Rheumatoid arthritis in a child is a very complex and dangerous problem. This disease is relatively rare in modern pediatrics. Nevertheless, information about its symptoms and causes needs to be familiarized with each parent. The fact is that this disease cannot be completely cured, but if therapy and preventive measures are started in time, the course of arthritis can be significantly alleviated and the likelihood of dangerous complications can be reduced.
General information about the disease
Rheumatoid arthritis in a child, better known in medicine as juvenile rheumatoid arthritis (JuRA), is a chronic joint disease of autoimmune origin. For 100 thousand children, there are approximately 16-19 patients with a similar diagnosis. According to statistics, girls suffer from an illness 2-3 times more often. In addition, the disease is usually diagnosed in children under the age of five.
The disease is actually very dangerous, since often the inflammatory process affects not only the joints (which in itself leads to degeneration of the joint structures), but also internal organs (for example, heart, eyes, etc.). The disease leads to a decrease in the quality of life of the child, and sometimes to a serious delay in physical development and disability.
Rheumatoid arthritis in children: causes
Unfortunately, the exact mechanism for the development of the disease has not yet been clarified. Rheumatoid arthritis is known to be an autoimmune disease. For one reason or another, a serious malfunction occurs in the functioning of the immune system, as a result of which it begins to perceive articular structures as foreign bodies. Thus, antibodies are produced in the body that first attack the cells of the synovial membrane of the joint, causing their inflammation and degeneration. As the disease progresses, the immune system begins to damage other parts of the joint, and sometimes the tissues of internal organs.
It is known that there is a genetic predisposition. There are other factors that can activate the development of this disease:
- a sharp change in the hormonal background (sometimes the disease is activated during puberty as a result of a jump in hormone levels);
- metabolic disorders;
- vaccination;
- infection of the child's body (it can be bacteria, viruses, mycoplasmas, etc.);
- severe overheating or hypothermia;
- dramatic climate change;
- joint injury.
Rheumatoid arthritis in children: photos and symptoms of the articular form of the disease
About 60–70% of patients suffer from this particular form of the disease. It begins, as a rule, with the defeat of one large joint (more often it is a knee or ankle). After 1-3 weeks, the other joint becomes inflamed. A characteristic feature is the symmetry of joint damage.
You may notice that the child began to limp. Morning stiffness appears in the affected joints. You can also note swelling in the inflammatory process. Due to the soreness and limited movement, small children stop playing, move a little - in a word, refuse physical activity, which is accompanied by discomfort. Left untreated, this can lead to muscle atrophy.
As the disease progresses, degeneration of the articular structures is observed, which can lead to disability.
Joint-visceral form of the disease
The most severe is considered to be articular-visceral rheumatoid arthritis in children. The symptoms here, in addition to joint damage, include all signs of intoxication, because the immune system damages the tissues of internal organs. As a rule, exacerbation begins with a sharp increase in temperature, chills, enlargement of the liver, spleen, and lymph nodes. You may notice swelling and redness in the affected joints. The child suffers from severe pain.
Damage to internal organs can lead to the development of amyloidosis, various diseases of the kidneys, heart, lungs, the development of vasculitis, loss of vision, etc.
Generalized articular arthritis
Rheumatoid arthritis in a child can occur in other forms, for example:
- oligosarticular chronic arthritis, which is accompanied by the defeat of 1-2 large joints (often knee) and a long, benign course of the disease;
- polyarticular form of the disease, which is accompanied by the defeat of several large structures or a combination of small and large joints; the disease proceeds undulating.
The main methods of modern diagnostics
Only a doctor knows how to correctly identify rheumatoid arthritis in children. Diagnostics is a long and complicated process. Naturally, for starters, a general examination is carried out, which allows you to determine the presence of an inflammatory process in the joints. In the future, as a rule, laboratory tests are performed. By the way, with juvenile arthritis, the rheumatoid factor in the blood is not detected in the initial stages of the disease in about 50% of cases.
Important for diagnosis are x-ray studies. An ultrasound of the affected joints can also be performed. More information about the state of the body can be obtained thanks to computed tomography. If there is a suspicion of a visceral form of the disease, then the doctor recommends an electrocardiography, tests for bacteriological culture, and an examination by an ophthalmologist.
The basic principles of therapy for childhood arthritis
The treatment of rheumatoid arthritis in children is a constant process, because, unfortunately, it is completely impossible to get rid of the disease. Therapy in this case is aimed at inhibiting the inflammatory process, reducing the speed of joint degeneration, as well as maintaining their mobility.
In acute and subacute periods, as a rule, drug treatment is performed to help eliminate inflammation. Periods of remission also include various recreational activities, including physiotherapy.
