Juvenile rheumatoid arthritis in children is a systemic inflammatory pathology of the connective tissue with a primary lesion of the joints. Such a disease leads to destructive changes in the articular surfaces, which over time (if there is no therapy) leads to disability of the child. In addition, this disease is also dangerous by the occurrence of renal amyloidosis, which leads to fatal consequences (patients may die from renal failure).
This rheumatic process is diagnosed on average in 10-20 children per year among 100 people. In contrast to adult rheumatoid arthritis, the juvenile form of the disease progresses faster and more severely. These features served as an occasion for scientists to isolate this pathology into a special group and consider it as a separate disease in children.
The disease proceeds as polyarthritis – typical symptoms are observed in symmetrical joints in different parts of the body. Moments of active inflammation of the synovial membranes covering the articular surfaces of the bones lead to their erosion and destruction. A prolonged autoimmune inflammation in rheumatoid juvenile arthritis leads to the accumulation of amyloid protein in the internal organs. The narrowing of the joint gap, the violation of the structure of the cartilage becomes not only the cause of severe pain in the child, but also the reason for the limited mobility of the limbs. Ankylosis (fusion of articular surfaces), which is the outcome of a long inflammatory and destructive process, leads to a complete restriction of movements in the joint.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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- Causes of the disease
- Symptoms of pathology
- Diagnosis and difference from other diseases
- Juvenile Rheumatoid Arthritis Treatment
- How to cure juvenile arthritis in a child
- Non-drug treatment
- How to cure arthritis in a child?
- Inexplicably arising – is there a remedy for arthritis?
- The fact of arthritis disease is established – what’s next?
- Prediction in the presence of concomitant lesions
- Therapy: what’s new?
- Estimated dates for achieving remission
- My kindergarten
- Information portal for parents and carers
- Causes, Symptoms, and Treatment of Juvenile Arthritis in Children
- What it is?
- Juvenile arthritis in children: causes
- Arthritis Diagnosis
- Short-Term Juvenile Arthritis Treatments
Causes of the disease
The reasons for the development of such a disease in children are not exactly established to date. Researchers were able to identify a relationship between the development of this pathological process and the Coxsackie B viruses, herpes, influenza A and B, entero and rotaviruses, and a number of bacterial infections. These infectious agents trigger nonspecific inflammation in the joints, which subsequently becomes the basis for the rheumatological process in a child.
The latent course of viral and bacterial infections does not allow either parents or doctors to establish even the fact of infection of the child. But over time, this can lead to joint damage. In some cases, it is assumed that the starting point for the development of juvenile rheumatoid arthritis is frequent injuries of the musculoskeletal system.
Therefore, most scientists still rightly believe that this is an idiopathic process (i.e. its reason is not clear). But it is provoked by a number of circumstances (predisposing factors):
- Hereditary predisposition. If close relatives of the child had cases of not only juvenile rheumatoid arthritis, but also other forms of autoimmune pathologies, the risk of the onset and development of the disease is higher.
- Hypothermia of the body. This feature was one of the first to be noticed. For a long time it was believed that it was cold that provoked the development of such a disease. However, hypothermia only leads to inhibition of the immune system, which, of course, provokes both the development of infections hidden in the body and the malfunctioning of immune cells.
- Excessive exposure of the child to the sun (increased insolation of the body). By analogy with hypothermia, overheating also leads to malfunctions of the immune system.
- The impact on the child’s body of other adverse environmental factors (radiation, chemical toxins, etc.). The exact (reliable) relationship between the action of these factors and the development of a disease such as rheumatoid arthritis in children has not been established. However, their effect on the genome of the body, the provocation of mutations in the genes leaves no doubt about the development of any pathology in the body of the child.
Symptoms of pathology
Symptoms of rheumatoid arthritis are usually unexpressed, but only at the beginning of development. The process can begin with the defeat of one joint, and then go into a generalized form, in which almost all systems of the child’s body are affected. Juvenile arthritis in children is characterized by the development of the following symptoms:
- Joint damage. The disease, starting with a minor, subtle inflammation of one joint, passes into the defeat of large joints, usually symmetrically located (knee, elbow, shoulder, and even hip). Less commonly involved are the small joints of the hand, as well as the cervical spine and joints of the lower jaw. The child will notice pain intensifying with functional load, as well as morning stiffness during movement in the affected joints.
