Juvenile rheumatoid arthritis: clinical picture and course options. Biological therapy

Juvenile arthritis (JA) is arthritis of unknown cause, lasting more than 6 weeks, developing in children under 16 years of age. When making a diagnosis, it is necessary to exclude other joint pathologies (see table “Differential diagnosis of juvenile arthritis” on pp. 60-61).

JA is one of the most common and most disabling rheumatic diseases found in children. The incidence of JA ranges from 2 to 16 per 100 thousand children under the age of 16 years. The prevalence of JA in different countries ranges from 0.05 to 0.6%. The prevalence of JA in children under 18 years of age in the Russian Federation reaches 62.3, the primary incidence is 16.2 per 100 thousand, including in adolescents the corresponding figures are 116.4 and 28.3, and in children under 14 years of age - 45 .8 and 12.6. Girls are more often affected by rheumatoid arthritis (RA). Mortality rate is within 0.5-1%.

Classification

In the International Classification of Diseases, X Revision (ICD-10), juvenile arthritis is included in category M08:

M08.0 —
M08.2 —
M08.3 —
M08.4 - pauciarticular youthful (juvenile) arthritis;
M08.8 - other juvenile arthritis;
M08.9 - unspecified juvenile arthritis.

There are three more classifications of the disease: the American College of Rheumatology (AKP) classification of juvenile rheumatoid arthritis (JRA), the European League Against Rheumatism classification of JIA (juvenile chronic arthritis), and the International League of Rheumatological Associations classification of JIA (juvenile idiopathic arthritis) (Table 1). Comparative characteristics of all classification criteria are presented in table. 2.

Treatment

1. Non-drug treatment

Mode

During periods of exacerbation of the disease, the child’s motor activity should be limited. Complete immobilization of joints with the application of splints is contraindicated; this contributes to the development of contractures, atrophy of muscle tissue, aggravation of osteoporosis, and rapid development of ankylosis. Physical exercise helps maintain the functional activity of joints. Cycling, swimming, walking are useful. Running, jumping, active games are undesirable. It is recommended to maintain a straight posture when walking and sitting, and sleep on a hard mattress and a thin pillow. Limit psycho-emotional stress, exposure to the sun.

Diet

Eating foods high in calcium and vitamin D to prevent osteoporosis. In patients with Cushing's syndrome, it is advisable to limit the consumption of carbohydrates and fats; a protein diet is preferable.

Therapeutic exercise (physical therapy)

An essential component of treatment for JA. Daily exercises are necessary to increase the range of motion in the joints, eliminate flexion contractures, and restore muscle mass. If the hip joints are affected, traction procedures on the affected limb after preliminary consultation with an orthopedist, walking on crutches. During the period of development of coxitis and aseptic necrosis of the hip joints, the patient’s movement without crutches is contraindicated. Physical therapy should be carried out in accordance with the individual capabilities of the patient.

Orthopedic correction

Static orthoses such as splints, splints, insoles and dynamic cuts in the form of lightweight removable devices. Static orthoses require intermittent immobilization - they should be worn or put on during free time and must be removed during the day to stimulate the muscular system during exercise, classes, occupational therapy, and the toilet. For severe osteoporosis in the thoracic and lumbar spine - wearing a corset or reclining system; with damage to the joints of the cervical spine - the head holder (soft, hard).

2. Drug treatment

Several groups of drugs are used to treat JA: non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs), immunosuppressants and biological agents obtained by genetic engineering. The use of NSAIDs and GCs helps to quickly reduce pain and inflammation in the joints, improve function, but does not prevent the progression of joint destruction and disability of patients. Immunosuppressive and biological therapy stops the development of destruction and disability of patients.

Glucocorticoids

Pulse therapy

Pulse therapy with GC is carried out in case of the development of severe systemic manifestations of JA (carditis, pneumonitis, polyserositis, hemophagocytic syndrome).

Advantages:

rapid (within 24 hours) suppression of the activity of the inflammatory process and relief of symptoms of the disease;
rapid elimination of the drug, short-term suppression of the adrenal glands, restoration of their function after 4 weeks.

Administration scheme:

the dose of methylprednisolone is 10-20 mg/kg per administration (not higher than 500 mg);
methylprednisolone is dissolved in 200 ml of 5% glucose solution or 0.9% sodium chloride solution;
duration of administration 30-40 minutes;
the drug is administered once a day in the morning;
GC pulse therapy is carried out for 3-5 consecutive days.

When using GC pulse therapy, adverse events may develop.

Transfusion adverse events:

increased blood pressure (BP);
hyperglycemia;
facial redness;
headache, dizziness;
change in taste;
heartbeat;
euphoria.

Long-term unjustified use of intravenous GCs causes the development of severe adverse events:

persistent increase in blood pressure;
severe steroid osteoporosis. It is most pronounced in the thoracic and lumbar spine. It manifests itself as a decrease in the height of the vertebral bodies, compression fractures. Accompanied by symptoms of compression of the spinal cord roots;
steroid myopathy;
posterior capsular cataract;
skin changes (hypertrichosis, purulent skin infection, stretch marks, skin trauma, rough scars, impaired wound healing, steroid acne on the face and torso).

HA for oral administration

GCs have a rapid anti-inflammatory effect in most patients. High doses of prednisolone (more than 0.6 mg/kg/day) stop acute inflammatory changes in the joints and control the activity of systemic manifestations. However, reducing the dose of prednisolone and its withdrawal, as a rule, lead to an exacerbation of the disease. And re-prescribing prednisolone at the original dose is no longer effective enough for most patients.

In connection with the above, the indication for prescribing oral GC is only the ineffectiveness of intravenous administration of GC, immunosuppressive and biological drugs, in combination or without intravenous administration of GC.

If GC is prescribed orally, the dose of prednisolone should not exceed 0.2-0.5 mg/kg per day, the daily dose is 15 mg.

The maximum dose of GC should be taken no more than a month after achieving remission. Subsequently, the dose of GC is gradually reduced to a maintenance regimen, followed by its abolition. Prednisolone must be prescribed with an adequate dose of methotrexate and/or cyclosporine (see “Treatment of juvenile arthritis with systemic onset”). The reduction in the dose of prednisolone should be slow; a maintenance dose (0.1 mg/kg body weight) should be taken for at least one year.

Tactics for reducing the dose of oral GCs.

The rate of reduction in the dose of GC should depend on its initial daily dose:

up to 15 mg - reduce by 1.25 mg 1 time every 3-4 days;
from 15 to 10 mg - reduce by 1.25 mg once every 5-7 days;
from 10 mg to 5 mg - alternating decrease. On even days the child takes prednisolone at the original dose, on odd days - 1/8 tablet less. This regimen is maintained for 7-10 days. In the absence of withdrawal syndrome, 1/8 tablet can be discontinued. Over the next 7-10 days, the child takes a constant (after stopping 1/8 tablet) dose of prednisolone;
from 5 mg until complete withdrawal - alternating reduction. On even days the child takes prednisolone at the original dose, on odd days - 1/8 tablet less. This regimen is maintained for 14 days. In the absence of withdrawal syndrome, 1/8 tablet can be discontinued. Over the next 4 weeks, the child takes a constant dose of prednisolone.

Dose reduction and discontinuation of prednisolone are usually accompanied by the development of withdrawal syndrome, especially in patients who have been receiving it for a long time. Withdrawal syndrome is manifested by myalgia, arthralgia, muscle tremors, fever, nausea, vomiting, depression.

For the purpose of replacement therapy for withdrawal syndrome, intravenous administration of methylprednisolone at a dose of 5 mg/kg can be used.