Drug therapy
Naturally, for many parents, the question of how to treat rheumatoid arthritis is extremely important. Symptoms and treatment in children are closely related - the list of medications used depends on the condition of the child. All drugs can be divided into two groups:
- medicines designed to eliminate the main symptoms during an exacerbation of the disease;
- drugs that suppress the activity of the immune system (their patient takes throughout life, even during periods of remission).
As a rule, for starters, children are prescribed non-steroidal anti-inflammatory drugs. The most effective of them include Butadion, Indomethacin, Voltaren, Ibuprofen. Naturally, the dosage and duration of the course of treatment are determined individually. By the way, these drugs act quickly, slow down the development of the inflammatory process, relieve soreness and fever. In addition, they are not so toxic and have few side effects, which is very important for the child's body. For example, if rheumatoid arthritis is found in a child (3 years old) at the acute stage, then most likely the doctor will prescribe such drugs, and they are even sold in the form of suppositories, which is also convenient.
In more severe cases (for example, with a generalized or visceral form), it is necessary to take corticosteroids, which cope with the inflammatory process much more effectively. As a rule, they are not prescribed for children under 5 years old, but sometimes they make exceptions. Such drugs are used in the form of tablets and solutions, and sometimes they are injected directly into the joint bag to achieve maximum effect.
Alas, anti-inflammatory drugs cannot slow down the process of joint degeneration. Therefore, patients are prescribed along with them the so-called immunosuppressants - drugs that inhibit the activity of the immune system. The most effective include “Plaquenil”, “Chrysanol”, “Sanocresin”, “Delagil”. Such drugs should be taken in courses, but constantly, even during the period of remission, in order to prevent the onset of another exacerbation.
Depending on the condition of the child, the doctor may prescribe the use of cytostatics (appropriate for the allergic-septic form of the disease), drugs that cause coagulation of the synovial membrane (for example, "Varicocide"), drugs that reduce the level of rheumatoid factor ("Cuprenil").
Physiotherapeutic methods and their effectiveness
The treatment of juvenile rheumatoid arthritis in children at later stages, in addition to the traditional administration of drugs, may include physiotherapy. There are many methods that are used to achieve remission, but they are selected by the attending physician individually for each child.
Almost all children are recommended from time to time to undergo therapeutic massage courses that help improve blood circulation, relieve muscle tension and strengthen them. Therapeutic gymnastics, which helps to maintain joint mobility, will also be useful. Naturally, the scheme of exercises and exercises are selected individually depending on the degree of development of the disease, the age and condition of the small patient.
There are many other techniques. In particular, rheumatoid arthritis in a child is an indication for spa treatment. Quite often, mud therapy, paraffin therapy, balneotherapy, etc. are effective. At later stages, current treatment is possible. With the right complexes of physiotherapeutic methods and medication regimens, good results can be achieved.
What are the predictions for a sick child?
What to expect if rheumatoid arthritis is detected in a child? The forecast, unfortunately, is not very comforting. This disease is lifelong and it is almost impossible to cure it completely, forever. Exceptions include oligoarthritis, which is not accompanied by destruction of the joints. But the most severe is the visceral form of the disease, because the number of possible complications here is much higher.
What to do if a child is diagnosed with this ailment? Timely and competently conducted therapy can slow down the processes of joint destruction and damage to other organs. There are cases when it was possible to achieve long-term remission and significantly improve the quality of life of the child. On the other hand, with frequent relapses, a serious violation of the basic functions of the joints is possible, which leads to disability.
Are there effective prevention methods?
Rheumatoid arthritis in a child is a chronic disease. And, unfortunately, drugs or other methods of preventing the primary development of the disease in modern medicine do not exist. Nevertheless, if the child is at risk (for example, there is a genetic predisposition, allergic disease, chronic inflammation), then so-called non-specific prophylaxis is possible, which includes the following conditions:
- Regular medical supervision. This may be a pediatrician or a rheumatologist who will constantly examine the child, monitor analyzes, etc. Since the disease is more or less associated with impaired functioning of the immune system, consultations of an immunologist will not be superfluous.
- High-quality treatment of chronic foci of infection is necessary, since a similar inflammatory process can trigger the development of arthritis. Depending on the nature of the disease, consultations with an ENT, a dentist, a nephrologist, a cardiologist, etc. are necessary.
- It is extremely important to exclude the contact of the child with infectious patients, because, again, damage to the body by pathogenic microorganisms or viruses can give an impetus to the development of arthritis.
- Doctors also recommend preventing excessive hypothermia and overheating of the body.
By observing these rules, you can reduce the likelihood of developing a disease or the appearance of a relapse.