Translated from Latin, juvenile – means youthful, that is, concerning children under 16 years old. Juvenile rheumatoid arthritis is the most frequent and most dangerous joint disease in children. Despite the fact that the incidence is not high and does not exceed 1%, this pathology can lead to irreversible changes and disability.
This term began to be used in 1946 by American doctors to refer to all chronic diseases of the joints. Currently, this term refers to a separate pathology, not a group of diseases, as it was before.
In the photo the lesions of the left hand joints
Juvenile rheumatoid arthritis can be caused by various causes, but the key factor is usually an inadequate response of the immune system, which in children is not yet mature and often fails. In girls, it occurs 1-5-2 times more often in boys.
The direct mechanisms that trigger pathological processes are:
- contact with bacterial or viral infection-
- general hypothermia-
- previous joint injury
- long stay in the open sun
- untimely prophylactic vaccinations.
Genetic and genetic predisposition also plays a big role in the development of the disease. This is confirmed by the study of twins and the presence of familial forms of arthritis. In addition, molecular genetics have established a link between the incidence and variability of certain genes of the main histocompatibility complex, which is responsible for the functioning of the immune system.
After contact with any environmental factor, the immunity is restructured in such a way that the body’s own cells are perceived as foreign, that is, an autoimmune reaction develops, which is the basis of rheumatoid arthritis.
The immune system is a powerful defense of our body, but unfortunately, it can sometimes attack it.
Symptoms of the disease
The symptoms of juvenile rheumatoid arthritis in children are the most diverse, but peripheral joints are most often affected. The process begins with the shell and gradually moves to the cartilage. Due to the fact that the cells begin to be produced in excess, the joint can change its shape (deform). Next, a layer of cells is formed, which closes the surface of the joint and disrupts metabolic processes – this further enhances the destruction of tissue. The onset of the disease may be acute or subacute.
In acute onset, the following symptoms are noted:
- sudden pain, swelling and redness in the area of large joints;
- a sharp rise in body temperature to 39 0 С;
- rash on the skin of an allergic nature: on the limbs and on the body;
- organs of the immune system may react (peripheral lymph nodes, spleen, sometimes liver) increase.
Often juvenile rheumatoid arthritis is accompanied by damage to the spine and temporomandibular joints. Subacute onset is characterized by a less pronounced clinical picture. The function is gradually disrupted, with the defeat of the knee or ankle, the gait may change, and younger children often stop walking. Morning stiffness is sometimes noted: after sleep for half an hour, the range of movement is limited.
Articular manifestations in children are typical and constitute about 70% of all symptoms of juvenile rheumatoid arthritis. Usually they are symmetrical and lead to deformation and fusion of the articular surfaces, which sharply limits mobility. If the pathology of the internal organs joins the lesion of the joints, then they are talking about the joint-visceral form, which is characterized by the following symptoms:
- prolonged rise in body temperature in the morning;
- allergic rash, aggravated by fever;
- proliferation of liver and spleen tissue due to activation of the immune system;
- arthritis proper, and often concomitant growth retardation.
In girls, these symptoms are accompanied by uveitis (inflammatory changes in the membranes of the eye) – in which the membranes of the eye are affected. First, tearing develops — photophobia and decreased visual acuity — ultimately this can lead to total blindness.
As a rule, juvenile rheumatoid arthritis is manifested by muscle weakness, anemia and pale skin. It is also possible vascular lesion, which leads to a deterioration in the blood supply to the extremities; pigmentation or ulcers develop on the skin, caused by insufficient oxygen and nutrient supply. In the area of the elbows and forearms, characteristic nodules can be found — they are painless — sometimes they are soldered to the bone and do not exceed 5 mm in diameter.
In the course of the disease, renal function also suffers – this is due to the postponement of a special type of protein (amyloid) in them – which clogs the renal tubules and reduces the filtration capacity. 20% of children have abdominal pain.
Swelling and deformation of the joints in a child are one of the symptoms of the disease.
What helps to establish the diagnosis?
The pathological process begins in the outer sheath of the joint, which is called synovial. Its cells in response to aggressive action produce specific antibodies, which are called rheumatoid factor. The definition of these proteins in the blood of children is the main feature in the diagnosis of arthritis.
The rheumatoid factor forms circulating immune complexes that destroy the inner lining of blood vessels and surrounding tissues.
Juvenile rheumatoid arthritis is diagnosed in children based on:
- clinical signs – previously described;
- X-ray examination data (restructuring of the bone structure, its destruction in the area of the joints, narrowing of the joint space and fusion of cartilaginous surfaces, damage to the spine in the cervical region);
- laboratory signs (positive rheumatoid factor and the result of synovial biopsy).
To determine the degree of involvement in the process of internal organs perform ECG and ultrasound. All children with lesions of the joints should be examined by an oculist for uveitis.
Skin rash as a symptom
Therapeutic measures in this pathology are aimed at suppressing the main process, preserving the mobility of the joint, preventing exacerbations.
Drug treatment of juvenile rheumatoid arthritis involves taking several classes of drugs:
Non-steroidal anti-inflammatory drugs (NSAIDs) are used to treat the joint form and suppress the inflammatory process quite well, relieve pain syndrome. The duration of treatment should not exceed two months, since side effects often develop, including gastric ulcer.
Glucocorticosteroids are hormonal anti-inflammatory drugs and can be used with the intra-articular route of administration. Since these drugs can adversely affect the function of the endocrine organs, children under 5 years of age are prescribed only in extreme cases.
Immunosuppressants, which suppress the immune system, should be administered immediately after a diagnosis is made, since it is this therapy that affects the cause of the disease. Juvenile rheumatoid arthritis is usually treated with methotrexate sulfasalazine and leflunomide. These drugs have a minimal amount of side effects and are well tolerated with prolonged use.
Biological agents – a new group of drugs – data on efficacy is currently not enough.
Methods of non-pharmacological therapy are auxiliary, because they can not eliminate the cause of the disease. These include:
Physical therapy, which is of great importance in improving motor activity. Exercises must be performed daily, sometimes with the help of an adult. Useful cycling and swimming.
Physical therapy, including magnetic therapy and electrophoresis with dimexidum, can reduce clinical manifestations and alter the immune status. For muscle relaxation and the return of range of motion, it is necessary to perform infrared irradiation — apply paraffin and mud on the affected area. Cryotherapy (that is, treatment with cold — we talked about it in detail here) and laser therapy are used during the exacerbation of the disease. They have a slight anti-inflammatory effect.
Massage can be performed only after periods of exacerbation. Due to the improved blood supply to the patient’s joint, its mobility increases and the degree of deformation decreases.
Treatment with folk remedies, as a rule, is ineffective and may be unsafe.
In extreme cases, the operational correction of deformations. After completion of the growth of the child may prosthetic knee and hip joints.
Juvenile rheumatoid arthritis is characterized by a rather favorable prognosis; approximately half of the children have a stable remission for ten years or more. However, in a third of patients, the course of the disease is rather severe and leads to disability.
Since the exact cause of the disease has not been established and preventive measures have not been developed. Parents should try to protect the child from hypothermia and overheating; reduce contact with infections and observe the timing of vaccinations.
Often the disease has a negative effect on the psyche. The child should not feel like an outcast or a disabled person. The task of society to help these children lead a normal life, and parents and doctors are simply obliged to instill optimism in the baby.