21.10.2020

Arthritis treatment in children

Infectious arthritis in children can be etiologically associated with viral infection (rubella, adenovirus infection, epidemic parotiditis, influenza, viral hepatitis), vaccination, nasopharyngeal streptococcal infection of the etiology (chronic tonsillitis, sinusitis, pharyngitis), tuberculosis, etiology (chronic tonsillitis, sinusitis, sinusitis, tuberculosis, etiology) dermatitis), etc. The occurrence of arthritis in children is promoted by unfavorable social conditions (unsanitary conditions, dampness in the room), frequent hypothermia, insolation, and weakened immunity.

The etiology of juvenile rheumatoid arthritis is not precisely established. Among the causes of this form of arthritis in children is considered a familial hereditary predisposition, as well as the influence of various exogenous factors (viral and bacterial infections, joint injuries, protein drugs, etc.). In response to external influences in the child’s body, IgG are formed, which are perceived by the immune system as autoantigens, which is accompanied by the production of antibodies (anti-IgG).

When interacting with autoantigens, antibodies form immune complexes, which have a damaging effect on the synovial membrane of the joint and other tissues. As a result of a complex and inadequate immune response, a chronic, progressive disease of the joints develops – juvenile rheumatoid arthritis.

Juvenile ankylosing spondylitis is a multifactorial disease, in the development of which a large role is assigned to hereditary predisposition and infectious agents (Klebsiella and other enterobacteria).

Postenterocolitic reactive arthritis in children is associated with a postponed intestinal infection: yersiniosis, salmonellosis, dysentery. Urogenital reactive arthritis is usually caused by a urogenital infection (urethritis, cystitis) caused by chlamydia or ureaplasma.

Symptoms of arthritis in children

Juvenile rheumatoid arthritis

When articular arthritis in a child can affect one or more joints (usually symmetrical), which is accompanied by their pain, swelling and hyperemia. Usually, large joints (knee, ankle, wrist) are involved in the pathological process, small joints of the legs and arms (interphalangeal, metatarsophalangeal) are less common. There is morning stiffness in the joints, a change in gait; children under 2 years old can completely stop walking.

In children with acute arthritis, body temperature can rise to 38-39 ° C. Articular arthritis in children often occurs with uveitis, lymphadenopathy, polymorphic skin rash, enlarged liver and spleen.

Articular and visceral (systemic) form of arthritis in children is characterized by arthralgia, lymphadenopathy, persistent high fever, polymorphic allergic rash, hepatosplenomegaly. The development of myocarditis, polyserositis (pericarditis, pleurisy), and anemia is characteristic.

The progression of arthritis in children leads to the development of persistent deformity of the joints, partial or complete limitation of mobility, amyloidosis of the heart, kidneys, liver, intestines. 25% of children with juvenile rheumatoid arthritis are disabled.

Juvenile ankylosing spondylitis

Symptoms include articular syndrome, extraarticular and common manifestations. Damage to the joints in children with this type of arthritis is represented by mono-or oligoarthritis, predominantly of the joints of the legs; is asymmetrical. More often, the disease affects the knee joints, the hilus joints, the metatarsophalangeal joints of the first toe; less commonly, hip and ankle joints of the upper limbs, sternoclavicular, sterno-rib, pubic joints. Characteristic is the development of enthesopathies, achillobursitis, stiffness of the spine, sacroiliitis.

Of extraarticular symptoms in ankylosing spondyloarthritis, uveitis, aortic insufficiency, nephropathy, and secondary amyloidosis of the kidneys are common.

The cause of disability in older age is ankylosis of intervertebral joints and hip joint damage.

Reactive arthritis in children

Reactive arthritis in children develops 1–3 weeks after an intestinal or urogenital infection. Articular manifestations are characterized by mono-or oligoarthritis: swelling of the joints, pain, aggravated by movement, change in skin color over the joints (hyperemia or cyanotic). The development of enthesopathies, bursitis, tendovaginitis is possible.

Along with damage to the joints, there are numerous extra-articular manifestations in reactive arthritis in children: eye damage (conjunctivitis, iritis, iridocyclitis), oral mucosa (glossitis, mucosal erosion), genitals (balanitis, balanoposthitis), skin changes (erythema nodosum) , heart damage (pericarditis, myocarditis, aortitis, extrasystole, AV blockade).

Common manifestations of reactive arthritis in children include fever, peripheral lymphadenopathy, muscle hypotrophy, and anemia.

Reactive arthritis in children in most cases undergo complete reverse development. However, with prolonged or chronic course, it is possible to develop amyloidosis, glomerulonephritis, polyneuritis.

Infectious arthritis in children

With arthritis of bacterial etiology, symptoms in children develop acutely. At the same time, the general condition of the child suffers: fever, headache, weakness, loss of appetite. Local changes include an increase in the affected joint in the volume, hyperemia of the skin and a local increase in temperature, pain in the joint area at rest and its sharp increase during movement, the forced position of the limb, which alleviates pain.

The course of viral arthritis in children is rapid (1-2 weeks) and is usually completely reversible.

