttocks and thighs.

The most dangerous manifestations of systemic forms of JRA include the accumulation of serous fluid in the cavities and internal organs, including the heart muscle and cavity of the lungs. Patients showing signs of cardiac and pulmonary insufficiency.

Increase in almost all groups of lymph nodes. They become large, well-palpable, not soldered to the skin and together, painless, sometimes protrude above the surface of the skin.

Increased liver and spleen due to General intoxication of the organism.

Oligoarthritis

Is the most common. Allocate persistent oligoarthritis, in which for the whole period of the disease affected not more than four joints, and progressive. When the number of affected joints increases after six months of the disease.

When oligoarticular type of juvenile arthritis the process is one-sided. Can affect both large and small joints. To manifest the disease may at any age starting from 1 year. Often accompanied by the development of uveitis (inflammation of the inner shells of the eyeball). Isolated oligoarthritis early, late onset and occur in all age groups of children. The consequences of this form of juvenile rheumatoid arthritis severe: growth retardation, asymmetry of limbs, including long, cataract and blindness (effects of uveitis), disability.

Arthritis

Rarer forms oligoarthritis JURA. The presence or absence of rheumatoid factor isolatedseronegative and seropositive sub-type:

If seropositive for rheumatoid factor variant, there is loss of limb joints. Quickly generated irreversible changes of the articular surfaces of bones. The disease is characterized by a subacute course and is considered as an early manifestation of rheumatic fever in adults.

Seronegative subtype in rheumatoid factor usually affects the joints of the cervical spine and temporomandibular joint. A disease occurs early enough (1 year) and is characterized by a benign course.

In the early emergence of both subtypes of polyarthritis occurs severe, irreversible growth retardation and early disability. In the joints formed complex contractures that are difficult to treat.

It is worth noting that any clinical form of juvenile rheumatoid arthritis carries a fairly heavy consequences. It is especially dangerous early manifestation of the disease and frequent relapses. Also unfavorable is considered to be from the development of systemic forms of JRA and younger child age. It is therefore important, as soon as possible to properly diagnose and begin treatment.

Read more: Causes, symptoms and treatment of arthritis


Diagnostic signs

First, you need to pay attention to clinical manifestations:

  • long arthritis
  • stiffness
  • rashes on the body, especially around the joints
  • unexplained fluctuations in body temperature
  • iridocyclitis
  • swollen lymph nodes

In the presence of such symptoms should also find out whether the family relatives suffering from rheumatoid arthritis.

Secondly, it is necessary to do x-rays of the affected joints, where it is possible to determine the stage of the disease (four of them) and the nature of joint damage. In the picture, there will be a change of the articular surface cartilage, narrowing of the cavity, fusion of the synovial membranes between self and other changes.

Will explore the patient's blood for the presence of rheumatoid factor and antibodies. Watch erythrocyte sedimentation rate, leukocyte count, and hemoglobin. Typically, the JURA is characterized by a high leukocytosis and anemia. The level of ESR indicates the degree of disease activity. Accordingly, the higher the ESR, the more active the process. Also appears in the blood C-reactive protein, IgG and IgM. Often the General analysis of bloodmay remain in the normal range.

ECG and ultrasound of the heart will show changes in the myocardium. Be sure to pass examination by an ophthalmologist to exclude ocular manifestations of JRA (examination of the fundus of the media of the eye and angle).


Aspects of treatment

The mainstay of treatment of juvenile rheumatoid arthritis is to suppress the severe inflammatory reactions in the joints, the elimination of systemic manifestations and minimization of consequences of the disease.

An important aspect in treatment is the proper mode of impellent activity of the child. You cannot use full immobilization of the joint, as it will lead to the aggravation of the process and the development of persistent contractures. To recommend quiet walks, Cycling, swimming. However, you should avoid physical overload, running, jumping, falling. In advanced pathological process and changes of the articular surfaces of the bones is recommended a special therapeutic exercise under the supervision of a physician or instructor. You should also use immobilization orthoses, corsets, crutches.

During exacerbation of the disease should avoid exposure to solar radiation, hypothermia, stress.

Drug therapy is prescribed immediately after diagnosis. The treatment is necessarily carried out in a hospital. Employ the preparations of NSAIDs, which relieve pain and inflammation. This group of drugs given orally. Dose is calculated depending on the body weight of the child.

Almost always in complicated and malignant course of the JURA resort to intra-articular introduction of glucocorticoids, which act quickly and effectively. However, these drugs should be treated with caution, given the children's age.

Immunosuppressive therapy (methotrexate, sulfasalazine) is used to influence the cause of the disease - the activity of the pathological humoral immunity. Is also toxic, so during treatment must be monitored the main indicators of the blood and to assess the impact on bone marrow.

To surgical treatment is resorted to when there are significant changes in the joints, limiting mobility and significantly impair the quality of life of patients. The operation is to remove contractures and prosthetics.

See also: Other methods of treatment of rheumatoid arthritis


The prognosis of the disease

The prognosis for patients with juvenile rheumatoid arthritis relatively favourable, especially at a timetreatment and adequate rehabilitation. Mild forms of the disease can pass without consequences for the musculoskeletal system. Severe forms always leave changes in joints and bones.

System for juvenile rheumatoid arthritis has a profoundly poor prognosis. In the absence of adequate treatment may be fatal. Even if success in treatment the consequences are always there, and not only in the joints. Such patients usually become disabled since childhood.