Among chronic joint pathologies of non-traumatic genesis, rheumatoid arthritis in children takes a leading place. At the heart of the disease are autoimmune processes that cause severe damage to the articular surfaces. At the same time, an inflammatory lesion of the internal organs occurs with the development of such serious complications as kidney failure, scleritis, myocarditis. Early development of arthritis in childhood can lead to subsequent disability of the baby.
Causes of Rheumatoid Arthritis in Children and Pathogenesis
Rheumatoid arthritis affects 20 children per 100 thousand patients under 16 years of age. Among girls, the disease is 3 times more common than among boys. The peak incidence occurs at the age of 3 years, a high risk of getting sick remains up to 9 years. Autoimmune failure causes the synthesis of antibodies against its own articular tissue. The reaction is directed to body cells. Inflammation begins with the synovial membrane and gradually passes to all joint components. Trophy and microcirculation are disturbed, destruction of the structural parts of the joint occurs. Factors that trigger the development of childhood rheumatoid arthritis include, for example:
streptococcal staph infection;
transferred flu, SARS, herpes;
injuries, subluxations, sprains;
Symptoms: how not to miss a disease?
Children’s rheumatoid arthritis has characteristic signs of joint tissue damage. The most common juvenile form, which is called Jura. The general inflammatory process is accompanied by fever, antipyretic drugs to eliminate which are ineffective. Pain in the joints, limitation of their mobility, impaired function are attached to severe intoxication. The disease is acute or subacute, resembles rheumatism, but there are characteristic differences. The oligoarticular type of arthritis in children is accompanied by changes in one or two large joints, usually the knee or ankle. In a generalized form, joint groups are multiply affected. The articular-visceral form is characterized by the addition of inflammation in the internal organs. Symptoms confirming rheumatoid inflammation include symptoms such as:
severe pain in the joint;
swelling and swelling;
limitation of mobility;
local temperature increase;
skin rash, etc.
How is the diagnosis?
Rheumatoid arthritis in adolescents and children is examined and treated by doctors, rheumatologists, arthrologists, immunologists. Specialists find out a medical history, collect complaints, perform examination and palpation. Differential diagnosis is carried out with rheumatism, reactive arthritis, psoriatic lesions, autoimmune joint injuries. Similar manifestations in children occur in diseases such as Felty’s disease, systemic lupus erythematosus (SLE). In the initial stages, the lesion resembles rheumatoid arthritis, however, the ailment has characteristic features: it occurs after a sore throat, affects the heart, and is accompanied by high fever. To confirm the diagnosis, doctors prescribe the following set of examinations:
research on a rheumatoid factor, HLA B27 antigen, ATsPs;
Radiological symptoms confirming rheumatoid arthritis in children are erosive defects, signs of osteoporosis with characteristic localization in the joints of the hands and feet.
Treatment: effective and safe ways
Arthritis therapy is carried out for a long time and comprehensively. Timely onset allows you to stop the progression of the disease, prevent serious consequences and functional impairment. In the acute period, all children undergo treatment in a rheumatology hospital; at the remission stage, they continue to take medication at home under the supervision of a pediatrician from the clinic.
The table includes effective drugs for the treatment of rheumatoid arthritis in children and the features of their action:
Может появляться полиморфная (разнообразная по возникающим элементам) сыпь и иногда увеличиваются лимфатические узлы. Однако эти проявления чаще характерны для системного варианта болезни.
Системный вариант течения (висцеральная форма ЮРА)
Наиболее тяжелая и чаще всего приводящая к инвалидности ребенка форма ЮРА. Для клинического проявления системного варианта характерно наличие следующих симптомов:
Полиморфная кожная сыпь.
Увеличение размеров лимфатическихузлов.
Увеличение размеров печени и селезенки.
Признаки артрита (воспалениев суставе) в пораженном суставе.
Некоторые ревматологи выделяют два вида системного варианта ЮРА: синдром Стилла и синдром Висслера-Фанкони, которые имеют некоторые отличия в степени проявления симптомов ЮРА, что практически не влияет на выбор препаратов для лечения.
Системный ЮРА часто осложняется нарушением функции различных органов: почек с возникновением почечной недостаточности, сердца с возникновением миокардита, кишечника. Это обусловлено отложением в органах и сосудах комплексов антиген-антитело, что вызывает амилоидоз внутренних органов.