Discontinuation of prednisolone for 2-4 months, prescribed at a dose of 1.0 mg/kg or higher, is contraindicated in patients with systemic onset of JA after achieving a therapeutic effect. The dose of GC can begin to be slowly reduced only against the background of elimination of systemic manifestations and a clinically significant effect of immunosuppressant therapy for at least one month.

Long-term use of GC, even in low doses, causes the development of serious, often reversible, and in some cases irreversible consequences. The longer patients take GC, the more severe their side effects.

Adverse events:

short stature. It is not recommended to prescribe GC to children under 5 years of age (especially under 3 years of age), as well as to prepubertal age. The administration of GC can lead to a complete cessation of growth and suppression of the pubertal growth spurt. Children with polyarticular JRA are more likely to develop short stature;
delayed sexual development;
arterial hypertension (isolated increase in systolic blood pressure (BP) or increase in systolic and diastolic blood pressure);
steroid osteoporosis. Develops in all patients treated with prednisolone for a long time. The most rapid loss of bone mass during GC treatment develops during the first 6-12 months from the start of treatment. Therefore, prevention of GC-induced osteoporosis should begin as early as possible. It is most pronounced in the thoracic and lumbar spine. It manifests itself as a decrease in the height of the vertebral bodies, compression fractures. Accompanied by symptoms of compression of the spinal cord roots;

obesity. Has characteristic features - a moon-shaped face, fat deposition on the neck, chest, abdomen, steroid “hump”, atrophy of the muscles of the arms and legs;
disproportionate physical development;
erosive and ulcerative processes in the upper gastrointestinal tract;
steroid myopathy;
posterior capsular cataract;
skin changes (hypertrichosis, purulent skin infection, stretch marks, skin trauma, rough scars, worsening wound healing, steroid acne on the face and torso);
development of hormone resistance:
- continuous relapses of the disease during treatment with maintenance doses of GC;
development of hormone dependence:
- exacerbation of the disease against the background of GC withdrawal;
withdrawal syndrome.

Intra-articular injection of HA

Local GC therapy quickly relieves acute inflammatory changes in joints and preserves their functional activity. For intra-articular injections, long-acting GCs are used: methylprednisolone, betamethasone, triamcinolone. In patients with oligoarthritis, intra-articular injections of HA prevent disproportionate growth of the lower extremities.

Excessive “passion” for local therapy is unacceptable. The administration of HA is carried out no more than once every 3-6 months in the same joint. The peculiarities of local GC therapy are that the initial duration of the effect ranges from several weeks to several months. However, in the future, the duration of improvement with repeated administration of drugs without immunosuppressive therapy is reduced, and the patient requires more frequent intra-articular punctures, which leads to the development of traditional adverse effects of GC therapy, including Cushing's syndrome and severe hormone dependence, especially with the introduction of long-acting betamethasone. Doses and indications for use are presented in table. 3 and 4.

Contraindications to local GC therapy:

local or systemic infection;
severe bone destruction;
severe periarticular osteoporosis;
difficult access to the joint;
blood clotting pathology;
ineffectiveness of previous intravenous therapy.

After administration, rest of the joints is required for at least 48-72 hours.

Side effects of intra-articular HA injections:

“steroid arthropathy” and osteonecrosis;
iatrogenic infection and hemarthrosis;
tissue atrophy, lipodystrophy, fat necrosis, calcification;
tendon ruptures;
damage to nerve trunks;
“post-injection” exacerbation;
erythema, feeling of heat.

In this regard, you can refrain from intra-articular administration of HA. If an adequate dose of an immunosuppressant and/or biological agent is prescribed, the activity of the joint syndrome usually decreases after 2-4 weeks of treatment, and it completely stops after 6-12 weeks of therapy. If there is pain and stiffness during this period, it is advisable to prescribe NSAIDs, as well as topical ointments and gels containing NSAIDs.

Nonsteroidal anti-inflammatory drugs

The most effective drug with the best tolerability should be selected. When using NSAIDs in rheumatology, one must remember that the development of the anti-inflammatory effect lags behind the analgesic effect. Pain relief occurs within the first hours after administration, while the anti-inflammatory effect develops only after 10-14 days of constant, regular use of NSAIDs.

Treatment should begin with the lowest dose; if well tolerated, the dose can be increased after 2-3 days. In recent years, there has been a tendency to increase single and daily doses of drugs that are well tolerated, while limiting the maximum doses of acetylsalicylic acid, indomethacin, and piroxicam.

For long-term treatment, NSAIDs are taken after meals (in rheumatology). For a quick analgesic and antipyretic effect, NSAIDs are prescribed 30 minutes before meals or 2 hours after meals, washed down with 1/2-1 glass of water. After taking NSAIDs, it is advisable not to lie down for 15 minutes in order to prevent esophagitis. The timing of drug administration may also depend on the time of maximum symptoms, taking into account the chronopharmacology of the drugs. This allows you to achieve the greatest effect with a lower daily dose. For morning stiffness, it is advisable to take rapidly absorbed NSAIDs as early as possible or prescribe long-acting drugs at night.

The most commonly used is Diclofenac sodium at a dose of 2-3 mg/kg body weight per day. In case of severe systemic manifestations, one should refrain from prescribing NSAIDs, as they can provoke the development of macrophage activation syndrome. The dosage regimen for various NSAIDs is presented in table. 5.

The most typical adverse events that occur while taking NSAIDs:

NSAID gastropathy - indigestion, gastroesophageal reflux, erosion of the upper gastrointestinal tract, gastritis, erosive and ulcerative lesions of the stomach and duodenum, small and large intestines, hemorrhage, bleeding, perforation of stomach and intestinal ulcers;
liver damage - increased activity of transaminases and other enzymes. In severe cases, jaundice and hepatitis may develop;
kidney damage: interstitial nephritis - “analgesic nephropathy”. Fluid retention in the body, swelling, increased blood pressure;
from the central nervous system: headache, dizziness;
from the hematopoietic system - the development of aplastic anemia and agranulocytosis;
on the part of the coagulation system - inhibition of platelet aggregation and a moderate anticoagulant effect, bleeding may develop, most often from the gastrointestinal tract;
hypersensitivity reactions - the appearance of a rash, Quincke's edema, signs of bronchospasm, the development of anaphylactic shock, Lyell's and Stevens-Johnson syndrome.

Immunosuppressive therapy

Immunosuppressive therapy should be differentiated, long-term and continuous, starting immediately after verification of the diagnosis during the first 3-6 months of the disease. The withdrawal of immunosuppressants in most patients causes an exacerbation of the disease.

Methotrexate- a drug from the group of antimetabolites, similar in structure to folic acid, has a dose-dependent immunosuppressive and anti-inflammatory effect. Methotrexate has a cytotoxic effect in doses above 100 mg/m2/week. In rheumatology, methotrexate is used in doses below 50 mg/m2/week and has a weak immunosuppressive and more pronounced anti-inflammatory effect. Methotrexate reduces disease activity, laboratory activity indicators, and induces seroconversion in the Russian Federation.

Indications:

youthful (juvenile) rheumatoid arthritis (RF+ and RF-);
youthful (juvenile) arthritis with systemic onset;
youthful (juvenile) polyarthritis (seronegative);
pauciarticular juvenile (juvenile) arthritis.