- The development of muscle atrophy and inflammatory processes in the joint bags (bursitis) and tendon sheaths (tendovaginitis) of the affected joints.
- The occurrence of severe intoxication of the body of children. General weakness, fatigue, adynamia, passivity, sleep disturbance and poor appetite are noted. Almost all children develop an increase in body temperature, sometimes up to very febrile numbers (about 40-41 degrees).
- The appearance of a skin rash. It is of the so-called “ephemeral nature” (it suddenly arises and also instantly passes), it is localized in the area of affected joints and on the front surface of the body.
- The occurrence of rheumatoid nodules – dense formations under the skin in the area of affected joints.
- Enlarged lymph nodes of all groups, as well as the liver and spleen.
- Damage to the eyes and internal organs (lungs, heart, kidneys, etc.). The clinical picture in this case is very diverse. It depends on the degree of organ involvement in the pathological process. The development of glomerulonephritis and renal failure due to amyloidosis leads to the appearance of a number of new symptoms associated with general intoxication of the body. This condition is considered extremely unfavorable for the child.
Most often, the disease develops gradually, each time involving more and more joints and becoming more severe.
Diagnosis and difference from other diseases
Diagnosis of juvenile rheumatoid arthritis is based on laboratory tests, joint radiography, and determination of diagnostic criteria. The latter are reliably established by a group of scientists, which helps to eliminate the subjectivity of the doctor in relation to the identification of this pathology. To confirm in children the juvenile form of rheumatoid arthritis, the following examinations are carried out:
- History taking and finding out the presence of characteristic symptoms of the disease. A number of them (duration of the course, number of affected joints, development of muscular dystrophy, rash, etc.) directly correlate with the severity of the course of the disease.
- Clinical blood test. Changes in it are usually nonspecific, but a high ESR level (40-50 mm / h), as well as leukocytosis without common signs of infection, are always suspicious for the doctor and give reason to prescribe additional studies.
- Laboratory determination of the level of immunoglobulins, circulating immune complexes (CICs), rheumatoid factors and proteins of the acute phase of inflammation. The combination of an increase in the level of all these factors not only indicates inflammation in the joints, but also allows you to doubt the autoimmune nature of the disease.
- X-ray of damaged joints. Such a study allows us to determine how much the articular surfaces change as a result of chronic rheumatoid inflammation. Special scales for assessing the severity of such changes help to assess how affected joint function. The degree of change in bone tissue and joint also reflects the severity of juvenile rheumatoid arthritis.
Since rheumatoid arthritis in a child at 2 years of age and older (under 16 years) can occur in completely different ways, doctors use the so-called diagnostic criteria for the juvenile form of the disease to assess the degree of progression of the pathology. If according to them the child has only 3 positive answers to the questions presented for resolution – the diagnosis is doubtful, 4 positive criteria according to the results of the examination – definitely, we are talking about juvenile rheumatoid arthritis, if there are 8 or more of these criteria, the course of the disease is classical, and the diagnosis does not cause doubt.
Further, depending on the number of affected joints, involvement in the pathological process of internal organs, positive or negative rheumatoid factor in the blood, the x-ray stage, the rate of progression of the pathology, etc. the final diagnosis is made.
Juvenile Rheumatoid Arthritis Treatment
Juvenile chronic arthritis in children requires complex treatment, depending on the severity of the pathology and the number of joints involved in the process. The following groups of pharmacological drugs are used to treat such a disease:
Under no pretext should the child’s parents ignore the symptoms and treatment of juvenile rheumatoid arthritis.
How to cure juvenile arthritis in a child
Causes of Juvenile Rheumatoid Arthritis in Children
Arthritis is, in essence, inflammation of the joints, and its kind of rheumatoid arthritis is their chronic inflammation. The word “juvenile” used in the name of the disease means that it is arthritis of unknown origin, its cause has not been established. Thus, juvenile rheumatoid arthritis is a disease of joints that are constantly inflamed and cause pain and discomfort, but it is impossible to identify a clear reason why this type of arthritis affects the joints of a particular person.
Juvenile rheumatoid arthritis (JRA) is an autoimmune disease, that is, the immune system malfunctions, the body perceives joint tissues as a danger from the outside, and rejects them, affects itself. Why does this happen? Doctors have no answer to this. Arthritis in young children and adolescents is, in principle, not so infrequent, but juvenile rheumatoid arthritis is the most common type of rheumatic disease among the population under 16 years of age. Frequency – approximately 1 case per 10 children. This is a pretty high rate.