Своевременная диагностика ЮРА усложняется неспецифическими симптомами заболевания, во многом схожими с более безобидными поражениями суставов.
Диагноз ЮРА устанавливается при сочетании клинических проявлений, изменений суставов на рентгенологических снимках, изменений в общих и специфических анализах крови.
При наличии только трех признаков, диагноз ЮРА вероятен; при наличии четырех – однозначен, а при выявлении восьми признаков проявления ЮРА считаются классическими.
К таким признакам относятся:
Воспаление сустава более трех месяцев.
Присоединение артрита другого сустава.
«Зеркальное» поражение суставов.
Ограничение движений в суставах.
Атрофические изменения мышц вокруг сустава.
Скованность в пораженных суставах по утрам.
Воспаление околосуставных тканей.
Изменения на рентгенологических снимках:
Поражение шейного отдела позвоночника.
Нарушение роста костей.
Остеопороз (разрыхление костной ткани).
Характерные изменения в полости сустава.
Положительный ревматоидный фактор в анализе крови.
Характерные изменения при биопсии синовиальной оболочки.
На какие заболевания похож ЮРА?
Ревматоидный артрит, который возникает после перенесенных инфекционных заболеваний, как правило, острого тонзиллита (ангина). В отличие от ЮРА, все признаки заболевания проходят бесследно через несколько месяцев при адекватной антибактериальной терапии.
Реактивные артриты. Начало заболевания похоже на проявления ЮРА, однако существует определенная связь с наличием инфекции в организме ребенка. Это подтверждается исчезновением симптомов после проведенного курса антибактериальной терапии.
Болезнь Рейтера. Возникает при хламидийном поражении суставов, что подтверждается специфическими анализами на хламидии (внутриклеточные микроорганизмы, первично передающиеся, как правило, половым путем. Возможны контактно-бытовые формы передачи инфекции). Эффект от лечения антибиотиками.
Болезнь Бехтерева. Как правило, поражаются тазобедренные суставы и позвоночник.
Артриты при псориазе. В диагностике помогает наличие псориаза у ребенка.
Лечение ЮРА осуществляется на протяжении всей жизни человека. Агрессивность применяемых препаратов соответствует агрессивности течения болезни. Лечение симптоматическое и направлено на предотвращение прогрессирование заболевания, что не всегда получается.
Кроме медикаментозного лечения, больной ребенок должен в обязательном порядке проходит курсы реабилитации и санаторно-курортное лечение.
Принципы лечения ревматоидного воспаления суставов у детей
Чтобы получить воспаление суставов, необязательно быть пожилым человеком. Сегодня подобные заболевания нередко обнаруживаются в молодом возрасте, даже встречается ревматоидный артрит у детей. Подобное состояние относится к системным аутоиммунным патологиям, поражающим преимущественно периферические синовиальные суставные ткани.
However, it is often found that pathology, in addition to joints, also covers internal organs, accompanied by various kinds of complications.
According to statistics, rheumatoid inflammation of the joints occurs in girls twice as often. Moreover, of all pathologies of a rheumatic nature, arthritis is considered the most common in children.
Such a disease is most typical for patients under 16 years of age, and in children rheumatoid inflammation of the joints develops and proceeds somewhat differently than in the adult population. That is why a similar arthritic form is isolated by a separate disease. Most often affected children 3-5 years old, as well as 12-14 years of age.
The main signs of pathology
When the pathological process is just beginning to develop, children usually do not feel pain, so the first bell about the onset of the disease is an increase in temperature, which cannot be brought down by heat tablets. Over the shade, temperature indicators can increase several times. Then other manifestations begin to appear:
Lymph nodes increase;
Concerned about myalgia (muscle pain);
A swelling appears in the area of the joints;
Carbon-like rashes appear on the skin surface;
There is stiffness in the morning, articular motor activity is significantly limited;
Muscle cramps are often disturbed, the manner of walking is disturbed;
Pleurisy or pericarditis develops;
With the neglect of the pathological process, external changes in the articular tissues occur.
Along with the characteristic symptoms, signs that are not associated with joints, such as appetite, apathy, decreased activity, etc. can develop. In pediatric patients, joint inflammation can occur in the articular or articular-visceral form.
