Arthritis in children
The content of the article:
- Causes and risk factors
- Forms of the disease
- Disease stages
- Symptoms of arthritis in children
- Diagnostics
- Arthritis treatment in children
- Possible complications and consequences
- Forecast
- Prevention
Arthritis in children is a group of polyetiological rheumatic diseases, which are characterized by inflammatory lesions of all components of the joint.
Reactive arthritis in children is diagnosed 2-3 times more often than in adults
Juvenile rheumatoid arthritis develops in children from 2 to 16 years old and resembles rheumatoid arthritis in adults, but has a number of differences in both articular and extra-articular manifestations. The disease is diagnosed in about 0.5% of young men, almost twice as often in girls than in boys. Juvenile rheumatoid arthritis ranks first in terms of prevalence in the general structure of rheumatic diseases of childhood and has a lifelong course. The autoimmune inflammatory process in children with rheumatoid arthritis is primarily directed at the synovial membranes of the joints.
Ankylosing spondylitis (ankylosing spondylitis) is a systemic progressive disease in which the musculoskeletal system (joints and tendon-muscle structures) is affected, and in some cases the eyes and internal organs. In about 10-25% of cases, the disease manifests itself in childhood (juvenile ankylosing spondylitis).
Reactive arthritis in children is a set of aseptic inflammatory diseases of the joints that develop against the background of an extra-articular infectious process in the body, that is, they are a pathological reaction of the immune system to an inflammatory process that is not directly related to the joints.
Causes and risk factors
The causes of juvenile rheumatoid arthritis in children are not fully understood. It is assumed that the disease occurs due to the excessive activation of the immune system of a child with a family-hereditary predisposition under the influence of provoking factors. Risk factors for the development of the disease include infectious processes in the body of bacterial and viral etiology, joint injuries, injection of protein preparations, hypersensitivity to exogenous stimuli. At the same time, in response to the influence of an unfavorable factor in the child's body, specific proteins are formed - IgG (immunoglobulins G), which the own immune system perceives as antigens, that is, foreign agents. This is accompanied by the production of anti-IgG antibodies, which, when interacting with an autoantigen, form immune complexes. The latter have a damaging effect on the connective tissue, first of all, the synovial membrane of the joint, as a result of which juvenile rheumatoid arthritis develops in children.
The development of juvenile ankylosing spondylitis occurs in a similar way, the primary cause of the formation of a pathological immune response is bacterial infection, primarily Klebsiella and other enterobacteriaceae.
Reactive arthritis in children can occur against the background of an infectious inflammation of the gastrointestinal tract (dysentery, salmonellosis, yersiniosis, etc.) or the urinary system (cystitis, inflammation of the urethra).
The main cause of ankylosing spondylitis in children is Klebsiella infection
Infectious arthritis in children develops against the background of viral infections (influenza, rubella, mumps, adenovirus infection, viral hepatitis), gonorrhea, tuberculosis, infectious skin diseases, as well as vaccinations. Infectious agents penetrate the joint cavity with the flow of blood, lymph, during trauma or medical manipulations.
The development of arthritis in children is facilitated by unfavorable living conditions (dampness in living quarters, unsanitary conditions), frequent hypothermia, intense insolation and other factors that contribute to a decrease in immunity.
Forms of the disease
The following forms of arthritis in children are distinguished:
- juvenile rheumatoid arthritis;
- juvenile ankylosing spondylitis;
- reactive arthritis;
- infectious arthritis.
Juvenile rheumatoid arthritis, in turn, depending on the clinical and anatomical features, has the following forms:
- predominantly articular (polyarthritis with damage to more than five joints, oligoarthritis with damage from two to four joints, monoarthritis - damage to one joint);
- systemic (including damage to blood vessels, heart, lungs, reticulo-endothelial system, serous membranes);
- Still's syndrome (articular-visceral form);
- Wissler-Fanconi syndrome (allergic-septic form);
- articular form with rheumatoid uveitis (inflammation of the choroid).
Depending on the immunological characteristics (the presence of rheumatoid factor), juvenile rheumatoid arthritis is defined as seropositive (RF +) and seronegative (RF-).
Reactive arthritis in children, depending on the origin, can be urogenital or post-enterocolitic.
By the nature of the inflammatory process, arthritis in children is divided into acute, subacute and chronic.
Disease stages
The stages of arthritis are distinguished based on the radiological criteria of joint lesions according to the classification proposed by the American radiologist O. Steinbrocker:
- There are no destructive changes in the joints, signs of osteoporosis are revealed.
- Slight narrowing of the joint space, signs of destruction of cartilaginous tissue, single usuria (erosion of the articular surfaces of bones);
- Pronounced narrowing of the joint space, significant destruction of cartilaginous tissue, multiple usurs, subluxations and deviations of the elbow are possible (elbow deviation);
- Signs of ankylosis of the joint.
Stages of arthritis in children
In accordance with functional disorders, there are 4 stages (degrees) of juvenile rheumatoid arthritis:
- Moderate limitation of mobility in the joint with full preservation of self-care and any activity.
- Self-service is retained, some activities (eg running, jumping, etc.) are not available, and the ability to perform other activities is retained.
- Self-service is preserved, all activities requiring mobility are not available.
- The ability to self-care is lost, the patient needs outside care.
Symptoms of arthritis in children
Symptoms of arthritis in children depend on the form of the disease, but common to all is dysfunction of the joint (impaired movement in it), accompanied by severe pain.
