Juvenile rheumatoid arthritis is a group of chronic inflammatory joint diseases in children starting at the age of 16.
All these diseases combine the tendency to chronic progressive progress, which has a significant impact on the quality of life of a sick child and a high probability of early disability.
In the classification of rheumatic diseases it is customary to use two terms:
- Juvenile chronic arthritis;
- Juvenile rheumatoid arthritis.
Multiple factors play a role in the development of the disease. The etiology( cause) of the disease is in most cases unknown. As the start mechanisms, the importance of bacterial and viral infections is discussed.
Symptoms and signs of
Juvenile rheumatoid polyarthritis is characterized by the presence of some features that differ from those of joint diseases in adults. Here are the most typical symptoms of the disease:
- The acute onset of the disease is often encountered, with fever and the presence of an exudative component;
- Presence of a variety of rashes;
- Lymphadenopathy - enlargement of lymph nodes and hepatosplenomegaly - enlargement of the liver and spleen;
- Arthritis affecting large joints;
- Often there are pathologies of the cervical spine. Micrognatia can develop( anatomical changes in the structure of the jaw apparatus);
- More frequent development of uveitis( inflammation of the choroid of the eye);
- Rheumatoid nodules are less common than in adult rheumatoid arthritis;
- High inflammatory activity.
The clinic of juvenile rheumatoid arthritis is diverse. There are seven options for characterizing the onset of the disease, determined in the first six months of the disease.
Most of the variants of juvenile rheumatoid polyarthritis are more susceptible to girls.
Now consider the symptoms of each group in more detail.
Lymph node enlargement
The onset of the disease is usually acute. It is characterized by inflammation of the joints with a previous rise in temperature for at least 2 weeks. The following are the signs, 2 of which are always present in the systemic arthritis clinic:
- Erythematous rash;
- Enlargement of lymph nodes;
- Enlarged liver and spleen;
- Serositis( inflammation of the serous membrane of the peritoneum, pericardium, etc.).
Destructive changes in the joints lead to a significant limitation of motor activity. There are 2 forms of the systemic version of juvenile rheumatoid polyarthritis:
- Still's disease;
- Weissler-Fanconi Syndrome.
Still's disease begins suddenly in a perfectly healthy child. The favorite age of this pathology is children under the age of seven. Symptoms of the disease develop rapidly, here are the main ones:
- High temperature in the morning( fever is hectic);
- Spotty-papular rashes with localization on the chest, on the back, on the lower and upper extremities, in the abdomen. If you easily press on the rash, it disappears.
- Enlarged liver, spleen, lymphadenopathy. Defeat of the heart, pleura;
- Inflammation of the joints
The Wissler-Fanconi syndrome is very similar in symptoms to Still's disease. The difference lies in the polymorphic rash of different localization, which occurs in response to mechanical stimulation.
Polyarthritis negative and positive
This group of juvenile rheumatoid polyarthritis is distinguished in three variants:
- Variant of acute course of the disease;
- Subacute variant in preschool children and school children;
- Subacute variant, proceeding according to the "adult" type.
Such polyarthritis includes diseases in which 5 or more joints are affected within 6 months.
With persistent oligoarthritis, no more than 4 joints are affected for the entire period of the disease. With the spread of oligoarthritis, 5 or more joints are involved in the inflammation process. These options are observed more often in younger schoolchildren.
This type of juvenile rheumatoid arthritis is characterized by inflammation of the joints and psoriasis, as well as the presence of 2 of the following signs:
- Dactylitis-inflammation of the fingers or toes;
- Change of nails - syndrome "thimble".With this pathology on the nails are formed small pits.
- Presence of close relatives of dermatologically confirmed psoriasis.
Psoriatic polyarthritis can occur in any childhood. Classic psoriasis of the skin is usually not combined with inflammatory phenomena in the joints.
Arthritis associated with
Enthesitis It is characterized by inflammation of the joints and inflammation of the tendons and ligaments at the points of attachment to the bones. Often, with this form of juvenile rheumatoid arthritis, the pathology of the eyes in the form of uveitis occurs. Uveitis is accompanied by photophobia, pain and reddening of the eyes. Boys older than 8 years are more likely to become ill.
To this group it is customary to include arthritis, which does not fit the above forms. The causes of such arthritis are established after detailed diagnosis.
In the early stages of the disease, it is often necessary to conduct differential diagnosis of juvenile rheumatoid arthritis with other diseases. These diseases include:
- Rheumatic fever;
- Reactive arthritis;
- Lyme disease;
- Lupus Erythematosus;
What pain medications are recommended for rheumatoid polyarthritis
Any form of JRA is indicated for complex treatment, including the administration of non-steroidal anti-inflammatory drugs, glucocorticoid hormones, basic anti-inflammatory drugs, intravenous immunoglobulin injections.
To reduce signs of inflammation, pain and redness, non-steroidal anti-inflammatory drugs are prescribed. When choosing a medicine, the doctor is guided by the list of drugs allowed in pediatrics, and also takes into account the effectiveness of the use and safety of medicines. Given the presence of a large number of side effects, preference is given to low-toxic drugs - meloxicam and nimesulide.
Glucocorticoids are prescribed during a period of exacerbation of the inflammatory process, in order to reduce its activity. Patients with a life-threatening condition are given pulse therapy with methylprednisolone. Using this method, the hormone is administered at high dosage to the patient for 3 days, then goes on to other methods of treatment. Patients without indications for pulse therapy, hormones are prescribed in medium and small doses. Dosages of drugs are reduced gradually, they can not be abolished dramatically. Treatment with hormones can last for a long time - it can last several months, and in some cases you have to take hormones for years.
Basic anti-inflammatory drugs( methotrexate) are prescribed simultaneously with glucocorticoids. After hormone withdrawal, treatment with basic drugs can continue for several years. To improve the tolerability of methotrexate, folic acid is prescribed.
Immunoglobulin is administered intravenously by courses that repeat every 3 to 4 months. One course requires 3 to 5 procedures. Treatment with immunoglobulin continues throughout the year.
Functional treatment, including a wide range of rehabilitation measures, is of great importance. Functional treatment is aimed at improving the quality of life of children with chronic joint diseases, restoring their functions, reducing the incidence of disability.
Is it possible to avoid?
It would be good if there was a specific prevention of the disease. But such, unfortunately, does not exist. You can talk about the prevention of recurrence of the disease - carefully follow the doctor's recommendations, take prescribed medications, limit physical activity.
We believe that the best preventive measure in this case can be considered a healthy lifestyle, which is accepted in the family. If you protect your health and children's health, the risk of juvenile rheumatoid arthritis will be minimal.
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