Rheumatoid arthritis in a child is a very complex and dangerous problem. This disease in modern pediatrics is relatively rare. However, every parent should be familiar with information about its symptoms and causes. The fact is that this disease cannot be completely cured, but if therapy and preventive measures are started in time, the course of arthritis can be significantly alleviated and the likelihood of dangerous complications can be reduced.
General information about the disease
Rheumatoid arthritis in a child, better known in medicine as juvenile rheumatoid arthritis (JRA), is a chronic disease of the joints of an autoimmune origin. There are approximately 16-19 patients with a similar diagnosis per 100 thousand children. According to statistics, girls suffer from the disease 2-3 times more often. In addition, the disease is usually diagnosed in children under the age of five.age.
The disease is actually very dangerous, since often the inflammatory process affects not only the joints (which in itself leads to degeneration of the articular structures), but also internal organs (for example, the heart, eyes, etc.). The disease leads to a decrease in the quality of life of the child, and sometimes to a serious delay in physical development and disability.
Rheumatoid arthritis in children: causes
Unfortunately, the exact mechanism of the development of the disease has not yet been elucidated. Rheumatoid arthritis is known to be an autoimmune disease. For one reason or another, a serious malfunction occurs in the work of the immune system, as a result of which it begins to perceive articular structures as foreign bodies. Thus, antibodies are produced in the body, which first attack the cells of the synovial membrane of the joint, causing their inflammation and degeneration. As the disease progresses, the immune system begins to damage other parts of the joint, and sometimes the tissues of the internal organs.
It is known that there is a genetic predisposition. There are other factors that can activate the development of this disease:
- a sharp change in hormonal levels (sometimes the disease is activated during puberty as a result of a jump in hormone levels);
- disturbances in metabolic processes;
- vaccination;
- infection of the child's body (it can be bacteria, viruses, mycoplasmas, etc.);
- severe overheating or hypothermia;
- dramatic changeclimate;
- joint injury.
Rheumatoid arthritis in children: photos and symptoms of the articular form of the disease
Approximately 60-70% of patients suffer from this form of the disease. It begins, as a rule, with the defeat of one large joint (more often it is the knee or ankle). After 1-3 weeks, another joint becomes inflamed. A characteristic sign is the symmetry of the damage to the joints.
You may notice that the child began to limp. There is morning stiffness in the affected joints. You can also note swelling in the area of the inflammatory process. Due to soreness and limited movements, small children stop playing, move little - in a word, they refuse physical activity, which is accompanied by discomfort. Left untreated, this can lead to muscle atrophy.
As the disease progresses, degeneration of articular structures is observed, which can lead to disability.
Articular-visceral form of the disease
The most severe is the articular-visceral rheumatoid arthritis in children. The symptoms here, in addition to damage to the joints, include all the signs of intoxication, because the immune system damages the tissues of the internal organs. As a rule, an exacerbation begins with a sharp increase in temperature, chills, enlargement of the liver, spleen, and lymph nodes. You may notice swelling and redness in the area of the affected joints. The child is in severe pain.
The defeat of the internal organs can lead to the development of amyloidosis, various diseases of the kidneys, heart, lungs, the development of vasculitis, loss of vision, etc.
Generalized articular form of arthritis
Rheumatoid arthritis in a child can occur in other forms, for example:
- oligo-articular chronic arthritis, which is accompanied by damage to 1-2 large joints (often the knee) and a long, benign course of the disease;
- polyarticular form of the disease, which is accompanied by damage to several large structures or a combination of small and large joints; the disease proceeds in waves.
Basic methods of modern diagnostics
Only a doctor knows how to correctly identify rheumatoid arthritis in children. Diagnosis is a long and complicated process. Naturally, to begin with, a general examination is carried out, which allows you to determine the presence of an inflammatory process in the joints. In the future, as a rule, laboratory tests are carried out. By the way, in juvenile arthritis, rheumatoid factor in the blood is not detected at the initial stages of the disease in about 50% of cases.
X-ray examinations are important for diagnosis. An ultrasound of the affected joints may also be performed. More information about the state of the body can be obtained through computed tomography. If there is a suspicion of a visceral form of the disease, then the doctor recommends an electrocardiogram, a bacteriological culture test, an examination byophthalmologist.
Basic principles of therapy for childhood arthritis
Treatment of rheumatoid arthritis in children is an ongoing process, because, unfortunately, it is impossible to completely get rid of the disease. Therapy in this case is aimed at inhibiting the inflammatory process, reducing the rate of joint degeneration, as well as maintaining their mobility.