The joint pathological form develops slowly. Rheumatoid arthritis in children in a similar form usually begins with the defeat of a major joint (knee or ankle). As a result, articular tissues cease to function properly, swell violently, the child greatly changes the manner of movement, begins to limp, and very small patients may even lose their walking ability. In the morning, joint-muscle stiffness is usually observed, it is difficult for the child to move the limb, but after some time (no more than an hour), the motor functions return.
Attention! Rheumatoid inflammation of the joints is far from always accompanied by painful symptoms in the affected joint. Pain can be mild and occur only during exacerbation.
At times, other joints are involved in the inflammatory process. In this case, the lesions are located asymmetrically, several joints can simultaneously inflame (wrist, ankle, knee or ulnar). Pain in this case is moderately pronounced, there are no signs of fever, and the increase in lymph nodes is insignificant. Sometimes a rheumatoid inflammatory process of a similar form is characterized by eye lesions.
Similar complications are usually associated with inflammatory lesions of the eye membranes (uveitis). Then vision begins to fall rapidly, up to complete blindness. But in general, the articular arthritis form is characterized by a benign course, because its development occurs rather slowly, and exacerbations are formed relatively rarely.
A similar form of childhood rheumatoid arthritis is severe. The pathology begins acutely: the child’s temperature jumps, the joint tissues swell severely and begin to burn, severe arthralgic pains worry. Usually, the inflammatory process symmetrically covers the large joints of the knee, ankle or wrist. However, it can also affect small articular formations on the hands and feet.
Attention! Rheumatoid inflammation of the articular-visceral form differs in children in an unfavorable nature, because the pathological process is complicated by inflammation of the internal organs. And joint damage is characterized by rapid progression, which affects musculoskeletal functions and is fraught with disability of the child.
A characteristic manifestation of this form of rheumatoid arthritis is inflammation of the cervical vertebral joints and a characteristic intense pain syndrome that impedes movement in the affected limb. An increase in lymph nodes and the appearance of an allergic rash are allowed. In addition, the spleen and liver significantly increase in the child, which is easily detected by the doctor upon palpation. Gradually, the inflammatory process spreads to the internal organs, then symptoms appear, indicating their defeat.
Stages of development
Rheumatologists distinguish several stages of development in childhood arthritis:
Exudative stage. In a large joint structure (usually a knee), swelling and pain occur. With the gradual development of pathology, the inflammatory lesion moves to symmetrically located articular tissues. Experts attribute this factor to the most important, from the point of view of diagnosis, criteria. In children, mainly articular tissues of the ankle, knees and elbows are affected;
Proliferative stage. At this stage, tissue located near the inflamed joint is affected. Moreover, the lesion extends to the tendons and articular membranes. Joint deformation occurs, symptoms of anemia, muscle dystrophy, and then atrophy occur.
Causes of childhood rheumatoid arthritis
Why rheumatoid arthritis develops in children is unambiguously difficult to say. This is a polyetiological process that develops in children with a certain predisposition to it, after provocative-triggering factors like infection of streptococcal or viral origin, as well as under aggressive environmental influences.
Attention! The main condition for the development of childhood rheumatoid arthritis is the presence of a genetically determined tendency to such a disease.
Provoke a rheumatoid inflammatory process in the joint tissues can factors like:
Infections of a bacterial nature (bronchitis, tonsillitis, otitis media, intestinal pathologies, etc.);
Hypothermia or overheating of the body;
Change of climatic conditions;
If there is a predisposition to such a pathology, the immune system responds to a simple infection too hyperactively and begins to produce autoimmune antibodies, which, after eliminating the infectious agents, are taken for the healthy tissues of their own body. As a result, articular tissues, as well as elements of internal organs, are damaged.
How to treat childhood rheumatoid arthritis
The basic principles of anti-arthritis therapy are:
Elimination of articular symptoms;
Disability of the child;
The fastest suppression of joint inflammation;
To achieve a long and stable remission state;
Preservation of the functionality of articular tissues;
Improving the quality of life;
An exception to the development of complications.
In general, to achieve these goals, a comprehensive treatment is selected, including medication, physiotherapy, etc.
Attention! Timely taken therapeutic measures for childhood arthritis guarantee the preservation of articular functions and a stable, long-term remission.
