Juvenile arthritis in children (chronic rheumatoid, systemic): causes, treatment

Juvenile arthritis is a complicated disease that threatens disability

Juvenile arthritis very often provokes the development of complex disorders in the body of the child and often leads to disability of children.

The most dangerous juvenile rheumatoid arthritis – the disease is quite rare. However, it ranks first in the group of rheumatic children’s pathologies. Children can «outgrow» the illness, and unable to disability.

It all depends on the extent of the disease, its type and the age of the baby. At the first sign juvenalnaja arthritis in children parents should be sure to consult your doctor, do not delay going to the hospital.

Such a dangerous and unpredictable «JURA»

Juvenile rheumatoid arthritis to designate the abbreviation of «JURA» is an autoimmune disease, accompanied by chronic inflammation of the joints. Affected not only the connective tissue, cartilage and bone, and internal organs in some cases. The disease occurs before the age of 16 years.

Rheumatoid arthritis is autoimmune in nature. What does it mean? The child’s body for unknown to date reasons begins to perceive its own cells as foreign.

The immune system produces a complex of antibodies, which are actively fighting the «enemy.» That is, the body begins to slowly destroy itself.

The antibodies affect the joints, causing inflammation. In some cases, the same pattern they violate the internal organs – heart, kidneys, liver. The disease is accompanied by the partial or complete loss of functional ability of joints – inability to bend the fingers or feet, depending on the localization of inflammation.

Juvenile rheumatoid arthritis are usually classified according to the type of lesion, the nature of the flow of pathology, the localization of inflammation and type of development.

Classification of the violations in detail

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There are two groups of diseases according to type of lesion. It is a systemic juvenile arthritis and joint. The latter has its subgroups.

System group

Systemic juvenile arthritis in children is characterized by inflammatory processes not only in the joints but also internal organs. This type of pathology, a dangerous accumulation of serum fluid, another name for which is «serous» in the organs.

This primarily affects the heart and lungs. Inflamed lymph nodes, sometimes they are clearly visible under the skin – they protrude above the surface, painless on palpation.

Systemic juvenile rheumatoid arthritis causes enlargement of the liver and spleen. This is the most severe form of the disease.

The articular group

Articular type of disease is characterized by lesions of the joints only. Depending on the number of affected areas of the articular type are divided into:

  1. Oligoarthritis means inflammation of not more than four joints. And inflamed areas are added with an interval of six months. The disease can affect children of any age – from years of life. If oligoarthritis affects both large and small, metatarsophalangeal and interphalangeal joints. Disease of this type is quite dangerous, as it can lead to growth retardation, deformations of the limbs and a wheelchair. Also for this type of violation is characterized by the deterioration of vision – develops uveitis, and subsequently cataract. Typically, vision is restored to the initial stages of treatment, but if neglected the disease, the child can lose vision forever.
  2. When arthritis affects the upper and lower limbs, number of inflamed joints – more than 5. Most often this disease occurs in girls. Can affect not only the limbs, but also neck, jaw. Pathology is characterized by a long and complicated treatment, often in hospital.
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The degree of activity of inflammation

The disease is divided into four groups according to the degree of inflammatory activity. Are the high, moderate, low and remission. Successful treatment and timely diagnosis of the disease, the disease goes into remission.

It is also customary to divide juvenile arthritis immunological basis. Allocate seropositive type, in which the blood reveal rheumatoid factor. Seronegative type is characterized by the absence of marker that indicates rheumatoid factor.

The first category is usually more difficult than the last – seronegative. In the classification of diseases included group defined according to the nature of the flow of the pathology.

Acute and subacute course of the disease

The disease can manifest itself in different ways.

Sharp and very painful

Systemic juvenile arthritis usually has an acute onset. Articular pathology can also have an aggressive course.

It is characterized by:

  • high body temperature;
  • swelling of the affected areas;
  • redness of the skin.

Inflamed not only large but also small groups of joints. It is observed the pain during movement and rest. Often appears allergic rash. The acute course of the disease is rare.

The subacute period

Subacute beginning is characterized by less clearly-marked sign. Body temperature is not observed. Often affects a single large joint, sometimes two or three.

The affected area increases in size, swells, but no ill effects. Toddlers up to two years very bad move, or stop coming at all. A clear manifestation of rheumatoid arthritis subacute considered to be the beginning of morning stiffness of the child. After sleeping baby difficult to move, lasts about an hour or more.

Another characteristic feature of subacute course of the disease is uveitis – the defeat of the choroid. Vision loss develops gradually and may take months before an accurate diagnosis.

This feature of the disease is often characteristic of girls up to 10 years. The onset of this nature is often accompanied with oligoarthritis – a subtype of JRA.

At the first signs of a disease should go to the hospital and begin tests.

The etiology of the disorders

The cause of juvenile rheumatoid arthritis considered genetic predisposition and viral, bacterial infection. However, this is only speculation, not established the etiology of the disease.

For many decades, scientists are trying to understand the nature of the disease, but in vain. It is known that more than half of patients are in the family of rheumatic diseases. This gave the basis for establishing the reason of genetic predisposition.

It was also found that many patients had a viral and bacterial infection, against which began to marvel at the joints. However, to prove these factors failed.