In the acute and subacute periods, as a rule, drug treatment is carried out to help eliminate inflammation. Remission periods also include various wellness activities, including physical therapy.
Drug therapy
Of course, for many parents, the question of how rheumatoid arthritis is treated is extremely important. Symptoms and treatment in children are closely related - the list of medications used depends on the condition of the child. All drugs can be divided into two groups:
- drugs designed to eliminate the main symptoms during an exacerbation of the disease;
- drugs that suppress the activity of the immune system (the patient takes them throughout life, even during periods of remission).
As a rule, non-steroidal anti-inflammatory drugs are prescribed for children to begin with. The most effective of them include Butadion, Indomethacin, Voltaren, Ibuprofen. Naturally, the dosage and duration of the course of treatment are determined individually. By the way, these drugs act quickly, slow down the development of the inflammatory process, relieve pain and fever. In addition, they are not so toxic and have few side effects, which is very important for the child's body. For example, if rheumatoid arthritis is found in a child (3 years old) at the acute stage, then most likely the doctor will prescribe just such medicines, and they are even sold in the form of suppositories, which is also convenient.
In more severe cases (for example, with a generalized or visceral form), corticosteroids are needed, which cope with the inflammatory process much more effectively. As a rule, they are not prescribed for children under 5 years old, but exceptions are sometimes made. Such drugs are used in the form of tablets and solutions, and sometimes injected directly into the joint capsule for maximum effect.
Alas, anti-inflammatory drugs cannot slow down the process of joint degeneration. Therefore, patients along with them are prescribed the so-called immunosuppressants - drugs that inhibit the activity of the immune system. The most effective include Plaquenil, Krizanol, Sanokresin, Delagil. Such drugs must be taken in courses, but constantly, even during remission, in order to prevent the onset of another exacerbation.
Depending on the condition of the child, the doctor may prescribe cytostatics (it is advisable for the allergic-septic form of the disease), drugs that cause coagulation of the synovial membrane (for example, "Varicocide"), drugs that provide a decrease in the level of rheumatoid factor ("Kuprenil ").
Physiotherapeutic methods and theirefficiency
Treatment of advanced juvenile rheumatoid arthritis in children may include physical therapy in addition to conventional medication. There are many methods that are used to achieve remission, but they are selected by the attending physician individually for each child.
Practically all children are recommended to undergo therapeutic massage courses from time to time, which help improve blood circulation, relieve muscle tension and strengthen them. Also, therapeutic exercises will be useful, which helps to maintain joint mobility. Naturally, the training scheme and exercises are selected individually depending on the degree of development of the disease, the age and condition of the little patient.
There are many other techniques. In particular, rheumatoid arthritis in a child is an indication for spa treatment. Quite often, mud therapy, paraffin therapy, balneotherapy, etc. are effective. At later stages, treatment with currents is possible. With the right combination of physiotherapy methods and medication regimens, good results can be achieved.
What are the prognosis for a sick child?
What to expect if a child has rheumatoid arthritis? The prognosis, unfortunately, is not very encouraging. This disease is lifelong and it is almost impossible to cure it completely, forever. The only exceptions are oligoarthritis, which is not accompanied by destruction of the joints. But the most difficultthe visceral form of the disease is considered, because the number of possible complications is much higher here.
What to do if a child has this disease? Timely and well-conducted therapy can slow down the processes of joint destruction and damage to other organs. There are cases when it was possible to achieve a long-term remission and significantly improve the quality of life of the child. On the other hand, with frequent relapses, a serious violation of the basic functions of the joints is possible, which leads to disability.
Are there effective prevention methods?
Rheumatoid arthritis in a child is a chronic disease. And, unfortunately, drugs or other methods of preventing the primary development of the disease in modern medicine do not exist. However, if the child is at risk (for example, there is a genetic predisposition, an allergic disease, chronic inflammation), then the so-called non-specific prophylaxis is possible, which includes the following conditions:
- Regular medical supervision. This may be a pediatrician or a rheumatologist who will constantly examine the child, monitor tests, etc. Since the disease is to some extent associated with disorders of the immune system, it will not be superfluous to consult an immunologist.
- Quality treatment of chronic foci of infection is necessary, since such an inflammatory process can provoke the development of arthritis. Depending on the nature of the disease, consultations with an ENT specialist, dentist, nephrologist, cardiologist, etc. are necessary.
- It is extremely important to excludecontact of a child with infectious patients, because, again, the defeat of the body by pathogenic microorganisms or viruses can give impetus to the development of arthritis.
- Also, doctors recommend preventing excessive hypothermia and overheating of the body.
Following these rules, you can reduce the likelihood of developing a disease or relapse.