According to doctors, the combination of factors can be considered the cause of Jura:
- hereditary predisposition (if a child has an entire family suffering from arthritis or rheumatism, he is at risk);
- viral and / or bacterial infection;
These situations, or rather their coincidence, can trigger the mechanism of development of juvenile anemia, but no one can say with accuracy that a particular factor has become a specific cause of the disease.
Juvenile rheumatoid arthritis most often affects children from a year to five. One of the biggest dangers of juvenile rheumatoid arthritis is that arthritis in young children is difficult to diagnose, especially if there is no obvious swelling or redness of the joint. They do not complain of pain in a particular place, but simply become moody, inactive, lose their appetite. In babies, the situation is further aggravated by the fact that infant swelling of the hands and feet can mask painful swelling. Parents should be alert if the child becomes limp, does not want to walk.
Approximately half of cases of juvenile rheumatoid arthritis are damage to 1-4 joints, of the second half, about three quarters of children suffer from multiple lesions, one quarter suffers a systemic disease when the disease is throughout the body, and not just joints.
In acute arthritis, the onset of the disease is accompanied by the following symptoms:
- pain, redness, swelling, hot skin in the area of the main joints –
- temperature to 39-40 degrees –
- rash on the arms, legs, torso
- muscle weakness
- weight loss-
- swollen lymph nodes, even the liver and spleen.
Joints most at risk for juvenile juvenile disease:
- Wrist band.
- Cervical spine.
Often joints are affected symmetrically. For young children, a regression in motor skills is characteristic, that is, the child, for example, began to walk, but again switched to crawling.
Juvenile rheumatoid arthritis is a serious disease that leaves an imprint on the entire future life of the child, so this diagnosis is not made the first time, especially when you consider the fact that the symptoms can be blurred and implicit and I can talk about a lot of different diseases. Your doctor will prescribe special tests and examinations to determine if your child is suffering from juvenile rheumatoid arthritis.
Methods for diagnosing Jura in children:
- Detailed blood test.
- Computed tomography
- Joint puncture.
- Blood test for bacteria.
- Rheumatic tests.
- Virus test.
- Autoimmune test.
- Bone scan.
Jura is treated comprehensively. The goal of treatment is to eliminate inflammation and relieve acute symptoms, to maintain joint mobility, the possibility of household stress, as well as the prevention of exacerbations in the future.
- Nonsteroidal anti-inflammatory drugs relieve pain and fight inflammation. They can not be used for more than two months due to adverse reactions.
- Hormonal anti-inflammatory drugs are effective, but can provoke a malfunction in the endocrine system, therefore, children under 5 years of age are used only in critical cases.
- Immunosuppressants are prescribed immediately as soon as Jura has been diagnosed. These drugs suppress the immune system, thereby preventing it from destroying articular tissues.
- Treated physical education. First, the doctor can give a referral to the LFK office to a specialist, and in the future, parents can deal with the child themselves. In the case of Jura, cycling and swimming are necessary.
- Physiotherapy: electrophoresis, paraffin, therapeutic mud, magnetotherapy, infrared radiation.
- Massage. When the acute period is removed, massage will improve blood circulation, it will be better to receive blood to the diseased joint, it will become more mobile.
Just massages, exercise therapy and physiotherapy will not help in the treatment of rheumatoid arthritis. These are supportive measures, but very important – thanks to them, arthritis is treated more quickly, and good prevention for the future is underway.
It is difficult to raise a child with Jura, it is constant courses of treatment, constant control over the way of life, but you should try not to injure the child’s psyche so that the child does not feel disabled. With proper treatment, half of the children enter the phase of persistent remission, which will last 10 years or more. About a quarter of patients still receive disability due to the severe course of the disease.
As such, there are no specific preventive measures to avoid juvenile rheumatoid arthritis due to unclear causes of the disease. Only obvious measures: do not overcool a child, do not overheat, set vaccinations on time, protect against infections, pay attention to changes in behavior, in the physical and emotional state of the child.
How to cure arthritis in a child?
