All about rheumatoid arthritis in children: causes, symptoms and treatment
How to diagnose and cure rheumatoid arthritis in children
Rheumatoid arthritis is a disease of unknown origin characterized by lesions of the joints. The most common form of child rheumatoid arthritis — juvenile (JRA). The disease usually diagnosed in preschool children, half the cases are children under 5 years. Cases rheumatoid arthritis girls is two to three times more than boys.
Untreated rheumatoid arthritis disrupts the normal development of the child, may lead to disability, cause difficulties in social adaptation.
If the child was somehow awkward to walk, and you see his joints swelling and fever, it is best to urgently take the child to the doctor.
How and why the disease occurs in children?
Causes of child rheumatoid arthritis is not fully understood. The bottom line is this: the body some children, suddenly, for whatever reason, ceases to recognise its own cells and begins to destroy its own organs and tissues. Occurs an autoimmune process that is characterized by high production of lymphocytes and of autoantibodies.
The reasons for the development of children’s rheumatoid arthritis:
- injuries of the joints, which is the trigger for the onset of the disease;
- infectious diseases — rheumatoid arthritis often begins after a flu, scarlet fever, or sore throat;
- immune system — the body begins to actively fight her own cells in the joints;
- high sensitivity to various environmental factors;
- family history-hereditary predisposition;
- psychological stress;
- sex — boys have less.
The pathogenesis of the disease
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Rheumatoid arthritis develops under the influence of several factors. First, the affected synovium of the joints. Then, under the influence of primary antigen (viruses or bacteria), the change of immune cells. The body begins to destroy them, treating such cells as foreign. Plasma cells begin to produce antigens, starts the inflammatory response.
In the synovium of the joints emitted a huge amount of white blood cells, causing the appearance of new antigens.
Once in the blood of the synovial sheath, the antigens are distributed throughout the body. This leads to the defeat of organs and systems. Due to the inflammatory reactions begin to break down the joints, violated the structure and function of cartilaginous and bony tissues.
In rheumatoid arthritis in children are affected:
- the liver;
- the small blood vessels.
You may experience complications, such as:
- necrosis of the liver.
Classification of existing forms of arthritis in children
- Children viral arthritis (reactive). Viral arthritis — joint inflammation that develops after a couple of weeks after infectious diseases due to weakened immune system and contact with the joint of viruses (infections of the intestinal, urinary tract, nasopharyngeal).
- Children’s infectious arthritis (septic). Children’s infectious arthritis — a serious disease characterized by inflammation of multiple joints. It occurs because of hitting the joints various infections and can develop in children of any age. The reasons for the development of infectious arthritis — infectious skin diseases, intestinal infections, infections obtained in the process of childbirth, etc.
- Juvenile arthritis in children (JRA). The JURA is a chronic inflammation of the joints, the cause of which is not known. The first attack of the disease may already be in a child up to four years, however, the first symptoms usually occur before the age of 16.
- Psoriatic arthritis. Psoriatic arthritis can develop in children who are sick with psoriasis. Sometimes this type of arthritis develops before the appearance of typical manifestations of psoriasis. In children with psoriatic arthritis usually inflamed finger joints.
Characteristic symptoms in the development of the disease
Early in the disease the child does not notice pain in the joints. The first symptom that is noted rheumatoid arthritis in children becomes a high temperature. The increase in temperature is observed up to several times a day, and it is not reduced after taking antipyretics tablets.
Soon the child becomes visible other signs of development of rheumatoid arthritis:
- The swelling and pain in the joints.
- Swollen lymph nodes.
- Restriction of mobility of joints, morning stiffness in the joints.
- Pain in the muscles.
- Acne on the skin.
- The gait disturbance.
- Muscle cramps.
- Inflammation of the pericardium or pleura.
- External change of the joints — at a late stage of the disease.
- A decrease in physical activity.
- The lack of appetite.
- Lesions of the internal organs.
For children juvenile rheumatoid arthritis also a typical triad of symptoms:
- Dystrophy of the cornea.