Treatment regimen:

Methotrexate is most often prescribed once a week (orally or parenterally). This is due to the fact that more frequent use of the drug is usually associated with the development of acute and chronic toxic reactions. Due to the possible intolerance of simultaneous administration of methotrexate in large doses, it can be prescribed in divided doses, at 12-hour intervals, in the morning and evening or 2 times a week.
In most patients with the systemic variant of JA, methotrexate in doses of 10-15 mg/m2/week does not significantly affect the activity of systemic manifestations of the disease. For JA with systemic onset, methotrexate is used in doses of 20-25 mg/m2/week, and if ineffective, in the form of pulse therapy in a dose of 50 mg/m2 once a week intravenously for 8 consecutive weeks; when the effect is achieved from the 9th week, methotrexate is administered at a dose of 20-25 mg/m2/week subcutaneously or intramuscularly. For parenteral administration, the contents of the ampoule are dissolved in 400 ml of isotonic sodium chloride solution. The infusion is carried out over 3-4 hours.
For polyarthritis, methotrexate is used in doses of 15-25 mg/m2/week, for oligoarthritis - 10-15 mg/m2/week.
The effect is assessed after 4-12 weeks. At these doses, methotrexate does not have a pronounced immunosuppressive effect and stops the destruction of joints in the event of a decrease in laboratory activity indicators. To reduce the side effects of the drug, you should take folic acid 1-5 mg/day on days free from taking methotrexate.

Adverse events:

headache, blurred vision, drowsiness, aphasia;
paresis, convulsions;
interstitial pneumonitis;
gingivitis, pharyngitis, ulcerative stomatitis;
anorexia, nausea, vomiting, diarrhea, melena;
ulceration of the gastrointestinal mucosa, gastrointestinal bleeding;
liver damage;
acute renal failure, azotemia, cystitis;
anemia, leukopenia, thrombocytopenia;
addition of a secondary (bacterial, viral, fungal, protozoal) infection;
dysmenorrhea, oligospermia;
alopecia, ecchymosis, acne, furunculosis.

To relieve adverse events during intravenous administration of methotrexate, it is advisable to premedicate with one of the following drugs:

Metoclopramide orally, intravenously or intramuscularly. Adults are prescribed 10 mg 3-4 times a day. The maximum single dose is 20 mg, the daily dose is 60 mg. For children from 2 to 14 years of age, a single dose is 0.1 mg/kg body weight, the highest daily dose is 0.5 mg/kg. The frequency of administration is 1-3 times a day.
Tropisetron orally or intravenously at a dose of 5 mg for adults, for children over 2 years of age - at a daily dose of 0.2 mg/kg, the maximum daily dose is up to 5 mg.

Cyclosporine

Cyclosporine not only causes symptomatic improvement, but also has a basic antirheumatic effect. Cyclosporine therapy causes a decrease in indicators of disease activity, severity of pain and synovitis, duration of morning stiffness, and improvement in the functional ability of joints. Cyclosporine inhibits the progression of the destructive process in the cartilage and bone tissue of joints and stimulates reparative processes. Cyclosporine improves functional status and minimizes disability in systemic JA. Reduces the rate of increase in structural changes in joints, regardless of the dynamics of laboratory activity indicators. Relieves acute coxitis, stimulates the repair of cartilage and bone in aseptic necrosis of the femoral heads. Cyclosporine is the drug of choice for the treatment of macrophage activation syndrome in systemic JA. Effective for the treatment of uveitis.

Indications:

youthful (juvenile) arthritis with systemic onset;
rheumatoid uveitis;
hemophagocytic syndrome in JA.

Treatment regimen:

The choice of the initial dose, as well as correction of the dosage regimen during treatment, is carried out taking into account clinical and laboratory parameters.
The daily oral dose is 3.5-5 mg/kg. The initial dose is 3.5 mg/kg/day. It is divided into two doses (1.5 mg/kg per day every 12 hours). If the number of capsules is not divided by two, then a larger dose is taken in the evening. It should not exceed the morning dose by more than 25 mg.
For the first 4 weeks, cyclosporine therapy is carried out at a dose of 3.5 mg/kg/day; if there is no effect during the first month of treatment, the dose of the drug is increased by 25 mg. The time period between dose increases should be at least 2 weeks.
The dose increase is carried out under the control of peripheral blood parameters (number of red blood cells, platelets, leukocytes) and biochemical parameters (concentration of creatinine, urea, bilirubin, potassium, transaminases in the blood serum).
The daily dose should not exceed 5 mg/kg/day.
In patients with necrosis of the femoral head or the threat of its development, as well as with the development of hemophagocytic syndrome, the dose of cyclosporine can be increased within the first 2-4 weeks of therapy. Safety indicators in this case should be monitored once every 7-10 days.
The effect develops after 1-3 months and reaches its maximum within 6-12 months.

Adverse events:

a feeling of heaviness in the epigastric region, loss of appetite, nausea (especially at the beginning of treatment), vomiting, diarrhea;
pancreatitis;
swelling of the gums;
liver dysfunction;
headache, paresthesia, convulsions;
increased blood pressure;
impaired renal function - so-called nephrotoxicity, leading to an increase in the concentration of creatinine and urea in the blood;
increased concentrations of potassium and uric acid in the body;
excessive hair growth;
reversible dysmenorrhea and amenorrhea;
slight anemia;
rarely - muscle spasms, muscle weakness, myopathy, thrombocytopenia.

Cytotoxic agents: cyclophosphamide, chlorambucil, azathioprine are used for the treatment of JA quite rarely due to low efficiency and a high incidence of severe side effects (leukopenia, infections, infertility, neoplastic processes).

Leflunomide

Leflunomide is effective in the treatment of RA in adults. Leflunomide reduces the inflammatory activity of the disease, has a pronounced analgesic effect, reduces the severity of articular syndrome, reduces ESR, circulating immune complexes, RF titers, and stops the progression of osteochondral destruction. The functional ability and quality of life of patients is significantly improved. Leflunomide is effective in both early and late stages of RA. It slows down the progression of joint destruction. The drug is not registered for JRA indications. However, the effectiveness and safety of the drug in children was studied in a double-blind, placebo-controlled study. Given its reliable efficacy and low toxicity, leflunomide can be prescribed if methotrexate is ineffective under the supervision of experienced rheumatologists.

Indications:

youthful (juvenile) rheumatoid arthritis (RF+ and RF-);
youthful (juvenile) polyarthritis (seronegative);
pauciarticular juvenile (juvenile) arthritis, torpid to classical immunosuppressants and biological agents.

Treatment regimen:

Doses. For body weight above 30 kg: 100 mg once a day for the first 3 days, then 0.6 mg/kg once a day. In children weighing less than 30 kg, the initial dose is 50 mg/day for 3 days, then 0.6 mg/kg/day.
It is possible to use leflunomide in combination with methotrexate at a dose of 5-7.5 mg/m2/week if leflunomide is insufficiently effective.

Adverse events:

increased blood pressure;
diarrhea, nausea, vomiting, anorexia;
diseases of the oral mucosa (aphthous stomatitis, lip ulcerations);
abdominal pain;
liver dysfunction (increased levels of transaminases, alkaline phosphatase, bilirubin);
slight loss of body weight;
headache, dizziness, asthenia, paresthesia;
tenosynovitis;
increased hair loss, eczema, dry skin;
leukopenia;
rash, itching, allergic reactions, urticaria;
hypokalemia;
taste disturbance;
anxiety;
ligament rupture;
Stevens-Johnson syndrome;
toxic epidermal necrolysis, erythema multiforme;
anemia, thrombocytopenia, pancytopenia, agranulocytosis, eosinophilia.

E. I. Alekseeva,Doctor of Medical Sciences, Professor
T. M. Bzarova

NCCD, Moscow

www.lvrach.ru

Factors provoking the development of seronegative polyarthritis

This disease belongs to the autoimmune group, which means that the immune system does not function properly, when the body’s own antibodies are perceived as foreign.

This reaction can be caused by several reasons, among which the first place is a genetic predisposition to arthritis of various types.

The second place is occupied by a negative environmental environment and disruptions in the functioning of the endocrine glands, and the third place belongs to stressful situations, general hypothermia of the body and allergic reactions. In addition, the likelihood that seronegative polyarthritis will progress increases sharply in patients over 40 years of age.