Tuberculous arthritis in children proceeds against the background of subfebrile fever, intoxication; more often in the form of monoarthritis with damage to one large joint or spondylitis. Characterized by pallor of the skin over the affected joint, (“pale tumor”), the formation of fistulas with the release of white caseous masses.

Diagnosis of arthritis in children

Due to the polysymptomatic course of arthritis in children, many specialists are involved in the diagnosis of the disease: pediatrician, pediatric rheumatologist, pediatric ophthalmologist, pediatric dermatologist, etc. When collecting anamnesis, attention is paid to the connection of arthritis in children with rheumatism, bacterial and viral infections, clinical course.

The basis of instrumental diagnosis of arthritis in children is ultrasound of the joints, radiography, CT or MRI of the joints and spine. The most characteristic features of arthritis in children are narrowing of the articular fissures, ankylosis of the joints, bone erosion, signs of osteoporosis, effusion in the cavity of the joints.

To clarify the etiology of arthritis in children, laboratory studies are conducted: the determination of ASL-O, rheumatoid factor, CRP, antinuclear antibodies, IgG, IgM, IgA, complement; PCR and ELISA detection of chlamydia, mycoplasma, ureaplasma, etc .; bacteriological examination of feces and urine; immunogenetic examination. An important role in the differential diagnosis of arthritis in children is played by the diagnostic puncture of the joint, the study of synovial fluid, synovial biopsy.

Tuberculous arthritis in children is diagnosed on the basis of history, chest X-ray, information about the BCG vaccination, the results of the Mantoux reaction. To exclude heart damage, an ECG, echocardiography is prescribed.

Arthritis treatment in children

Combined therapy of juvenile rheumatoid arthritis and ankylosing spondylitis in children involves courses of drug treatment, physiotherapy, massage, exercise therapy, mechanotherapy. During periods of exacerbation, NSAIDs, glucocorticoids (including pulse therapy with methylprednisolone), immunosuppressants, and biological agents are prescribed. Local treatment of arthritis in children includes intraarticular injection of drugs, temporary immobilization of the joints, wearing a corset.

The approach to the treatment of reactive and infectious arthritis in children involves the conduct of etiotropic, pathogenetic and symptomatic therapy. Specially selected antibacterial drugs, immunomodulators, NSAIDs, glucocorticoids are used. Treatment of tuberculous arthritis in children is carried out with the participation of the pediatric TB specialist with the help of anti-tuberculosis drugs.

In all forms of arthritis in children, cycling, swimming, kinesiotherapy, balneotherapy, and spa treatment are beneficial.

Arthritis in children is an etiologically diverse group of rheumatic diseases occurring with inflammatory lesions of all elements of the joints. Arthritis in children is manifested by local changes (redness, swelling, pain, limited mobility in the sore joint) and general symptoms (fever, rejection of mobile games, weakness, capriciousness of the child). The diagnosis of arthritis in children is established on the basis of anamnesis, laboratory tests, ultrasound, radiography, CT, and MRI of the joints. Treatment of arthritis in children includes medical therapy, physical therapy, physiotherapy, massage, temporary joint immobilization.

The concept of “arthritis in children” combines various diseases by origin and course, occurring with articular syndrome and occurring in childhood. In pediatrics and pediatric rheumatology, arthritis is detected in every thousandth child. The importance of studying the problem of arthritis in children is determined by its social significance, namely, the high degree of disability of young patients, who as a result of the disease often lose their basic self-care functions and cannot do without the help of adults.

Classification

The most common forms of arthritis in children are: rheumatoid arthritis, juvenile rheumatoid arthritis, juvenile ankylosing spondylitis, reactive arthritis and arthritis associated with infection.

Rheumatoid arthritis is one of the manifestations of rheumatism in children (along with rheumatic heart disease, small chorea, ring-shaped erythema, rheumatic nodules) and is etiologically associated with a previous streptococcal infection (sore throat, scarlet fever, pharyngitis).

Juvenile rheumatoid arthritis is  characterized by chronic inflammation of the joints of unknown etiology; occurs in children under the age of 16; has a steadily progressive course; sometimes accompanied by the involvement of internal organs. Rheumatoid arthritis in children can occur in articular form (like monoarthritis, oligoarthritis or polyarthritis) or systemic (articular-visceral) form with damage to the heart, lungs, reticuloendothelial system, with vasculitis, polyserositis, uveitis, etc.

Juvenile ankylosing spondylitis (ankylosing spondylitis) occurs with chronic inflammation of the spine and peripheral joints. In 10-25% of cases, the disease will debut in childhood.

Reactive arthritis in children is a group of aseptic inflammatory diseases of the joints that develop as a result of an extra-articular infection. Postenterocolitic and urogenital arthritis are referred to as reactive arthritis in children. Some authors attribute Reiter’s syndrome to reactive arthritis.

Infectious arthritis in children include articular syndromes that have developed as a result of viral, bacterial, fungal, parasitic infections, Lyme disease. In infectious arthritis, pathogens penetrate directly into the joint cavity with the flow of lymph, blood, as a result of manipulation or injury.

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