Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis is arthritis that affects children under 16 years of age. The disease is characterized by inflammation and restriction of movement of joints. It lasts longer than six weeks. This disease is also known as the children's chronic arthritis and juvenile chronic polyarthritis.

juvenile rheumatoid arthritis

Typical signs of juvenile rheumatoid arthritis – pain in the joint swelling, stiffness in the movements. These symptoms are worse in the morning or after a short NAP. Children, even small, the pain is not complaining.

This disease may be accompanied by fever. loss of appetite and weight loss. In some cases the hands and feet rash. Sometimes increased lymph nodes.

In juvenile rheumatoid arthritis may slow growth. In some cases, the affected joints develop at different rates, and because of this, the length of the hands or feet of the child may differ from each other.

Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis is an autoimmune disease, i.e. the immune system mistakenly perceives its own tissue as a foreign body and tries to destroy them. However, why there is such disruption of the immune system, experts still don't know. Assume that you start an outbreak of infectious disease, immunizations. especially against measles, mumps or rubella. Moreover, after vaccination with rheumatoid arthritis get sick more often girls. However, infection is not the only reason for the development of juvenile rheumatoid arthritis. It can also develop after injuries of the joints, hypothermia, overheating in the sun.

In juvenile rheumatoid arthritis is not purulent inflammation of the synovial membranes. Joint fluid thus secreted in increased amounts and accumulates in the joint cavity. Synovium thickens, adjacent to the joint and after some time connected with it. Erosion of the cartilage. And after a while the cartilage is destroyed. Moreover, the time during which these changes occur, all patients are different.

The number of affected joints are distinguished:

  • mono-arthritis if one joint affected;
  • oligoarthritis, if not more than four affected joints;
  • polyarthritis, if more than four affected joints;
  • systemic rheumatoid arthritis that affects not only the joints but other organs and tissues.

Oligoarthritis can be of two types – first and second. 80% of children suffering from oligoarthritis per the first type – girl. The disease starts at a younger age, usually affects the ankle, knee and elbow joints. Rheumatoid factor is absent. In 10% of cases in children for life stay vision problems and in 20 % of cases with joints.

per oligoarthritis of the second type affects mostly boys. It develops later than oligoarthritis of the first type. This affects large joints, most often the hip. The disease is often accompanied by inflammation of the sacroiliac joint in 10-20 % of cases it is joined by acute iridocyclitis. Rheumatoid factor is absent. Often children who had had per oligoarthritis of the second type, there is the disease of the joints and tendons attach to the bones.

arthritis

Arthritis is divided into positive and negative for rheumatoid factor. Those and other affects mostly girls. Polyarthritis, negative rheumatoid factor may occur in children at any age, and it affects any joints. Occasionally the disease is accompanied by inflammation of the mucous membrane of the anterior eyeball. In 10-45 % of cases the outcome of the disease – severe arthritis.

Polyarthritis, positive rheumatoid factor usually develops in older childhood, it affects any joints. 50% of the time for life to children who have suffered this disease continues to be severe arthritis.

60% of children with systemic rheumatoid arthritis boys. The disease can develop in a child at any age. Marvel can be any joints. Rheumatoid factor is absent. 25% of the time I had been ill for life continues to be severe arthritis.

Current patterns of juvenile rheumatoid arthritis may be acute, subacute, chronic and chronic with exacerbations.

Diagnosis

For correct diagnosis required the consultation of a paediatrician, neurosurgeon, traumatologist-orthopedist. Definitely need to take the General and biochemical blood tests. Also do:

Main objectives in the treatment of juvenile rheumatoid arthritis – the removal of inflammation, destruction of articular manifestations, to restore the normal function of the affected joints, preventing their destruction.
To relieve inflammation prescribe NSAIDs or glucocorticoids.

Often for the treatment of juvenile rheumatoid arthritis and is prescribed immunosuppressants (drugs that suppress the immune system). Taking these drugs may need continuous and long-term. And their cancellation often causes worsening of the disease.

When severe deformation of the joint is performed the operation for its restoration.

Good effect in the treatment of rheumatoid arthritis gives physiotherapy. It helps to relieve inflammation and to prevent deformation of the compositions. Often used electrophoresis, ultrasound, ultraviolet irradiation of the affected joints, magnetic therapy and mud therapy.

Lifestyle

Children suffering from juvenile rheumatoid arthritis, is contraindicated immunizations. But MANTOUX, in spite of the fact that tuberculin is a killed culture of Mycobacterium tuberculosis, risk for suffering from this disease carries. They can't take drugs that stimulate the immune system.

Prevention

Specific prophylaxis of juvenile rheumatoid arthritis has not been developed because the exact cause doctors don't know. But to prevent this disease need to reduce risk factors. It is necessary to avoid hypothermia, prolonged exposure to the sun. to defend against infections.

Arthritis is considered to be a disease of the elderly, but lesions of the joints are common in children. The disease can acquire chronic course, the so-called juvenile arthritis. In some cases, the disease develops very hard, with systemic manifestations, then it is classed as an orphan because, though uncommon, almost always results in the disability of the child. Treatment of juvenile arthritis long and costly, but nevertheless to treat such patients is necessary and possible. Today, doctors-rheumatologists not conceal his joy: new treatments for juvenile arthritis to stop the progression of the disease and to avoid disability in children.

arthritis in children

The disease occurred in early childhood, and then the boy was prescribed hormonal therapy. Unfortunately, the parents more than five years did not bring the child for treatment to the regional hospital. At some point, the disease is out of control, and the child died. The tragedy could have been avoided if parents regularly showed son the doctor. "During this time, new drugs, new treatments, and the boy may have saved," says Natalia.