Features of the clinical course

Characteristic signs of the disease include:

inflammation is accompanied by asymmetric damage to the articular joints. As a rule, at the initial stage of arthritis development, large joints (knees and elbows) are involved in the pathological process, and as the disease progresses, small joints (hands, feet) are involved;
this polyarthritis differs from other forms in the absence of morning stiffness of movements, and upon deeper examination of the patient, severe deformation of the joints and rheumatoid nodes characteristic of all arthritis are not observed;
in rare cases, diagnostics reveals visceritis and vasculitis. With a complicated course of the disease, disturbances in the functioning of the renal system are possible.

However, it should be noted that polyarthritis of a rheumatoid nature is much easier than other forms. If therapy is started in a timely manner, the prognosis for recovery is favorable.

Development of juvenile seronegative polyarthritis

A separate group includes seronegative juvenile arthritis, which affects children from 1 to 15 years of age, most often girls. The disease occurs acutely, most often with a sharp increase in body temperature, painful swelling in the joints and general intoxication of the body.

Primarily, juvenile arthritis symmetrically affects the ankle, elbow, hip and knee joints. The child experiences pain when moving. Subsequently, muscle atrophy, contractures, and lymphadenitis are noted.

Seronegative polyarthritis in childhood is treated in a hospital setting with bed rest and drug therapy. For acute symptoms, juvenile arthritis involves taking antihistamines (Loratadine, Erius, etc.), as well as NSAIDs (Ibuprofen, Butadione, etc.) with simultaneous physiotherapy and vitamin therapy. Surgery is performed only if absolutely necessary.

During remission, the child is recommended to undergo a rehabilitation course at sanatorium-resort treatment, gymnastics and massage. It is important to consider that in order to prevent juvenile arthritis from developing, it is necessary to receive all vaccinations in accordance with age and the vaccination schedule.

lechuspinu.ru

Treatment approaches

Treatment of rheumatoid polyarthritis is a rather labor-intensive task that requires a competent approach from the doctor using modern therapeutic methods and an individual approach to patients.

Currently, three main types of treatment for this disease have been developed:

Use of pharmacological drugs;
Non-drug treatment;
Rehabilitation.

Since rheumatoid polyarthritis is an autoimmune disease, its progression can only be stopped by influencing two levels of pathogenesis:

Suppress immune activity.
Block the release and synthesis of inflammatory mediators.

How to treat rheumatoid polyarthritis? Suppression of immune activity is the doctor’s first priority when managing such patients. Controlled immunosuppression is a very complex task that requires more effort compared to the second level. The first level involves the use of basic anti-inflammatory drugs and glucocorticosteroids. To reduce the production of inflammatory mediators, non-steroidal anti-inflammatory drugs are prescribed. The group of drug treatment of the disease includes the following groups of drugs:

Immunosuppressive drugs are used to reduce activity and reduce clinical manifestations of the pathological process. The severity of the effect of use varies from insignificant to persistent remission for several years. In addition, a successful course of treatment will be characterized by inhibition of the destruction of the affected joints. Drugs from this group are able to suppress the proliferation activity of immune cells, as well as delay the development of the erosive process.
At the same time, application non-steroidal anti-inflammatory drugs is characterized by a rapid decrease in the intensity of pain and improvement in joint mobility, and the effect is felt already in the second hour after administration. It must be said that despite the subjective improvement in the patient’s condition, the activity of rheumatoid polyarthritis will not decrease. Drugs from this group do not affect the main factor of pathogenesis (autoimmune process), therefore inhibition of joint destruction is not observed when used.
Glucocorticosteroid drugs are able to influence both the suppression of immune activity and the reduction of the synthesis of inflammatory mediators. Clinical studies have provided evidence of a reduction in the severity of joint destruction and an improvement in the well-being of patients with long-term use of these drugs in small dosages. The effect of administration can be felt just a few hours after intravenous or intramuscular administration. At the same time, monotherapy with glucocorticosteroids without the use of cytostatics and NSAIDs does not have a sufficient level of effectiveness, as a result of which combined use is recommended.

The non-drug treatment group includes physiotherapy, diet, and therapeutic exercises. Also, recommendations for the management of patients indicate the benefits of acupuncture, but the results of modern clinical studies cast doubt on the effectiveness of this technique. Non-drug treatment can improve the general well-being of patients, but it cannot reduce the severity of symptoms and influence the pathogenesis of the disease.

Orthopedic treatment includes prosthetics, orthotics and surgical correction of deformed joints. This also includes rehabilitation treatment, which includes physical exercises that improve blood supply to the affected joints. Its main goal is to maintain the functional activity of patients and improve the quality of life.

Important! Where to get treatment? A rheumatologist treats systemic diseases. If you suspect rheumatoid polyarthritis, you should consult a rheumatologist at the clinic. Once the diagnosis is confirmed, treatment takes place at a rheumatology hospital. As the condition progresses, consultation with a traumatologist and physiotherapist may be required.

Spa treatment and discounted medications

Any citizen who has any disability group and has not lost the right to receive social services in terms of drug coverage can take advantage of the right to receive preferential medications. This right is protected by Federal Law No. 178 “On State Assistance” of 1999.

If the patient does not have a disability group, then by order of the Ministry of Health and Social Development of Russia dated 2006 No. 655, a list of pharmacological drugs has been developed for a certain group of people, which allows them to demand vital medications for themselves and their loved ones. This group includes people suffering from socially significant pathologies. Patients with rheumatoid arthritis will be pleased to know that their disease is included in this list, and they can demand assistance from the state in purchasing medications. The list of preferential drugs includes methotrexate, glucocorticoids and other drugs from the basic therapy of rheumatoid polyarthritis. Unfortunately, bicillin, so beloved by our rheumatologists because of its ability to prevent the development of exacerbations, is not included in this list. In most regions, financial costs are borne by the regional budget.

The prescription of pharmacological drugs to persons entitled to receive free drugs is carried out by a medical professional. The purpose of a particular pharmacological agent depends on the characteristics of the disease, its severity and course.

Important! If for any reason a patient is denied access to free medications, then the complaint should be addressed to the deputy chief physician responsible for the distribution of preferential medications or directly to the head physician of the medical institution at the place of residence.

List of preferential medications that can be prescribed to patients with rheumatoid polyarthritis:

Prednisolone	eye drops; ointment for external use; pills
Methylprednisolone	pills
Hydrocortisone	eye ointment; ointment for external use; pills
Dexamethasone	eye drops; pills
Methotrexate	pills; concentrate for the preparation of solution for injection; injection solution in graduated syringes
Leflunomide	film-coated tablets
Sulfasalazine	pills
Infliximab	lyophilized powder for the preparation of solution for intravenous administration
Rituximab	concentrate for solution for infusion
Abatacept	lyophilisate for solution for infusion

Also, citizens included in the preferential category can apply for treatment in a sanatorium at the expense of the state. The duration of sanatorium-resort treatment for adults is 18 days, and for children 21 days. In institutions specializing in the treatment and rehabilitation of such patients, a menu should be drawn up that limits the consumption of the following products:

Grilled meat;
Spinach;
Sausage;
Beans, beans;
Sorrel.

It is recommended to follow a diet that includes different types of fish, vegetables, fruits and fresh juices. The sanatorium must also have a physical therapy instructor (PT). Physical exercises can relieve pain and improve the overall well-being of patients.

Some forums also advise doing therapeutic fasting, visiting Dr. Bubnovsky’s clinic, or taking ASD 2, but the effectiveness of these treatment methods is extremely doubtful and requires verification.

Details of preferential sanatorium-resort treatment must be obtained from the attending doctor of the medical organization where the patient is being observed.

