Joint diseases in children are rare. The most common and dangerous pathology of the musculoskeletal system is juvenile rheumatoid arthritis. This is an inflammatory disease characterized by primary damage to the joints, but can be involved in the process and internal organs. This pathology occurs in approximately 1% of children under 16 years of age, moreover, girls suffer from it 2 times more often than boys. Juvenile rheumatoid arthritis in adults is called differently, since the word "juvenile" means "juvenile." This disease is quite serious, in more than half of cases it leads to disability.
Development mechanism
Juvenile rheumatoid arthritis belongs to the group of autoimmune pathologies. This means that the immune system is malfunctioning. In this case, special antibodies are produced in the body. They perceive their own cells as alien and attack them. Most often, the synovial membrane of the joints undergoes such attacks. As a result of this, chronic inflammation develops in them. But various internal organs and systems of the patient can be involved in the process. Therefore, the disease often becomes systemic.
Usually juvenile rheumatoid arthritis in children begins with large joints. They are struck symmetrically, for example, inflammation captures the knee joints. Gradually, the inflammatory process can spread. At the same time, small joints of the hand are involved in it. Inflammation can lead to the destruction of cartilage, due to which the limbs of the child begin to deform. Often the patient’s heart, kidneys, eyes, and skin are also affected. Inflammation is difficult to defeat, as it is constantly supported by the immune system. Therefore, the disease is lifelong.
Reasons for the appearance
Juvenile rheumatoid arthritis is believed to develop in children due to a genetic predisposition. This is indicated by many cases of family morbidity. But inflammation does not always occur. The trigger for the appearance of an autoimmune reaction of the body can be various external factors:
- joint injuries;
- viral infections - influenza, Coxsackie virus;
- bacteria, for example, streptococci, mycoplasmas or chlamydia;
- hypothermia of the body;
- prolonged exposure to the sun;
- severe stress;
- incorrect vaccination.
Classification
Juvenile rheumatoid arthritis has many varieties that depend on the individual characteristics of the body. Previously, this name denoted a group of various articular pathologies. Now this disease has several forms.
- The joint form is the easiest course of pathology. It is characterized by damage to the synovial membrane of the joints, arthralgia, or exudative inflammation. In this case, monoarthritis, oligoarthritis or polyarthritis can develop.
- The articular-visceral form is also called systemic juvenile rheumatoid arthritis. In addition to joints, internal organs and various body systems are affected.
- Still's syndrome is characterized by acute onset and rapid progression. The child's body temperature rises - up to 39 degrees, an allergic rash appears, the lymph nodes increase and the serous membranes of the internal organs become inflamed. In this case, mainly small joints of the hands and feet are affected, anemia develops.
- Allergosepsis Wislera-Fanconi is a severe form of arthritis. The temperature rises above 40 degrees, red spots appear on the skin, the heart and other internal organs become inflamed. Most often, this species affects adolescents.
According to the rate of development of the inflammatory process, an acute form of juvenile rheumatoid arthritis is distinguished, which can be characterized by high or moderate activity, as well as a chronic course. Since the disease is considered incurable, the goal of therapy is to achieve a stable remission - a long period without pain and inflammation.
Articular manifestations
The most severe course is systemic juvenile rheumatoid arthritis. This form of the disease usually progresses rapidly and without timely treatment can lead to the death of the child. But when only joints are affected by the inflammatory process, the patient's condition can also be severe. Symptoms of juvenile rheumatoid arthritis in children with its articular form are as follows:
- joints swell;
- stiffness is felt in the morning, and it can last more than an hour;
- the joint becomes hot to the touch, blushes;
- soreness is felt not only when moving, but also at rest, and a characteristic sign of pathology is increased pain at night and in the morning;
- in the later stages, joint deformation begins;
- the patient loses the ability to serve himself;
- develop contractures, subluxations, ankylosis of the joints.
Systemic Juvenile Rheumatoid Arthritis
This form of pathology is characterized by rapid progression and a very severe course. About 70% of patients at the same time receive disability for life, because the systemic version of juvenile rheumatoid arthritis is considered incurable, only temporary remission can be achieved.
This form of pathology can be determined by characteristic signs. The autoimmune process affects not only the joints, but also the internal organs. In this case, the symptoms of juvenile rheumatoid arthritis are as follows:
- body temperature rises to 39 degrees and above, most often this happens in the evening;
- inflammation of the walls of the capillaries leads to the appearance of digital arteritis - small brownish spots near the nails;
- rheumatoid nodules are formed under the skin in the area of the joints - painless mobile formations up to 2 cm in diameter;
- inflammatory diseases of the heart often develop - pericarditis or myocarditis, which are characterized by pain, arrhythmia, shortness of breath and swelling;
- sometimes the lungs are affected, then pleurisy or fibrosis develops;
- enlarged lymph nodes;
- the liver and spleen are affected;
- when an autoimmune process affects the eyes, uevit develops, which can lead to cataracts or blindness;
- the child feels weak, he has anemia, pallor of the skin.
Consequences of the disease
Juvenile rheumatoid arthritis is a very serious disease. Even with timely treatment, it can lead to disability. But without treatment, the pathology will inevitably end in death. If the disease affects only the joints, its consequences are limited to complications from bone and cartilage. Most often, contractures develop that restrict movement in the joint. At the same time, the limbs of the child are bent with difficulty and complete ankylosis gradually develops - loss of joint function. Since bone growth occurs at this time, they are deformed. Possible growth retardation of the patient, asymmetric limbs, gait changes. If the disease begins in a small child, he may lose his ability to walk. Sometimes the consequence of the pathology is osteoporosis, leading to frequent fractures.