The disease is considered autoimmune: at some point a failure occurs in the functioning of the immune system of the body, and he begins to attack its own cells. The body begins a violent reaction, which primarily affects the joints. Sometimes the disease begins with systemic lesions, when the patient is running a high temperature, rash, ache, and swell joints, there is morning stiffness, but most importantly – it affects all the organs: heart, liver, lungs.

Although the disease is genetically determined, predisposing factors are many. Often juvenile arthritis hurt those who have a genetic predisposition to autoimmune diseases: not only rheumatic diseases in the anamnesis from relatives, but such as diabetes type I diabetes, asthma, psoriasis and others. But the factors that trigger this complex pathological process, it could be anything. This injury of the joints, severe infectious and viral diseases, and even psychological trauma.

To interrupt the complex cascade of immune inflammation and restore function of the joints and other affected organs – the main task of doctors. If not treat this disease, the joints just destroyed, and the child becomes disabled. Considering that this disease can affect even babies up to a year, the delay in treatment almost always leads to disability.

Juvenile rheumatoid arthritis (JRA) is a chronic inflammatory disease of joints of unknown cause, lasting longer than 6 weeks, developing in children under the age of 16 years.

How common is juvenile rheumatoid arthritis?

Juvenile rheumatoid arthritis is one of the most frequent and most debilitating rheumatic disease that occurs in children. The incidence of JURA from 2 to 16 per 100 000 of children population under the age of 16 years. The prevalence of JRA in different countries — from 0.05 to 0.6%. Rheumatoid arthritis most often affects girls.

Why there is juvenile rheumatoid arthritis?

In the development of the JURA take part hereditary and environmental factors, among which the most important is infection.

There are many factors that trigger the mechanism of the disease. The most common are viral and mixed bacterial-viral infection, injury of joints, exposure or hypothermia, preventive vaccination, especially held against or immediately after acute respiratory illness or a bacterial infection. The possible role of infection in the development of the JURA it is anticipated, however it is still not completely proven.

Relation of onset of the disease with acute respiratory illness, carried out preventive vaccination against measles, rubella, mumps. Interestingly, the debut of JURA after vaccination against mumps is more common in girls. Known cases when YURI appeared after vaccination against hepatitis B. the Role of intestinal infections, Mycoplasma, beta-haemolytic Streptococcus in the development of the JURA by the majority of rheumatologists is not recognized.

However, it is known that these infections are the cause of the development of reactive arthritis, which can transform into the JURA. The role of viral infection in the development of chronic arthritis are less obvious.

It is known that more than 17 viruses can cause infection, accompanied by the development of acute arthritis (including viruses rubella, hepatitis, Epstein-Barr, Coxsackie, etc.).

In the development of chronic arthritis etiological role of viruses has not been proven. Genetic predisposition to JRA confirmed familial cases of the disease, twin studies, genetic studies.

juvenile arthritis in children

If juvenile rheumatoid arthritis?

With JRA have 40-50% of children have a good prognosis, can occur remission lasting from several months to several years. However, the worsening of the disease may develop years after remission.

1/3 of patients have a continuously relapsing course of the disease. In children with early onset of the disease and adolescents with a positive rheumatoid factor high risk of severe arthritis, disability of the musculoskeletal apparatus. Patients with late-onset possible transformation of the disease in ankylosing spondylitis.

15% of patients may develop blindness. Mortality in the JURA is very low and it is noted in the absence of timely treatment, the accession of infectious complications or the development of amyloidosis.

What is juvenile rheumatoid arthritis?

The main clinical manifestation of the disease is arthritis. The joint involvement is manifested by pain, swelling, deformation and limitation of movement, increased skin temperature over the joint. Children are most commonly affected large and medium joints, in particular knee, ankle, wrist, elbow, hip, and less often small joints of the hand. Typical JURA is the defeat of the cervical spine and maxillo-temporal joint.

Pathological changes in the joint characterized by the development of reactions of inflammation, which can lead to the destruction of cartilage and bone of the joints, narrowing of joint gaps (the space between the ends of the bones forming the joints) until the development of ankylosis (fusion of the articular surfaces of the bones forming the joints).

In addition to the destruction of joints may include the following extra-articular manifestations:

  • The increase in body temperature, sometimes to high numbers; usually develops in the morning can be accompanied by chills, increased pain in joints, appearance of the rash. The febrile period may last weeks and months, and sometimes years, and often precedes the joint affection.
  • The rash may be various, not accompanied by itching, is located in the region of the joints, on the face, chest, stomach, back, buttocks and extremities, disappears quickly, increasing the height of the fever.
  • Heart disease, the serous membranes, the lungs and other organs. The clinical picture of the lesion of the heart in the JURA: the pain behind the sternum, in the region of the heart, and in some cases pain in the upper abdomen; feeling short of breath, forced position in bed (the child is easier in the sitting position).
  • Swollen lymph nodes may be up to 4-6 cm in diameter. As a rule, lymph nodes, mobile, painless.
  • The enlarged liver and spleen.
  • Eye disease is typically for girls with JRA at a younger age. Marked redness of the eyes, lacrimation, photophobia, irregular contour of the pupil, decreased visual acuity. Ultimately may develop complete blindness and glaucoma.
  • Growth retardation and osteoporosis are one of the manifestations of the JURA. li>
29.03.2019