The articular form of juvenile rheumatoid arthritis is accompanied by the appearance of intense pain in the affected joints, hyperemia of the skin over them, and their swelling. Usually large joints are affected, less often the small joints of the upper and lower extremities. In the morning after waking up, there is stiffness in the joints, which disappears after a while. The gait is disturbed, children of the first years of life may stop walking altogether. Juvenile arthritis is often accompanied by muscle weakness. With an exacerbation of the disease, the body temperature can rise to 38-39 ˚С.
The articular form of arthritis in children is characterized by pain in the affected joint
With the articular-visceral form of the disease, patients have arthralgia, persistent fever, polymorphic allergic skin rashes, an increase in the size of the liver and spleen, lymphadenopathy. The defeat of the joints is accompanied by inflammation of the myocardium (myocarditis), inflammation of the serous membranes of several cavities (polyserositis), anemia. With the progression of the pathological process, deformation of the joints occurs, partial or complete loss of mobility.
In the case of juvenile ankylosing spondylitis, the joints of the lower extremities are usually inflamed. As a rule, the joints of the metatarsus, knee joints are affected, less often the ankle and hip joints, joints of the upper limbs, sternocostal, sternoclavicular and pubic joints are involved in the pathological process. Children may develop aortic insufficiency, nephropathy, inflammation of the choroid.
The first symptoms of reactive arthritis in children usually appear several weeks after an infectious disease. The defeat of the joints is accompanied by swelling, severe pain, aggravated by movement, discoloration of the skin of the affected area (hyperemia or cyanotic shade). Extra-articular manifestations can include lesions of the eyes, heart, mucous membranes of the genitals, oral cavity, peripheral lymphadenopathy, muscle wasting. Reactive arthritis can deform the feet.
With infectious arthritis in children, there is an increase in the affected joints in volume, pain during movement and at rest, as well as signs of general intoxication of the body.
Diagnostics
To make a diagnosis, carry out:
- collection of complaints and anamnesis;
- objective examination;
- radiography;
- Ultrasound of the joints;
- computed or magnetic resonance imaging;
- puncture of the joint.
To identify possible heart damage, electrocardiography, echocardiography are performed.
To diagnose arthritis in children, perform joint ultrasound, x-rays, CT or MRI
Laboratory examination includes a general analysis of blood and urine, determination of C-reactive protein, rheumatoid factor, antinuclear antibodies, if necessary, an enzyme immunoassay, polymerase chain reaction, bacteriological examination of the patient's biological fluids to determine the infectious agent.
Arthritis treatment in children
Treatment of arthritis in children is carried out with medications, and after elimination of the acute inflammatory process, it includes physiotherapy (phonophoresis, laser therapy, cryotherapy, the use of ultraviolet rays with different wavelengths for therapeutic purposes), therapeutic massage, physiotherapy exercises and mechanotherapy (a set of exercises that are carried out with the help of special devices and simulators for the purpose of functional adaptation of the patient). For the period of treatment, such types of physical activity as running, jumping should be limited, it is necessary to avoid both prolonged exposure to direct sunlight and hypothermia. Patients are shown a diet, mainly milk-vegetable. The diet should contain dairy and sour milk products, fresh fruits and berries, fresh, boiled and stewed vegetables, easily digestible meats (chicken, turkey,veal, fish). Significantly limit the use of carbohydrates (sugar and confectionery should be excluded altogether for the period of treatment) of animal fats and salt.
The child's menu for arthritis should include fermented milk products, fresh vegetables and fruits
In the acute course (exacerbation) of juvenile rheumatoid arthritis and other forms, hospitalization may be required, in most cases, treatment is carried out at home. With intense joint pain, severe intoxication, high temperature, bed rest is required.
In order to relieve the acute inflammatory process, nonsteroidal anti-inflammatory drugs are prescribed, sometimes glucocorticosteroids. With severe pain syndrome, intra-articular injections of anti-inflammatory drugs are prescribed. Wearing of a corset, orthoses, temporary immobilization of joints may be recommended.
Locally prescribed drugs with anti-inflammatory action in the form of a cream, gel, ointment.
When treating reactive arthritis, the first step is to eliminate the primary infectious focus in the urinary or gastrointestinal tract. Antibacterial drugs are used to treat reactive and infectious arthritis in children. Antimicrobial therapy is usually given for at least one month.
During the rehabilitation period after suffering arthritis, children are recommended swimming, cycling, and kinesiotherapy. Sanatorium treatment is shown.
Possible complications and consequences
The consequence of arthritis in children may be deformity of the joints, partial or complete loss of mobility in the joints, growth retardation, loss of vision, macrophage activation syndrome, pulmonary and / or heart failure, secondary amyloidosis of the gastrointestinal, urinary tract and myocardium.
Forecast
Juvenile rheumatoid arthritis is a lifelong diagnosis. With timely diagnosis and properly selected treatment, it is possible to achieve long-term remission without pronounced deformation of the affected joints and loss of their functions. The prognosis worsens with an early onset of the disease, frequent relapses and the development of complications. In juvenile rheumatoid arthritis, disability occurs in about 25% of cases.
The prognosis for reactive arthritis is variable. In about 35% of cases, the inflammation disappears within six months, and the disease does not recur later. Approximately the same number of patients have relapses of the disease. In 25% of cases, there is a tendency for a slight progression of the pathological process. In about 5% of patients, a severe course of the disease is observed with subsequent ankylosing and destructive changes in the joints and spine.
Prevention
To prevent the development of arthritis in children, as well as to prevent relapse, it is recommended:
- timely treatment of diseases that can lead to the development of arthritis in children;
- limiting contact with infectious patients;
- avoiding prolonged exposure to direct sunlight;
- avoidance of hypothermia;
- avoiding a sharp change in climatic conditions;
- sufficient physical activity, good nutrition, compliance with sanitary standards - that is, measures aimed at strengthening the child's immunity.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