A systemic version of juvenile rheumatoid arthritis can cause more serious consequences. Due to inflammation of the choroid, a gradual loss of vision occurs. And the deposition of proteins in the internal organs leads to renal failure, an increase in the liver, and a violation of the heart rhythm. The patient has the following symptoms: lethargy, shortness of breath, increased pressure, muscle twitching. Any form of the disease can lead the patient to disability, this happens in about a third of patients. Only with a mild course of the articular form of pathology due to adequate treatment can the child be completely relieved of the disease.
Diagnosis of Juvenile Rheumatoid Arthritis
Usually, the disease begins acutely or subacute, accompanied by severe pain in the joints and fever, so parents immediately consult a doctor. The diagnosis is made on the basis of an external examination, collection of anamnesis about the heredity of the child, his infectious diseases. To confirm the diagnosis, laboratory tests are performed.
First of all, blood is checked for the presence of rheumatoid factor. The analyzes also show accelerated ESR, anemia, and neutrophilic leukocytosis. But not always with juvenile rheumatoid arthritis in the blood there is a rheumatoid factor. With a seronegative form of the disease, it may not be. Therefore, blood is still tested for antibodies to the cyclic citrulline peptide. In addition, an instrumental examination of the heart, lungs and other organs with ultrasound, CT or MRI is necessary. Radiography of the joints and spine is also prescribed.
Treatment features
The prognosis of the patient’s recovery greatly depends on the timeliness of the initiation of therapy. Moreover, the main goal of treating juvenile rheumatoid arthritis in children is to stop the inflammatory process and slow down the destruction of joints. For this, complex therapy is necessarily applied. In the acute period, the child is placed in a hospital under the supervision of specialists, then treatment is carried out at home. It is necessary to carefully observe all the recommendations of the doctor and do not stop treatment until remission occurs.
First of all, medications are prescribed for this: painkillers, anti-inflammatory, hormonal, as well as cytostatics. They help reduce inflammation and relieve other negative symptoms. With the help of well-chosen drug therapy, you can also slow down the destruction of the joints. But drugs alone for effective treatment will not be enough. The regimen of a child’s day, diet, proper motor load, local physiotherapeutic treatment are very important.
Therefore, the result of treatment depends on the parents, who must monitor the implementation of all the recommendations of the doctor. First of all, the child needs adequate physical activity. Restriction of movement is shown only in the acute period with severe pain, then you need to move. It is very useful swimming, cycling on a flat road. Every day you need to perform the exercises prescribed by the doctor for therapeutic exercises.
In addition, physiotherapeutic procedures are used to increase the effectiveness of drug treatment. Most often prescribed magnetotherapy, electrophoresis with "Dimexidum", infrared radiation, paraffin baths, mud therapy. These methods are used only during remission. In case of exacerbation, only cryotherapy and laser treatment are allowed. In addition, a massage is prescribed to restore normal blood circulation and normalize muscle tone during remission.
It is not recommended to use alternative methods of treatment for this disease. And any procedures can be carried out only on the recommendation of a doctor. In the most difficult cases, the child may need an operation with which the deformations of the musculoskeletal system are corrected. Sometimes endoprosthetics are also necessary, which can be done after the growth of the child is completed.
Drug therapy
The main treatment for juvenile rheumatoid arthritis is the use of drugs. Moreover, they are always prescribed in the complex. Some drugs are used to relieve pain and inflammation, while others suppress the abnormal activity of immune cells or slow down the destruction of joints. Many drugs have negative side effects, so you can take them only as directed by your doctor, strictly observing the dosage and regimen. Most often, a complex of drugs from several groups is used to treat juvenile rheumatoid arthritis.
- Nonsteroidal anti-inflammatory drugs help reduce pain and reduce inflammation. They also have antipyretic properties. But they are used only in the acute period as a symptomatic remedy, since they do not affect the cause of the disease. The most commonly prescribed are Indomethacin, Naproxen, Diclofenac, Ibuprofen.
- Glucocorticosteroids have a similar effect, but a stronger effect. They are used if the pain in the child is very severe pain and NSAIDs can not remove them. "Prednisolone", "Metipred", "Dexamethasone" and others are prescribed.
- Basic antirheumatic drugs are the main therapeutic agent for this pathology. They not only relieve inflammation, but also stop the destruction of joints. The most commonly used are Leflunomide and Sulfasalazine.
- Cytostatics are also effective, which normalize the immune system. These are Methotrexate, Cyclosporin, and some others. You need to take them for a long time, although such drugs are drunk once every few days.
Prevention
Juvenile rheumatoid arthritis can occur in any child. There is no primary prophylaxis even in the presence of a genetic predisposition, since it is impossible to predict what factors will trigger the activation of autoimmune processes. But when a disease is detected, measures must be taken to prevent exacerbations.
The child needs to eat fully, engage in physical therapy. Useful not long walks, cycling, swimming. But there should not be overloads, neither physical nor psychological. During remission, the patient must be protected from infectious diseases, stress, overwork. And with the onset of exacerbation, it is immediately necessary to begin drug therapy and reduce physical activity. Sick children are very useful spa treatment.