The etiology and treatment of juvenile rheumatoid arthritis
In pediatric patients with juvenile rheumatoid arthritis is quite common. This pathology occurs similar to adult arthritis. The disease is typical for children under the age of 16. This is the most frequently diagnosed disease in rheumatology. Young girls have been suffering from arthritis in 1,5-2 times more often. The disease is completely cured. The treatment is carried out also in throughout life. It is important that in the absence of proper treatment of juvenile arthritis could cause early disability. What is the etiology, clinic and treatment of the disease?
Juvenile rheumatoid arthritis is a pathology emerging in children and adolescents under 16 years of age, which can affect not only the joints but other organs. Such a diagnosis, the doctor can put in the case of a child of arthritis, continued over 6 weeks. The disease occurs not so often. International statistics says that YURA is detected in 0.05 to 0.6% of children. Children under 2 years of age suffer from this disease is extremely rare. Sex differences in morbidity among children. Arthritis is diagnosed more often in girls. The disease progresses steadily. If treatment is not started early, there is a high risk that the child will be disabled.
The primary incidence ranges from 6 to 19 cases per 100 thousand children. It is important that the prognosis for health in many respects depends on at what age the disease started. The older the child, the worse the prognosis. A type of rheumatoid arthritis is a disease of Steele. The disease is very hard, with a strong fever, articular syndrome, lymph system, and sore throat. This pathology occurs in adults.
Juvenile arthritis may occur for various reasons. The exact cause is not yet installed.
The Possible etiological factors are as follows:
- viral or bacterial infection;
- traumatic damage to the joint
- increased insolation;
- ingested protein components;
- genetic predisposition
- disruption of the functioning of the immune system.
viral infections are most dangerous are those that are caused by a virus Epstein-Barr, parvovirus, and retroviruses. The mechanism of the disease is associated with autoimmune disorders. When exposed to any adverse factor in the baby's body are formed of special immunoglobulins. In response to this, the synthesis of rheumatoid factor. Happens damage to joints. When this affects the synovium and blood vessels, and cartilage. To collapse not only the joints but also marginal parts of the bones (epiphyses). The resulting circulating immune complexes are carried to the blood vessels in various organs. Thus there is the risk of developing multiple organ failure.
YURA Classification ICD 10 takes into account the type of joint damage. Isolated polyarthritis and oligoarthritis. ICD 10 classifies arthritis acute and subacute. There is a classification that takes into account clinical symptoms of the disease.
In this case are the following forms of juvenile arthritis:
- mixed (articular-visceral);
- form with limited viscerotomy.
disease Progression can be slow, moderate and fast. Syndrome still is a kind of articular-visceral forms of arthritis. Oligoarthritis is of two types. The first type is very common. It accounts for about 40% of all cases of juvenile arthritis. Most often this disease develops in girls who are not yet 4 years old. It is important that it is not always in the course of laboratory investigations in patients with arthritis children the blood is found rheumatoid factor. It is about seronegative juvenile arthritis.
Signs of the JURA diverse. The disease may be acute or subacute. The acute form is more typical for children of preschool and younger school age. In the absence of therapy, the prognosis is poor. The main symptoms in this case will be:
- involvement of the joints;
- slight fever
- the rash on the body;
- increase in size of liver or spleen.
In the acute phase of the disease is observed bilateral involvement of the joints. More susceptible to inflammation of the knee, elbow, hip joints. Acute onset is observed in the presence of systemic and generalized type of arthritis.
Often the process involved joints in the cervical spine. Articular syndrome is characterized by:
- stiffness in the morning lasting up to 1 hour or more;
- swelling in the joints
- a change in gait;
- impaired function of the affected part of the body.
If juvenile arthritis affects the small joints of the fingers or toes, it is possible deformation of the fingers. When the articular form of arthritis is often observed defeat of organs of vision. Developed iridocyclitis or uveitis. This may decrease visual acuity. Seronegative form of arthritis occurs more easily compared to seropositive. In the latter case, in the joints often reveals rheumatoid nodules.
In the studied pathology is often affected other vital organs. In systemic form of arthritis can occur:
- kidney damage according to the type of glomerulonephritis
- inflammation of the heart muscle
- pleural effusion
- liver and spleen.