Rheumatic diseases begin implicitly, occur for a long time and are difficult to treat – especially if drug therapy was started after the due date, when the disease can be reversed, and time is lost. A significant decrease in the quality of life of patients (both large and small), a possible disabling outcome, are encouraging doctors to find more and more new drugs. Fortunately, to date, a significant breakthrough has been achieved in the treatment of rheumatic diseases. What is especially pleasing, some of the drugs are approved and approved for use in children. What is the time limit for stopping the progression of joint diseases and how to do it?
Inexplicably arising – is there a remedy for arthritis?
Of the diverse group of rheumatic diseases, juvenile idiopathic arthritis is the most common in childhood. This is the scientific name for joint disease of a non-infectious nature that develops in children under 16 for an unclear reason.
Many groups of joints can be affected at once, only a couple can be affected – but in any case, the disease gives the child considerable inconvenience, because he experiences pain and cannot develop harmoniously, being distracted by discomfort during movements.
It is worth noting that joint damage in arthritis does not develop suddenly, acutely: the child does not start to scream from pain in the arm or leg. But this disease is insidious. Parents may initially not pay attention to the baby’s complaints about stiffness in the joints in the morning. After all, children sometimes speak with a whimpering appearance of “painful”, “painful” even when they simply want to attract the attention of adults. However, if the child regularly points to the same place, if the parents see local signs of inflammation – swelling of the joint, its swelling and redness, and even restriction of passive movements – this is a good reason to show the child to a pediatrician, and then to the orthopedist, rheumatologist. Moreover, the sooner the better.
In a study conducted at the St. Petersburg Pediatric Medical University, the average age of children was 3 years 9 months (1,7-7,8 years) – and these were children with an already developed clinical picture of the disease, and even a certain “experience” of the drug therapy. This disease does not spare even the smallest. What is the way out, how to help kids?
The fact of arthritis disease is established – what’s next?
So, when the mother’s doubts were confirmed, the child did not just complain about discomfort in the joint, and the doctor examined a small patient (performed blood tests and an X-ray) and diagnosed with juvenile arthritis. What to do next, what treatment will lead to – mother is faced with exciting questions.
It is worth immediately clarifying that rheumatic diseases in childhood can respond well to drug therapy and go into long-term remission. Doctors do not say “completely cured” in such cases, but use the term “inactive disease”. But this also means a rather big victory – drugs remove the inflammatory process that underlies the disease, which manifests itself as a clinically significant improvement in well-being, and a complete regression of symptoms that worry the baby.
Experts say that the earlier a diagnosis was made and treatment started, the greater the chances of a faster recovery and restoration of joint functions. The most favorable, “golden” time for rheumatologists is the first two months of active symptoms of the disease. Two months is a rather short period, but quite real if the parents are vigilant and immediately seek medical help.
Prediction in the presence of concomitant lesions
Juvenile idiopathic arthritis can occur with involvement in the inflammatory process of the membranes of the eye (uveitis), the intestinal mucosa (enthesitis), which significantly complicates the picture of the disease and prolongs the time of remission. However, with the help of modern drugs, albeit in a longer period, but these children have every chance to hear from the doctor the cherished “disease is not active.”
Therapy: what’s new?
Monocomponent therapy is not used for the treatment of rheumatic diseases, that is, the treatment of the baby will not be limited to prescribing a single pill. Moreover, the list of drugs can not be independently reduced or reduced dosages – this will lead to the fact that the disease will progress and time to stop the pathological process will be missed, and the baby will receive ineffective dosages of drugs (and this threatens the development of side effects of the drug without tangible benefits from them application).
A significant breakthrough in recent years has been the appearance in the arsenal of doctors of immunobiological drugs – they affect the key immune factors that trigger the disease. But their use becomes possible and necessary after treatment failure with a standard course of therapy for juvenile arthritis, including non-steroidal anti-inflammatory drugs and cytostatics. That is, if the initial treatment aimed at eliminating the symptoms did not lead to a good result, it’s time to hit the disease at its core – the cells responsible for the development of inflammation in the joint.
For children, the most significant (and studied in clinical studies) are drugs that block the so-called tumor necrosis factor-alpha (adalimumab and etanercept – only these two drugs are approved for children). Over a certain period of inclusion of these drugs in clinical guidelines (and standards of medical care), a certain experience has been gained in using this group. For example, a Russian study, which included 964 small patients, showed the following results: if the child’s illness lasts more than two years, adalimumab will be more effective than etanercept. If a child is diagnosed with inflammatory lesions of the choroid (uveitis), adalimumab is also more suitable.