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However, the etiology of the disease began to consider the sensitivity to external factors.

Symptoms of the disease

Depending on the type of pathology are different groups of symptoms. So articular form JRA will differ in symptoms from the system.

The articular manifestations of juvenile arthritis include:

  • defeat all the groups of the joints – there is swelling and puffiness;
  • «warmth» of the joint increased temperature of the affected area;
  • pain during movement and rest;
  • morning stiffness – needs to last at least an hour, otherwise the clinical symptom is not included;
  • the limbs do not bend, there is a subluxation;
  • the loss of functionality of the joints in the later stages of the disease.

System type YURA and his symptoms more aggressively. The disease has significant symptoms. They include:

  • high body temperature up to 40°C;
  • inflammation in all joints – can be affected by one or more;
  • appear characteristic brown spots near the nail;
  • irregularities in the heart, shortness of breath, pain, arrhythmia, tachycardia or bradycardia;
  • swollen lymph nodes;
  • uveitis;
  • enlargement of the liver and spleen.

Along with the General symptoms of systemic JRA there are two syndrome – still and Viscera-Fanconi. The first is characterized by the appearance of an allergic rash, inflammation of serous membranes. The second has features such as spots on the skin, inflammation of the tissues in the heart and pulmonary fibrosis. Both syndrome accompanied by symptoms characteristic of the system type of the disease.

A common feature for concern is the swelling of the joints, swelling. So initially appears juvenile chronic arthritis, rheumatoid diagnosed too late.

Diagnostic methods

For the diagnosis of the disease resort to laboratory examinations of blood to identify indicators sea, rheumatoid factor, ACCP marker of the disease.

Also send the patient’s ECG, x-ray and ultrasound. In addition to the standard examination, the doctor collects the medical history the medical history of the child, parents and other next of kin to identify rheumatic conditions in the family. May require examination by an ophthalmologist and rheumatologist.

Only on the basis of the collected test results, pictures and conclusions of other doctors can make an accurate diagnosis and identify the type of JURA.

Therapeutic approach

Drug treatment of juvenile arthritis in children includes the administration of nonsteroidal anti-inflammatory drugs. They quickly and effectively reduce pain, reduce swelling of joints and increase their functionality.

These include:

  • Piroxicam;
  • Diclofenac;
  • Indomethacin;
  • Ibuprofen;
  • Naproxen etc.

The drug is taken orally after meals in the case of long-term therapy. For quick needed analgesic effect, the doctor prescribes medication 30 minutes before eating.

After taking the medication is not recommended to take a supine position, as can develop esophagitis. Let the child move, does not bear the first 10-15 min.

Medicines in this group do not inhibit the process of joint destruction. To the same effect are the drugs of glucocorticoid group. These include:

  • Prednisone;
  • Methylprednisolone;
  • Betamethasone;
  • Triamcinolone.

Glucocorticoid a group of drugs used to achieve rapid suppression of the inflammatory process. With their help, stoped the painful symptoms. The drug is rapidly excreted from the body.

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However, there are a number of contraindications, which can not be performed intra-articular injections. Drugs are not used for a long time – there may be complications, side effects.

Immunosuppressive therapy is focused on the process of joint destruction. This group of medicines is designed for long-term use without interruption. Assigned to the medication one to three times per week depending on the tolerability of the body.

There are the following drugs:

  • Methotrexate;
  • Cyclosporine;
  • The Leflunomide.

Each is appointed with caution and taking into account the characteristics of the organism, type of disease and tolerance of the components of the medication.

Administering medication often has side effects. Therefore, you should always be seen by a doctor and during tests in order to monitor the body’s reaction to the medication.

Exercise and diet

In addition to the medical treatment necessary to monitor the mobility of the child. You can’t immobilize the body. Shown walking, swimming, Cycling and other physical activity that do not involve any sudden movements.

Depending on the degree of joint damage is applied orthopedic correction wearing special devices, corsets, Shin, splints the.

Because the disease can affect the baby as weight loss and set, diet appointed. The doctor determines the list depending on the individual characteristics of the organism.

Frequently assigned eating foods with calcium, vitamin D and protein. The diet is prescribed in the prevention of osteoporosis – the effects of systemic JRA.

A comprehensive approach to treatment will save the child from disability and other serious complications.

Prognosis and complications

Juvenile rheumatoid arthritis usually heals and leaves no consequences for the musculoskeletal system. Children often «outgrow» the disease.

However, the running stage of the disease of a systemic nature, do not go unnoticed. Affects not only the joints but other organs. Rarely, but if you ignore the disease may occur death.

Complications include vision loss, kidney failure, osteoporosis, immobility of the joints. As a result of osteoporosis frequent fractures. Unfortunately, the systemic form of the disease rarely goes unnoticed.

How to prevent the disease?

To the prevention of disease can be attributed only to the careful observation of the child. This is especially true of families with rheumatic pathology are not uncommon.

To prevent the disease is impossible, as the reason for its appearance is unknown. However, the timely detection of early signs of arthritis already will have the character of secondary prevention.

To delay trip to the doctor and self-medicate a child should not be. This can lead to complications and serious consequences.