To this species revmatoidnogo arthritis is the syndrome of Steele and Wiseley-Fanconi. Syndrome still often diagnosed in preschoolers. It has the following features:
- acute onset
- mild fever
- polyarthritis with involvement of the small joints;
- to increase and tenderness of lymphatic nodes;
- myocardial damage;
- increased ESR in the KLA.
In subacute course of the disease the symptoms are less pronounced. Initially, one joint is affected. It is often ankle or knee joint. May be affected in like 1 joint and several. When oligoarticular form of the disease affects 2-4 joints. The pain syndrome may not be. When doctors determined the swelling and dysfunction of the joint. The movement of the sick child is difficult. The liver and spleen are of normal size. Subacute proceeds more favorably and better respond to therapy.
It is Necessary to know not only the causes and symptoms of juvenile rheumatoid arthritis, but also methods of its diagnostics. In the early stages of the disease the symptoms may be mild, so the diagnosis is often difficult.
The Main methods of diagnosis is:
- medical history;
- external examination of the child;
- laboratory investigation
- x-ray examination of the affected joints.
Of great importance in the diagnosis are clinical symptoms (presence of a rash around the joint, stiffness, long-term course of arthritis, lability of temperature, concomitant lesions of the eye, lymph nodes). Medical examination of the child holds a paediatric rheumatologist. May need to consult an ophthalmologist. During laboratory analysis can identify the reduction of hemoglobin in blood (anemia), presence of rheumatoid factor, antinuclear antibodies. Rheumatoid factor is found in the blood is not always. This variant is observed in seronegative arthritis in children and adolescents.
Compulsory method of investigation for suspected rheumatoid arthritis in children is x-ray or MRI. The main radiological signs of the disease are: joint space narrowing of one or more joints, ankylosis, osteoporosis, the presence of bone erosions, the changes of the cervical spine, the presence of Usarov, the destruction of cartilage. Uzury are edge defects in the field of bone.
depending on the data of x-ray examination is determined by the stage of rheumatoid arthritis. According to the classification, stage 1 is characterized by the presence of epiphyseal osteoporosis. In phase 2 osteoporosis is complemented by narrowing of the joint cavity and isolated Uzury. For stage 3 disease is characterized by loss not only of bone, but cartilage. In addition, there are subluxations and multiple edge defects. Stage 4 arthritis occurs most severely. In this stage there is destruction of cartilage and bone. Ankylosis develops. Conservative therapy for stage 4 of the disease ineffective. The most radical method of treatment is surgical intervention.
The Treatment is carried out only after diagnosis. You want to exclude diseases such as ankylosing spondylitis, psoriatic arthritis, reactive arthritis, Reiter's syndrome, systemic lupus erythematosus, tumor, ankylosing spondylitis. In the presence of rheumatic diseases in children, the treatment should be complex.
Treatment of juvenile rheumatoid arthritis includes limiting physical activity, avoiding sun exposure, the use of NSAIDs to eliminate pain and inflammation, immunosuppressants, physical therapy, physical therapy.
Symptomatic drugs (painkillers from the group of NSAIDs and glucocorticoids) are prescribed during an exacerbation of arthritis. From NSAIDs most oftenthis is done by "Indomethacin, Diclofenac, Nimesulide, Naproxen". Of glucocorticoids is "Betamethasone" and "Prednisolone". In the basic group of medicines for the treatment of rheumatoid arthritis includes: "Methotrexate, Sulfasalazine, Cyclosporine, Hydroxychloroquine". Treatment with these drugs may last for years.
These medications are appointed long course. With their help it is possible to achieve a prolonged remission, improve the prognosis for health, slow down the process of destruction of bone and cartilage. Are drugs pathogenetic therapy. The treatments include massage, diet and additional vitamins. In the diet to include foods containing vitamins and minerals (calcium, phosphorus). Of physiotherapy methods used by UFOs, phonophoresis, laser therapy. In the case of development of contractures may require skeletal traction.
In the later stages of the disease with the development of ankylosis can be performed arthroplasty (replacing the artificial joint). Thus, juvenile rheumatoid arthritis is an incurable disease and in the absence of pathogenetic therapy can lead to disability.