The following drugs are also allowed for the treatment of juvenile arthritis in the Russian Federation: tocilizumab and abatacept. Abatacept is used in children from six years old, all other immunobiological preparations – from two years old.
Estimated dates for achieving remission
In the R. Burgos-Vargas study, a significant improvement in the condition of small patients (including those involving the intestines in the inflammatory process) began already by the 12th week of the use of immunobiological preparations. The approximate rate of achieving clinical remission, according to researchers from St. Petersburg, is 12 months.
In this case, different forms of arthritis go into remission at different speeds. Canadian scientists analyzed the database of children with rheumatic diseases and found: before the introduction of immunobiological drugs into practice, the health of children with psoriatic arthritis (91% over 2 years) was the fastest to improve, while in the group of rheumatoid arthritis-positive remission for only 2% of children reached the same 48 years.
Currently, parents and doctors have reliable allies in the fight for children’s health. It’s the parents’s small business: turn to doctors on time and carefully follow the prescribed recommendations of doctors they trust.
Information portal for parents and carers
Causes, Symptoms, and Treatment of Juvenile Arthritis in Children
Arthritis is an inflammatory process in the joints that causes pain and swelling. Juvenile arthritis (juvenile arthritis in children) is a term used to refer to arthritis in young people. The most common form of juvenile arthritis is juvenile (chronic) idiopathic arthritis, also called juvenile rheumatoid arthritis.
What it is?
Arthritis is a group of more than 100 diseases. This is only one category of rheumatic diseases. Rheumatic diseases cause severe pain, stiffness of movements, swelling in the joints and bones. They also affect various areas of the body, including internal organs.
Some rheumatic diseases can destroy connective tissue. These types of tissues include muscles, tendons, and ligaments. Other types of rheumatic diseases are caused by the body’s immune system, which attacks its own healthy cells and tissues, taking them for foreign. Similar phenomena are known as autoimmune disorders.
Juvenile arthritis in children: causes
Experts do not know what causes juvenile arthritis and other rheumatic diseases in children. In many cases, the cause may vary depending on the type of disease. Certain factors that may play a role in one or more types of these diseases include:
- the immune system;
- genes and a genetic predisposition to juvenile arthritis;
- problems with the nervous system;
- metabolic problems;
- excessive tension and stress;
- environmental triggers;
- the effect of hormones on the body.
Who is most often diagnosed with juvenile arthritis in children? Minor arthritis affects children of any age and any ethnic origin. But some types are more common in the following children:
Juvenile rheumato >Each type of rheumatic disease has its own set of symptoms. In each child, the symptoms manifest themselves in different ways. But the most common symptoms of juvenile arthritis in all diseases are:
- strong pain;
- swelling in painful places;
- difficulty in movement, which lasts at least 1 hour after morning awakening;
- the appearance of lameness;
- redness in the joints;
- chronic fatigue;
- febrile temperature;
- enlarged lymph nodes;
- sharp weight loss;
- visual impairment;
- increased nervousness.
The diagnosis process begins with a study of the medical history and physical examination of the patient. A series of laboratory tests are performed. These include:
- General blood analysis.
- Blood chemistry.
- A blood test to detect antinuclear antibodies.
- A blood test for creatinine (exclude k >
Treatment will depend on the symptoms, age and general well-being of the child, as well as on what prognosis is given for his condition in the future. It also matters what type of disease the child has and how severe the condition is. The treatment plan, in addition to basic therapy, must necessarily include a consultation with a rheumatologist, orthopedist, physiotherapist and other medical professionals.
As such, juvenile arthritis in children does not suggest treatment. The goal of therapy is to relieve pain, eliminate symptoms and inflammation. Organs such as the eyes and heart are also often checked for problems. Treatment plans include both short-term and long-term methods.
Short-Term Juvenile Arthritis Treatments
- Medication. Short-term relief of pain and inflammation may include painkillers such as Acetaminophen, Ibuprofen, or other non-stero >
There are 2 main types of surgery: restoration and replacement. Surgery to repair a damaged joint may include removal of damaged areas or correction of bone deformation. If the joint after juvenile arthritis is too damaged, it may need to be replaced with an artificial joint.
If only a few joints are affected, juvenile arthritis in children results in minor damage. In some children, the disease can lead to persistent chronic pain and disability. Other complications include stunted growth, anemia, and eye or heart problems.