Specifics of the condition

Since rheumatoid arthritis is a systemic disease, it has many manifestations. These may include general weakness, fever, inflammation of the salivary glands, increased sweating, muscle atrophy and eye damage. Despite the variety of symptoms, the main clinical manifestation that worries most patients is joint damage.

In the first stage of the disease, small joints of the hands and feet are affected. It all starts with the metacarpophalangeal and wrist joints. Rheumatoid polyarthritis is characterized by a symmetrical lesion, which distinguishes it from other rheumatological diseases, for example, Reiter's syndrome. This disease is also characterized by the appearance of “starting” pain, which gradually fades after active movements in the joint. As erosion of the interarticular cartilage progresses, pain will persist even after physical activity.

A typical symptom of rheumatoid polyarthritis is the appearance of pain in the joints in the morning, which makes it extremely difficult to perform daily manipulations (brushing teeth, tying shoelaces, combing, preparing breakfast). During the day the patient “disperses”, in the evening the pain begins to fade, and in the morning everything returns again. At the peak of the inflammatory process, redness of the skin over the area of the affected joint will appear, as well as slight swelling and an increase in temperature compared to other areas of the body.

If the disease is not treated, the pathological process spreads to larger joints (knees, elbows, shoulders). The disease most rarely affects the spine and hip joints. Treatment of all joints at the same time is carried out with regular use of basic medications.

Classification

It is customary to classify the stage of severity of rheumatoid polyarthritis based on the X-ray picture:

First stage characterized by an increase in the density and thickness of the soft tissues around the finger joints. Periarticular osteoporosis is also noted, manifested in the form of increased radiological transparency of bone tissue. Narrowing of the joint space indicates the activity of the disease and the imminent transition to the next stage. A typical manifestation of rheumatoid polyarthritis at this stage is mild or complete absence of symptoms. The first stage can last for years and does not bother the patient at all. In addition, it should be noted that the changes described above are not specific and may appear in other rheumatological diseases.
At the second stage The bone is more involved in the pathological process. Radiologically, one can note cyst-like areas of clearing in the area of the epiphyses of the metacarpal and phalangeal bones, an increase in the narrowing of the joint space, unexpressed marginal deformation of the bones and the appearance of erosions in the joints. This stage is divided into two stages - erosive and non-erosive. The first erosive changes are recorded in the metacarpophalangeal joints of the index and middle fingers, the wrist and metatarsophalangeal joints of the 5th finger. This stage is characterized by the absence of subluxations. Significant deformation and ankylosis of the joints do not develop.
At the third stage X-ray signs recorded at the previous stage will increase. Severe destruction is observed in most joints of the hands and feet. At this stage, significant deformation is noted, as well as dislocations and subluxations of some joints.
Fourth stage has the same symptoms as the third, but with the addition of ankylosis of the joints. Ankylosis is a pathological condition in which fusion of the articular ends occurs, causing the joint to become immobile for both passive and active movements. Severe deformation, reduction in size or destruction of the bone tissue of the hands is also added.

Seronegative type

Analysis of the level of rheumatoid factor is of great diagnostic value in the diagnosis of rheumatoid polyarthritis. Based on this analysis, two forms of the disease were identified - seronegative and seropositive. In the first case, the rheumatoid factor will be increased, but in the second - not.

Rheumatoid factor is a specific immunoglobulin produced by the body against itself. As a rule, in the presence of RF, the symptoms of the disease are more pronounced with massive destruction of the joints.

Regardless of the form of polyarthritis, the outcome of the disease depends on a number of factors, including the activity of the pathological process and the effectiveness of the prescribed treatment. Timely prescribed basic drug therapy can improve the prognosis for the patient and reduce the likelihood of severe joint disorders.

Still's disease should also be highlighted. This disease is a juvenile form of seronegative rheumatoid arthritis, characterized by chronic polyarthritis and systemic inflammation. The peculiarity of Still's disease lies in the clinical signs in which the symptoms of polyarthritis fade into the background, giving way to systemic inflammatory processes. There is no specific arthropathy in juvenile arthritis, so destruction of the same joints will occur as in the normal form of the disease. Still's disease is also characterized by eye complications:

Cataract;
Iridocyclitis;
Corneal degeneration.

In conclusion, I would like to say that despite the unfavorable prognosis and the high likelihood of developing disability, rheumatoid polyarthritis can and should be fought. Treatment is lifelong and includes a number of expensive drugs, but most patients are entitled to assistance from the state. In addition, it should be mentioned that thanks to radiography, it is possible to monitor the progression of the disease, so patients are recommended to undergo regular X-ray examinations. Rheumatoid polyarthritis can develop at almost any age, so if you notice similar symptoms in yourself or your loved ones, you should consult a doctor.

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Based on the number of affected joints, they are classified into:

monoarthritis, if one joint is affected;
oligoarthritis (pauciarticular arthritis), if no more than four joints are affected;
polyarthritis (generalized arthritis), if more than four joints are affected;
systemic rheumatoid arthritis, which affects not only the joints, but also other organs and tissues.

Oligoarthritis can be of two types - first and second. 80% of children suffering from type 1 oligoarthritis are girls. The disease begins at a young age, usually affecting the ankle, knee and elbow joints. The disease is accompanied by chronic iridocyclitis. Rheumatoid factor (autoantibodies to immunoglobulin G) is absent. In 10% of cases, children have vision problems for the rest of their lives, and in 20% of cases - with joints.

Oligoarthritis of the second type mainly affects boys. It develops later than type 1 oligoarthritis. In this case, large joints are affected, most often the hip. The disease is often accompanied by sacroiliitis (inflammation of the sacroiliac joint), in 10-20% of cases it is accompanied by acute iridocyclitis. Rheumatoid factor is absent. Often, children who have had type 2 oligoarthritis still have spondyloarthropathy (a disease of the joints and the places where tendons attach to the bones).

Polyarthritis is divided into rheumatoid factor positive and negative. It is mostly girls who suffer from both. Polyarthritis negative for rheumatoid factor can develop in children at any age, and it affects any joints. Rarely, the disease is accompanied by iridocyclitis (inflammation of the choroid of the anterior part of the eyeball). In 10-45% of cases, the outcome of the disease is severe arthritis.

Polyarthritis, positive for rheumatoid factor, usually develops in older childhood and affects any joints. Occasionally it is accompanied by sacroiliitis. In 50% of cases, children who have had this disease continue to have severe arthritis for the rest of their lives.

60% of children suffering from systemic rheumatoid arthritis are boys. The disease can develop in a child at any age. Any joints can be affected. Rheumatoid factor is absent. In 25% of cases, those who have been ill have severe arthritis for the rest of their lives.

According to the nature of the course, juvenile rheumatoid arthritis can be acute, subacute, chronic and chronic with exacerbations.

In most cases, juvenile rheumatoid arthritis begins acutely or subacutely. An acute onset is more typical for generalized articular and systemic forms of the disease with a relapsing course. With the more common articular form, mono-, oligo- or polyarthritis develops, often of a symmetrical nature, with predominant involvement of large joints of the extremities (knee, wrist, elbow, ankle, hip), sometimes small joints (2nd, 3rd metacarpal, phalangeal, proximal interphalangeal).

Swelling, deformation and local hyperthermia in the area of the affected joints, moderate pain at rest and during movement, morning stiffness (up to 1 hour or more), limited mobility, and changes in gait occur. Young children become irritable and may stop walking. There are cystic formations and hernial protrusions in the area of the affected joints (for example, a cyst of the popliteal fossa). Arthritis of the small joints of the hands leads to spindle-shaped deformities of the fingers. Juvenile rheumatoid arthritis often affects the cervical spine (pain and stiffness in the neck) and the TMJ (bird jaw). Damage to the hip joints usually develops in the later stages of the disease.