Treatment with medicines
In the treatment of childhood rheumatoid arthritis, drugs of various pharmacological groups are used:
Anti-inflammatory drugs. They are intended to eliminate inflammatory symptoms, however, do not have any effect on the general course of pathology. Children are usually prescribed Meloxicam, Ibuprofen, Diclofenac, etc. But with prolonged treatment, they negatively affect the gastrointestinal tract, so their purpose is short-lived;
Cytostatics. They are used as a basic treatment to suppress the aggressiveness of the immune system in relation to your own body and to stop the further development of the disease. Commonly prescribed are azathioprine, cyclophosphamide, mercaptopurine, or leukeran. But long-term use is prohibited for children, since there are adverse reactions such as toxic effects on germ cells and bone marrow, inhibition of infectious resistance;
Glucocorticoids. They are prescribed as part of pulse therapy in the case of intraorganic lesions or a severe course of pathology, if other symptomatic drugs are ineffective. Children may be prescribed methylprednisolone or prednisolone. Take them exclusively in a short course;
Targeted treatment. A very expensive technique based on the use of biological agents that stop the development of pathology and block the production of autoantibodies.
Since very harmless preparations are used in children’s treatment, it is necessary to carefully monitor the condition of the child and, with the slightest complaints of epigastric pain, it is necessary to undergo an examination for the presence of erosive and ulcerative gastritis. If the picture of the pathology is too severe, then they resort to cleaning the blood from cellular antibodies in an extracorporeal way. In the presence of deformations or contractural complications, prosthetics, functional treatment or surgical orthopedic correction can be applied.
Children’s rheumatoid arthritis persists for life, but with early diagnosis and timely adequate therapeutic measures, a prolonged state of remission is achieved. If the disease was discovered late, the child is concerned about frequent relapses, then the prognosis is poor – the child will become disabled early and will be deprived of the joys of an active life.
Arthritis rheumato >Causes of development, symptoms and photos of rheumatoid arthritis in children «
Rheumatoid arthritis is an autoimmune chronic joint damage. The disease is characterized by rapid development, an aggressive course, as a result of which not only joints are damaged (inflammation of one or several joints can be observed), but also internal organs, poisoning of the body is observed. Thus, all necessary measures for the treatment of the disease should be taken immediately after diagnosis. In this case, there is a high probability of successful healing.
To date, scientists are conducting numerous studies, during which more advanced methods for diagnosing and treating the disease are being developed. As a result of studies, it was found that young girls are most susceptible to the disease.
Causes of the disease
Unfortunately, the causes leading to the onset and progression of rheumatoid arthritis in children are not fully understood. It is known that the disease is progressive in nature, and the more its symptoms appear at an earlier age, the more difficult the treatment and recovery process is. That is, rheumatoid arthritis is most dangerous for young children.
The occurrence of the disease can lead to:
Malfunctions in the immune system. In a healthy child, immunity works selectively, that is, it destroys only bacteria and viruses that are foreign to the body. Pathologies in the immune system lead to the fact that the body’s own cells, including joint cells, are “attacked”. As a result, arthritis develops.
Joint injuries can lead to the development of an inflammatory process.
Symptoms of the disease
It is very important to listen carefully to your child, because his complaints about pain and discomfort can help you identify the presence of the disease in time, and, accordingly, begin treatment earlier. So, the main signs of rheumatoid arthritis are:
Sore joints, stiffness, impaired functionality. This is especially pronounced in the morning.
Joints are affected symmetrically (for example, knee, elbow joints are affected both at once).
There is painful swelling in the area of the damaged joint. Over time, if you do not take the necessary measures, dislocations develop, the functionality of the joint is significantly reduced.
Secondary symptoms that may not appear include:
Swollen lymph nodes.
The formation of subcutaneous swelling in the area of the elbows, painless to the touch.
Fever (hyperthermia lasts for several days).
If rheumatoid arthritis is not treated on time, internal organs are affected, which leads to a deterioration in the general condition of the patient. In addition, pathologies in the work of the peripheral nervous system (neuritis) are observed.
Apathy, loss of appetite, weakness and poor health.
Eye damage in the form of cataracts, corneal dystrophy.
