Symptoms and treatment of reactive arthritis in children

Reactive arthritis in children is a consequence of infectious diseases of the bowel or urinary system. Most often the disease occurs in boys and young men. The main causes of reactive arthritis are considered to be of chlamydial infection and diarrhea caused by Salmonella, Shigella, Yersinia.

The Exact mechanism of development of reactive arthritis are unknown until the end. Many doctors believe that the development of the disease is associated with disorders of the immune system. The cell membrane of Escherichia coli and chlamydia are similar to the membranes of human cells that make up ligaments and bone tissue. Therefore, a child with a weakened immune system is the body bacteria starts to fight its own cells. In addition, chlamydia infection is very difficult to cure, while the disease occurs often enough. Therefore, the most cases, arthritis is caused just by chlamydia.

First signs of disease

depending on the type of infection symptoms in children can vary, especially in the early stages of the pathological process. If the infectious agent is chlamydia, 2 weeks after the symptoms of urogenital infections occur General weakness, weight loss, low-grade fever. These symptoms are blurry, ill-defined character. After that the child may have an infectious conjunctivitis, often associated with ulceration of the cornea, lesions of the iris. with the improper or late treatment of the disease can lead to blindness.

All of these symptoms align symptoms of urethritis and inflammation of the mucous membranes. In boys the disease appears in the form of phimosis and sores on the skin of the penis. The girls appear vulvitis, cystitis and vulvovaginitis. After some time, the above signs of join pain in the joints and muscles. The disease is characterized by lesions of multiple large joints of the lower extremities (hip, ankle and knee) and joints of the toes. Arthritis of the joints of the upper extremities is much rarer.

Chlamydial infection of the joints often occur without pain and limitation in movement or with mild symptoms. However, such diseases are recurrent in nature. The combination of arthritis, urethritis and conjunctivitis in reactive arthropathies called Reiter's syndrome.

If the arthritis is caused by Shigella or Salmonella, the symptoms will be slightly different. Begins the inflammatory process acute, with sudden fever and severe symptoms of intoxication. Then these symptoms align more severe than chlamydial infection, pain in the joints. In the area of inflamed joints, there are extensive swelling, joint capsule cavity contains a large amount of liquid. The skin of the affected area turn red, cause a local temperature rise, the fingers are characteristic form. In half of the cases there is pain in the muscles and tendons around the inflamed joint.

How to identify reactive arthritis?

since the disease is similar to some other pathological processes symptoms, the doctor prescribes a number of diagnostic procedures. Using immunological assays revealed antibodies to chlamydia (if the disease is a consequence of chlamydial infection). Methods such as hemagglutination, to determine blood antigens to the bacteria that causes intestinal infections. Inoculation of feces and urine makes it possible to pinpoint the pathogen and quickly make a diagnosis.

When diagnosing it is important to distinguish reactive arthritis from pathological processes such as tuberculosis and viral arthropathy, juvenile spondyloarthritis, Lyme disease, rheumatoid arthritis, streptococcal joint damage. In the final diagnosis the doctor help serological tests, in contrast, viral arthritis, reactive when these tests will come back negative. In addition, an x-ray done of the affected joint, the joint capsule biopsy and some other tests.

modes of treatment

Treatment of reactive arthritis in children should be comprehensive. It is first necessary to destroy the bacteria that caused the infection. In addition, symptomatic therapy is carried out in order to facilitate the General condition of the patient. Also conducted pathogenetic therapy aimed at eliminating the consequences of the inflammatory process.

since reactive arthritis is mostly associated with chlamydial infection, treatment includes antibiotics that destroy the cell membrane of these bacteria. These include macrolides, tetracyclines and fluoroquinolones. Since the last 2type of antibiotics cause serious side effects, in the treatment of children of early age, they do not apply. The child will normally be prescribed azithromycin, josamycin and roxithromycin. The course of treatment lasts not less than a week. In adolescence, perhaps the use of antibiotics tetracycline and fluoroquinolone.

Infections caused by Escherichia coli, treated with amikacin and gentamicin, administered intramuscularly for 7 days. At older ages, perhaps the use of ofloxacin and ciprofloxacin.

Prolonged or chronic course of arthritis treatment with antibiotics may not be enough. You must appoint Immunostimulants, which take in conjunction with antibiotics under a special scheme. Immunomodulators do not assign, if the arthritis is accompanied by symptoms of spondylitis.

Symptomatic therapy aimed at relieving pain in joints. To this end, the doctor may prescribe nonsteroidal anti-inflammatory drugs, e.g. diclofenac, meloxicam, etc.

If the inflammation and pain cannot be removed with the help of NSAIDs, used the introduction of hormonal drugs: corticosteroids, methylprednisolone is in the cavity of the joint capsule. This method gives a quick effect, but it cannot be applied in case if in the cavity of the joint capsule are bacteria. If none of the above methods of pathogenetic therapy fails, the patient is prescribed immunosuppressants – drugs that temporarily reduces the activity of the immune system. This eliminates effects associated with the exclusion of the cells of the body immune system.

If timely treatment to the doctor and early treatment of the disease ends in complete recovery. However, some young patients with a predisposition, reactive arthritis can become chronic or recurrent in nature. In severe cases, the inflammatory process can capture the spine, causing spondylitis.

The prevention of reactive arthritis are timely diagnosis and treatment of chlamydial and intestinal infection in the child.

In addition, to be screened and, if necessary, treatment needs and all the rest of the family. This will minimize the risk of re-infection.