Low-grade fever, weakness, moderate splenomegaly and lymphadenopathy, weight loss, growth retardation, lengthening or shortening of the limbs may occur. The articular form of juvenile rheumatoid arthritis is often combined with rheumatoid eye damage (uveitis, iridocyclitis) and a sharp drop in visual acuity. Rheumatoid nodules are characteristic of the RF-positive polyarthritic form of the disease, which occurs in older children, has a more severe course, and has a risk of developing rheumatoid vasculitis and Sjögren's syndrome. RF-negative juvenile rheumatoid arthritis occurs at any childhood age and has a relatively mild course with rare formation of rheumatoid nodules.

The systemic form is characterized by pronounced extra-articular manifestations: persistent febrile fever of a hectic nature, polymorphic rash on the extremities and trunk, generalized lymphadenopathy, hepatolienal syndrome, myocarditis, pericarditis, pleurisy, glomerulonephritis. Joint damage may appear in the initial period of systemic juvenile rheumatoid arthritis or several months later, taking a chronic relapsing course. Still's syndrome is more often observed in preschool children; it is characterized by polyarthritis affecting small joints. Wissler-Fanconi syndrome usually occurs at school age and occurs with a predominance of polyarthritis of large, including hip joints without pronounced deformities.

Complications of juvenile rheumatoid arthritis are secondary amyloidosis of the kidneys, liver, myocardium, intestines, macrophage activation syndrome with a possible fatal outcome, cardiopulmonary failure, and growth retardation. Type I oligoarthritis is accompanied by chronic iridocyclitis with a risk of vision loss, type II oligoarthritis is accompanied by spondyloarthropathy. The progression of juvenile rheumatoid arthritis leads to persistent deformation of the joints with partial or complete limitation of their mobility and early disability.

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Seronegative polyarthritis: treatment methods

The main difference between seronegative polyarthritis and other groups of rheumatoid arthritis is negative rheumatoid tests. This greatly complicates the diagnosis and seronegative rheumatoid polyarthritis is easily confused with another disease (for example, arthrosis). The situation is complicated by the fact that seronegative polyarthritis is quite common and accounts for 20% of the total number of rheumatoid arthritis. In order to understand the causes and methods of treating this disease, it is necessary to have at least a minimal understanding of the common disease called rheumatoid arthritis.

What is rheumatoid arthritis?

The etiology of the disease is not completely clear. Basically, changes in the joints that are pathological in nature are caused by autoimmune damage to the connective tissue, but scientists have not yet figured out what processes in the body trigger immune reactions. In addition, risk factors include metabolic disorders, hypothermia and permanent residence in regions with a cold climate, stressful situations and overexertion, various injuries, and the presence of foci of chronic infectious diseases.

Often, predisposition factors to rheumatoid arthritis are activated during adolescence, when a restructuring of physiological functions occurs and at the time of puberty. A common occurrence is the diagnosis of the disease during menopause or the postpartum period. That is, the disease begins to actively manifest itself at the moment of a radical restructuring of physiological functions. Rheumatoid polyarthritis defines itself as seasonal spring-autumn exacerbations.

The most common symptom of rheumatoid arthritis is polyarthritis, i.e. multiple inflammatory processes of several joints at once. Polyarthritis can affect the hand, intervertebral, wrist, knee, foot and neck joints. As a rule, this is a bilateral and symmetrical lesion.

Diseased joints begin to react painfully to palpation, swelling appears, stiffness develops, and an increase in skin temperature is observed. If stiffness and stiffness of the joints manifests itself in the morning and lasts more than 1 hour, then this almost 100% indicates the emergence and development of processes associated with the disease rheumatoid arthritis.

Many patients with polyarthritis note a sharp loss of appetite, severe weight loss, weakness and fatigue.

Another negative factor of rheumatoid arthritis is the large number of extra-articular manifestations and the occurrence of various complications. The progressive development of the disease is often characterized by:

rheumatoid nodules;
muscle atrophy;
vasculitis, expressed in skin necrosis, gangrene of the fingers, etc.;
damage to the pulmonary (pleurisy, upper respiratory tract obstruction, pneumosclerosis) and cardiovascular system;
neurological disorders;
eye damage;
osteoporosis.

Key features of seronegative rheumatoid polyarthritis

As it became clear, seronegative polyarthritis is one of the forms of rheumatoid arthritis. Its main feature is the absence in the blood serum of rheumatoid factor, a group of autoantibodies that are an indicator of the occurrence of the disease.

There is another explanation for what rheumatoid factor is. This is an immunoglobulin, which, under the influence of viruses, bacteria or other internal factors, is perceived by our immune system as a foreign particle. The body begins to actively produce antibodies, which are detected in laboratories.

Rheumatoid factor takes part in the formation of subcutaneous rheumatoid nodes and some other extra-articular lesions. Apparently, this protein is not a necessary condition for rheumatoid arthritis, because it is not detected in 20% of patients who are diagnosed with seronegative rheumatoid arthritis.

Rheumatoid factor is of great importance in the diagnosis of the disease, but its absence gives more favorable prognoses in the treatment of the disease. With seronegative polyarthritis, stiffness in the morning is less pronounced or absent altogether. Deformation and dysfunction of the joints are not so obvious. There are no subcutaneous rheumatoid nodes, the disease is less often complicated by vasculitis and visceritis, but as it develops, kidney damage is characteristic.

Specifics of diagnosing seronegative rheumatoid arthritis

Seronegative polyarthritis manifests itself more acutely than seropositive polyarthritis. Fever often occurs with temperature fluctuations of 3-4°C, chills. There is a noticeable enlargement of lymph nodes, loss of body weight, muscle atrophy, and anemia. Unlike seropositive arthritis, which is characterized by symptoms of symmetrical polyarthritis, seronegative polyarthritis affects the joints in an asymmetrical manner. Initially, large joints begin to be involved in the disease, then the pathological process moves to the hands and feet. The wrists and wrist joints are most affected.

The main distinguishing feature of seronegative polyarthritis is that the Vaaler-Rose reaction does not detect rheumatoid factor. There is no significant increase in ESR and other indicators of the inflammatory process. Characterized by a higher level of IgA compared to sero-positive rheumatoid arthritis. The asymmetry of erosive lesions is detected using radiography. Using this study, it is possible to identify the discrepancy between severe lesions of the wrist joints and less pronounced changes in the small joints of the hand.

Features of the treatment of seronegative polyarthritis

Medicine has not yet found effective methods that can fully cure polyatritis. Modern treatment methods are aimed at pain relief, reducing inflammation, and improving the function of the affected joint. Basically, these goals are achieved through the use of anti-inflammatory drugs: immunosuppressants and cytostatic agents.

Non-steroidal anti-inflammatory drugs are used to treat patients during the acute inflammatory period (pain, joint swelling and fever). NSAIDs minimize inflammation and reduce pain. Side effects of NSAIDs include gastrointestinal disorders, heartburn, and swelling. In some cases, there are signs of kidney and liver damage.
The most commonly prescribed NSAIDs include: aspirin, diclofenac, ibuprofen, indomethacin, ketoprofen, movalis, meloxicam, etc.

Corticosteroid hormonal drugs (prednisolone, hydrocortisone and dexamethasone) are of primary importance in the treatment of rheumatoid arthritis. These are synthetic analogues of hormones produced by the adrenal glands. Corticosteroids can be prescribed as tablets, ointments, and injections. The high risk of side effects and their severity dictate the need to select a lower dose, which at the same time gives a greater effect. Bolus therapy is practiced (administration of an increased dose through a vein). Side effects associated with the use of corticosteroids include moon face, emotional instability, increased appetite, weight gain, stretch marks on the skin, increased hair growth, osteoporosis, high blood pressure and sugar. Side effects are reduced to zero when the dose is reduced or the drug is stopped.