Usually rheumatoid arthritis (children) develops slowly, gradually progressing. There may be periods of exacerbations of the disease.
Stage of development of rheumatoid arthritis in children
- Exudative phase. First, there is soreness and swelling of one large joint, most often the knee, and a couple of months, the disease spread to the symmetrical joint. The symmetry of joint damage is an important diagnostic criterion. The child usually involves knee, elbow and ankle joints.
- The proliferative phase. In this phase, the affected periarticular tissue, inflammation of joint membranes and tendons. The joints are deformed, showing signs of General degeneration, muscle atrophy and anemia.
Clinical forms of the disease
There are two clinical forms of the disease: articular form (60 — 75 % of cases) and visceral-joint, which is much rarer.
The articular form
The disease develops gradually, accompanied by infrequent outbreaks of acute forms of fever, without lesions of the internal organs. Allergic rash is rare.
The articular form of the disease often affects several joints, it rarely occurs arthritis and lose one joint.
The main clinical symptom is pain. In severe forms of the disease the pain is pronounced, occurs when touched, and the slightest movements.
In 20% of cases articular form develops rheumatoid arthritis — disease of the vascular layer of the eye. Added to it a clouding of the lens and corneal dystrophy.
This is the most severe form of infantile rheumatoid arthritis. It is characterized by:
- An acute onset.
- Rapid development.
- High fever.
- The expressed articular syndrome.
- Severe reaction of lymphoid organs and liver.
- Viscinity (pleurisy, myocarditis, pericarditis).
The joint involvement is symmetrical and multiple. Can be amazed at all the joints.
Methods of diagnosis of the disease, which are used by modern medicine
There are several ways to diagnose:
The clinical signs are
- Edema and swelling for 6 weeks.
- The inflammatory process in the joints for three months.
- The occurrence of joint contractures.
- Symmetric defeat of joints.
- Muscular atrophy.
- Inflammation of the joint capsule and tendons.
- Morning stiffness (not typical for children of early age).
- Appearance of rheumatoid nodules near joints.
- Injuries to the eyes.
These include x-rays and fluid analysis.
On the x-ray can see:
- Typical erosion, so-called «Uzury».
- The bones of the diseased joint are fused, forming ankylosis.
Analysis of liquids:
- General clinical analysis of blood.
- The study of synovial fluid.
- Biochemical blood tests, including for rheumatoid factor.
The complex of measures for the cure of the disease
Treatment of rheumatoid arthritis in children should be comprehensive and aimed at removing all inflammatory processes and allergic reactions.
- Ibuprofen, aspirin, indomethacin, voltaren and phenylbutazone. Melon drugs inhibit the inflammatory response.
- Delagil and plaquenil — these drugs inhibit the secretion of antibodies and immune complexes.
- The gold-aqueous solution and suspension special oil — very effective drugs, but their use for the treatment of children is limited because of their toxicity.
- Kuprenil decreases changes of bone tissue.
- Corticosteroids — these drugs have immunosuppressive and anti-inflammatory effect.
- Local treatment – in the joint cavity administered anti-inflammatory drugs and immunosuppressants.
Medicines is particularly effective in the period of exacerbations.
Physiotherapeutic methods of treatment
- Laser therapy;
- Ultrasound treatment;
- Treatment of pulse currents;
- Ultraviolet irradiation;
- Electrophoresis with medical drugs;
- Paraffin therapy and other physiotherapeutic methods.
Physiotherapeutic methods provide an effective therapeutic effect in the beginning of the disease, and in addition — during the rehabilitation period.
Measures to restore joint function
- A special diet;
- Sanatorium-resort treatment;
- The methods of traditional medicine.
Such methods are used in the periods of remission and after treatment in the hospital.
If the joints are very severely deformed, it may require surgical intervention. In this case, the affected joint is completely replaced by a prosthesis.
Possible effective prevention?
Any specific prophylaxis is absent because of lack of knowledge about the mechanisms and causes of child rheumatoid arthritis.