Depending on the variant of the development of the disease, its symptoms are different. So, the acute form of arthritis in a child is characterized by the manifestation of secondary symptoms. There is an increase in body temperature, worsening of the general condition, a rash may occur, signs of malfunctions of the internal organs appear. Then changes in the joints are already noted.
The subacute form is characterized by a deterioration in the functionality of the affected joint (usually a large joint). Then there is inflammation. Concomitant diseases, for example, eye disease, which, over time, causes deterioration and loss of vision, can join.
Forms and stages of the development of the disease
There are various forms of the course of the disease:
Oligosarticular chronic arthritis is a disease that affects the joints in isolation (as a rule, the joints of the knees are damaged). The course of the disease is quite long. Therapy consists in taking non-steroid drugs, calcium preparations, and proper nutrition.
Polyarticular arthritis is characterized by the presence of numerous inflammations in several joints (both large and small). It is important not only to relieve inflammation, but also to regulate the functioning of the immune system.
Depending on the duration of the disease, there are various stages:
The exudative stage is characterized by a lesion of one of the joints, over time (usually after 1 – 2 months), the inflammatory process affects the paired joint. In children, the joints of the knees and elbows most often suffer.
The proliferative stage involves damage to the tissues around the joint, their deformation, muscle atrophy.
Diagnosis of the disease
A child’s disease can be recognized by characteristic signs (given the picture of the course and symptoms of the disease), as well as using special laboratory tests (x-ray, analysis of body fluids).
As a result of an X-ray examination, damage to the joints (erosion, ankylosis, osteoporosis) is revealed.
It is necessary to pass numerous tests (blood, synovial fluid).
Treatment of the disease
As soon as you find the corresponding symptoms, the presence of which may indicate the development of rheumatoid arthritis, you should immediately consult a doctor. Treatment of rheumatoid arthritis is a whole range of measures that must be taken as soon as possible:
Watch your baby’s diet. It is necessary to minimize salt intake (we exclude sausages, pickles, cheeses from the diet). But foods rich in calcium (nuts, dairy products) must be present in the daily menu. In addition, it is necessary to take special calcium preparations in combination with vitamin D.
The administration of anti-inflammatory drugs of the non-steroidal group is prescribed. Caution should be exercised here, since excessive consumption of these funds can disrupt the functioning of internal organs. It is best to use the latest generation of drugs. They have a more balanced composition, relieve joint pain, without causing side effects on other organs and systems.
Immunosuppressant drugs affect the immune system, not allowing it to further destroy joint cells.
If treatment using these drugs does not bring the desired result within 1.5 months, more potent drugs from the group of glucocorticosteroids are prescribed. These funds cause growth retardation, so they can not be used under the age of 5 years, as well as in the teenage period.
In addition to drug treatment, physical therapy and physiotherapy are prescribed, as well as spa treatment.
If the joints are affected so badly that it prevents the child from moving and developing normally, surgical intervention is necessary. In this case, the damaged joint is replaced by a prosthesis.
Identify arthritis in a child is necessary as early as possible. This will provide timely medical care, stop the destructive processes in the body.
Prognosis and prevention
In order to prevent the occurrence of the disease, it is important to constantly strengthen the body of the child, his immunity. This will help to avoid malfunctions in the immune system, help protect against diseases that can trigger the development of rheumatoid arthritis. For prevention, it is important to organize the daily routine, the correct diet of the child.
It is known that the disease can give a relapse. Thus, if the child is already ill, it is important to take special measures to prevent the return of the disease. These measures include constant monitoring of the child, as well as drug prophylaxis (calcium, amidopyrine, acetylsalicylic acid, in some cases bicellin, are prescribed). Duration of taking drugs is from 3 to 6 months.
As for the forecasts, it all depends on how timely treatment was prescribed. In the event that the disease has not acquired a severe, neglected form, there are great chances of a successful outcome. If treatment is not started on time, the patient develops all kinds of pathologies that can even lead to disability and death.
Orthopedic doctor, traumatologist
I have been treating joints for many years. I can say with confidence that the joints are always treatable, even in the very ripe old age.
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Rheumatologist. For more than 20 years, he has been involved in the diagnosis, treatment and prevention of joint diseases. Specialization: diagnosis, treatment and prevention of diseases and deformations of the musculoskeletal system.