Seronegative polyarthritis is more difficult to respond to basic therapy than seropositive polyarthritis. More often, a side effect such as secondary amyloidosis develops. It is necessary to take into account the higher risk of pronounced side effects when taking trovolol. Otherwise, the treatment of seronegative polyarthritis is similar to the treatment of the seropositive variant.

Self-medication for rheumatoid arthritis is strictly contraindicated. The correct group of drugs can only be prescribed by a highly specialized doctor (rheumatologist, or even better, an arthrologist). Surgery is used only for advanced stages of arthritis. Optimal treatment includes not only drug treatment, but also exercise therapy, a balanced diet, and maintaining a healthy lifestyle. Traditional medicine also alleviates the course of the disease, but should be used only in conjunction with traditional medicine methods.

Juvenile polyarthritis (seronegative)

Separately, I would like to mention seronegative juvenile polyarthritis. Most often the disease manifests itself at the age of 2-4 years. The inflammatory process is indicated by the occurrence of a feverish state, swelling and pain in the joints, and intoxication of the body. First, the disease affects the knee, elbow, ankle, and hip joints, then moves to the cervical spine, wrist, jaw, and joints.

The lesion is most often symmetrical. There is an accumulation of exudate in the joints. The child complains of pain when moving. Muscle atrophy, hypotonia, and contractures are noted. An x-ray shows the presence of increased new bone formation on the side of the periosteum with simultaneous resorption.

Within a few days, the lymph nodes, liver, and spleen become greatly enlarged. The diagnosis is based on the history and clinical picture. An electrocardiogram shows a tendency to tachycardia, myocardial dystrophy, a blood test shows anemia, increased ESR, leukocytosis.

Treatment for juvenile seronegative polyarthritis must be carried out inpatiently. Strict adherence to bed rest and the use of antibiotics in the acute period are indicated. NSAIDs (aspirin, butadione, amidopyrine) and antihistamines are mainly used. Glucocorticoid drugs are used in courses of 1-2 weeks, mainly prednisolone is prescribed. In schoolchildren with an acute course of the disease, indomethacin, brufen, delagil, chloroquine can be used. For juvenile polyarthritis (seronegative), in combination with basic therapy, effective measures are physiotherapeutic procedures, courses of vitamins, plasma transfusions, aloe. During remission, useful measures are sanatorium-resort treatment, therapeutic massage and gymnastics. After consultation with an orthopedist, surgical intervention is possible.

To prevent the disease, compliance with the schedule of necessary vaccinations is of great importance; to avoid the spread of streptococcal infection, proper child care is necessary.

Seronegative rheumatoid arthritis according to ICD10 belongs to inflammatory polyarthropathies (class M diseases), has code M06.0. The disease is associated with joint damage. The seronegative form means the absence of one of the main diagnostic criteria - rheumatoid factor - in the blood test results. The pathology is dangerous due to the development of complications that can lead to disability of the patient. This article will help you recognize the disease and learn about modern treatment methods.

Etiology of the disease

Seronegative arthritis is joint damage that leads to disruption of the immune system. Autoantibodies arise, proteins produced by the body, the action of which is directed “against itself.” This process is called rheumatoid factor. Based on the presence or absence of specific proteins in a blood test, doctors determine the form of the disease. A positive result indicates seropositive arthritis, a negative result (absence of rheumatoid factor) indicates seronegative arthritis.

The difference between seronegative and seropositive rheumatoid arthritis also lies in the severity of the disease. The first form is less susceptible to complications, the patient rarely exhibits extra-articular lesions, and symptoms are more easily tolerated than in the second form. With seropositive arthritis, the patient often experiences stiffness, crooked fingers, morning joint stiffness, and erosive changes.

Note!
The seronegative form has a favorable prognosis for treatment; it occurs spontaneously at the initial stage and is acute, which distinguishes it from the seropositive form, which develops gradually and manifests itself with vivid symptoms over time.

Seronegative arthritis most often occurs in the hip joint, its functionality is impaired at an early stage of development. According to statistics, ¼ of patients (20%) with arthritis suffer from a seronegative form. It leads to the following malfunctions in the body:

The patient's joint function is impaired;
Deformation of the hip joint occurs;
Contracture develops (narrowing, tightening);
There is tight mobility in the joints in the morning;
The appearance of extra-articular lesions;
The interphalangeal, metatarsophalangeal, and metacarpophalangeal joints are affected.

The disease has several stages:

At the initial (first) stage, doctors diagnose only periarticular osteoporosis (bone density decreases, and mineralization decreases over time);
Afterwards, in addition to osteoporosis, a narrowing of the connecting gap occurs;
At the third stage of development, bone erosion is added to the previous symptoms;
The fourth stage combines the characteristics of the first three and is manifested by the presence of ankylosis of the joints.

Scientists have been studying for many years what becomes the decisive factor in the occurrence of the disease. Today doctors talk about a combination of reasons leading to the development of rheumatoid factor. Among them:

Hypothermia;
Psycho-emotional disorders;
Disturbances in the functioning of the body's immune system;
Injuries;
Hereditary factor;
Infectious joint lesions;
Allergic reaction;
Viral diseases;
External unfavorable factors (smoking, polluted environment).

Symptoms, concomitant diseases

An experienced orthopedist can recognize seronegative arthritis by the patient’s external manifestations and complaints. Symptoms will depend on the severity of the disease.

The following symptoms indicate the disease:

Damage to the joints, manifested in changes in their shape and pain;
Increased fatigue;
Enlarged lymph nodes;
Weight loss;
According to the general blood test, an acceleration of ESR indicators and signs of anemia are observed;
Body temperature remains at 37.0-37.5 degrees;
Increased sweating;
Acute fever;
General weakness;
Inflammatory process in internal organs;
Absence of rheumatoid nodes;
Decreased appetite.

If diagnosed and treated untimely, the disease can develop into seronegative. This is an inflammatory process in the synovial membranes of the joint. It is characterized by the presence of joint stiffness in the morning, erosion and osteoporosis, and symmetrical arthritis in the joints.

Patients should be wary of the development of seronegative arthropathy, reactive secondary joint damage resulting from infection, endocrine diseases, and allergic reactions. It manifests itself as severe pain due to the inflammatory process and severe deformation.

A separate group includes juvenile seronegative polyarthritis, which occurs in children aged from one to 15 years. Girls are more often affected by the disease. It manifests itself with the following symptoms:

General intoxication of the body;
Soreness;
Sudden increase in body temperature;
Swelling in the joint area.

Juvenile seronegatvina polyarthritis can be distinguished by its clearly occurring symptoms and acute course. The pathology symmetrically affects the hip, elbow, ankle, and knee joints. Children with this diagnosis find it difficult to walk and experience pain when moving.

Diagnostics

Due to the fact that the symptoms of seronegative rheumatoid arthritis are less pronounced, it is more difficult to recognize during diagnosis. After collecting anamnesis, doctors conduct a mandatory x-ray examination. It helps to detect minimal changes in the shape of the foot, the presence of osteoporosis, and the prevalence of ankylosis that are invisible to the eye.

Laboratory blood tests are mandatory. They allow you to determine the absence or presence of RF (rheumatoid factor) and make the correct diagnosis. The results should show an increase in leukocytes and ESR, which indicates signs of inflammation. Laboratory technicians use the Valera-Rose reaction, which helps detect the absence of autoantibodies.

Treatment

The treatment of seronegative rheumatoid arthritis includes several techniques that involve the use of medications and related non-drug agents. The complex of therapy necessarily includes 4 groups of medications: anti-inflammatory drugs, synthetic or biological drugs, NSAIDs (non-steroidal anti-inflammatory drugs), glucocorticoids.

The first group of basic anti-inflammatory medications includes: azathioprine, sulfasalazine, penicillamine, cyclosporine, etc. NSAIDs include Diclofenac, Nimesulide, Celecoxide. They are designed to relieve pain and relieve swelling. Synthetic and biological drugs include Rituximab, Infliximab, and Tocilizumab. Glucocorticoids allow you to maintain remission longer and help you quickly achieve positive results in treatment. Medicines used: Metypred, Dexamethasone, Prednisolone.

Note!
The disease is highly resistant to drugs. It is impossible to cure seronegative rheumatoid arthritis quickly and effectively without additional non-drug methods.

The treatment package must include:

Physiotherapy;
Regime (limiting strong physical activity, giving up bad habits);
Diet (polyunsaturated fatty acids, fresh vegetables and fruits should predominate in the menu);
Physiotherapy.

Unconventional methods of treatment

Your doctor may recommend treating seronegative rheumatoid arthritis with folk remedies. Making natural ointments and rubbing tinctures helps well in alternative therapy. They help to quickly relieve pain and swelling, and allow you to maintain long-term remission.

Turpentine and honey ointments are popular. They can be used not only by adults, but also by children over 12 years of age. To prepare turpentine ointment, you need to mix well camphor (3g), olive oil (150 ml), turpentine (150 ml), alcohol (70%). The resulting mass is left in a cool place for 3 hours, after which the ointment is rubbed into the affected area until completely absorbed, 1 time per day.

Honey ointment is easy to prepare. Products are mixed thoroughly: 150 ml. flower honey, half a glass of vodka, 15 g salt, 200 ml. black radish juice. The resulting ointment is rubbed in 2 times a day until pain and swelling disappear completely.

Red wine is used as a compress. It is heated to a temperature of 36.8-37.0 degrees, mixed with 2 tbsp. spoons of dry mustard, mix thoroughly. Blot a cotton cloth with the resulting solution and apply it to the sore spot. The compress relieves pain well. Use up to 3 times a day until the pain disappears.

In order to forget for a long time what seronegative rheumatoid arthritis is, you should follow the doctor’s recommendations and use medicinal and non-medicinal methods and folk remedies in treatment. With the right treatment, patients can achieve stable remission.

Patient K.
Age: 14 years
Diagnosis: Juvenile polyarthritis, seronegative.
The duration of the disease was 11 years.
Therapy before prescribing infliximab: NSAIDs, methotrexate (17.5 mg/m2 per week) for several years, sulfosalazine (35 mg/kg per day), myacalcic, alendronate, chondroprotectors, prednisolone; combination therapy with leflunomide 20 mg/day and methotrexate 10 mg/m2 per week for 6 months.
The duration of infliximab therapy is 27 months.
Fig.1. General appearance of the patient before Infliximab therapy.

Fig.2. General appearance of the patient during therapy with Infliximab.

Fig.3. Functional ability of the wrist joints before Infliximab therapy.

Fig.4. The functional ability of the wrist joints did not respond to Infliximab therapy.

Fig.5. Functional ability of the knee joints before Infliximab therapy.

Fig.6. The functional ability of the knee joints did not respond to Infliximab therapy.

Fig.7. Functional ability of the knee joints before Infliximab therapy.

Fig.8. The functional ability of the knee joints did not respond to Infliximab therapy.

Fig.9. Exudative-proliferative changes in the wrist joints and small joints of the hands before Infliximab therapy.

Recently, the number of cases of reactive arthritis in children has increased significantly. Due to inflammation in the joints, which manifest themselves against the background of various infections (flu, ARVI), including the digestive and genitourinary systems, this problem is slowly coming to the fore.

Features of arthritis in children

Reactive arthritis in children (arthropathy) is not one disease, but a whole group that includes non-purulent inflammatory lesions of the joints that progress due to immune dysfunction. Inflammation most often affects the knee, ankle joints, lumbar spine, and metatarsophalangeal joints of the big toes. The development and course of the disease, different from adults, is observed in children with hip joint disease. Less common are lesions of the small wrist joints.

In children, pain in the affected area occurs more often not with physical activity, but with pressure on the joint and periarticular area. Thus, a characteristic feature of the disease is pain in the area of the junction of the Achilles tendon and the heel bone. Young children may maintain their normal range of motion and be active, but complain of pain when pressing on them.
place.

The course of the disease can be mild, without obvious complaints about health. Suspicion can only be caused by severe swelling of the tissues, which is sometimes also absent.

In a more severe form, reactive arthritis occurs in children who are susceptible to allergic reactions. In such patients, there is an increase in temperature and multiple joint lesions (hip, knee joints), accompanied by pain and swelling. Often, such children, due to the involvement of the gastrointestinal tract in the inflammatory process, experience symptoms such as stool upset and vomiting. Very rarely, the pathology can be complicated by heart damage, which carries a serious risk to the health and life of the small patient.

Joint damage in children occurs asymmetrically. Usually several joints become inflamed at once, less often just one (this condition is called oligoarthritis)

Features of damage to the hip joint

Particular signs of the disease in children are observed with inflammation of the hip joint. For a long time, a child may only have symptoms of ordinary conjunctivitis (as a complication of ARVI), which is why doctors for a long time cannot associate such manifestations with joint disease. Only after inflammation of the urethra joins the symptoms do specialists begin to suspect and treat reactive arthritis of the hip joint.

Causes and symptoms

Common symptoms of pathology in young patients are:

swelling of the tissue around the joint;
local increase in skin temperature at the site of injury;
pain with various movements, pressing on the joint;
joint deformation.

In young children the disease manifests itself:

frequent, strong crying;
temperature rise to 39C;
manifestations of intoxication of the body;
decreased appetite and, as a result, weight loss;
restless sleep;
lethargy during the day;
children under the age of 12 months may stop walking (this is especially common with inflammation of the hip or knee joint).

In this article we tell you why dorsal disc protrusion occurs and why it is dangerous.
How to identify and treat protrusion of the lumbar spine can be found here, and about the diagnosis and treatment of protrusion of the cervical spine, read here

Types of Arthritis

Reactive arthritis is divided into several types, which are characterized by their own distinctive signs and causes of occurrence.

Infectious

The cause of infectious arthritis is pathogenic microorganisms that enter directly into the joint with the bloodstream, lymph from another inflammatory focus or as a result of injury. The causative agents of the disease can be bacteria, mycoplasmas, viruses, and fungi.
Very often in young patients, arthritis of infectious origin occurs under the influence of Staphylococcus aureus. Less commonly diagnosed is a disease caused by intestinal, Pseudomonas aeruginosa. Also, the development of pathology can be provoked by gonococci (in children who were born to women with gonorrhea).

The symptoms of infectious arthritis are pronounced and develop rapidly.

fever;
headache;
lethargy;
loss of appetite.

volumetric enlargement of the joint in which inflammation develops (for example, obvious enlargement of the knee joint);
skin hyperthermia;
joint pain that increases sharply with movement.

Viral

It is a complication of various viral diseases, such as influenza, ARVI, rubella, hepatitis, enterovirus infection, etc. The disease caused by the action of viruses occurs quickly in children and, most often, has reversible consequences.

Typically, articular manifestations of pathology occur at the peak of the disease that caused it (ARVI, rubella, etc.), or develop a little later.

swelling of the joints;
skin redness around the sore joint;
temperature increase (local);
pain on movement or palpation;
slight decrease in motor activity in the joint.

Post-vaccination

Occurs several weeks after vaccination against the background of a post-vaccination reaction (fever, intoxication). In children, the lesion is “volatile” (one joint hurts one day, another one hurts another day). Often the course of the disease is benign, and the symptoms disappear within 10-14 days after the first manifestations (sometimes on their own).

swelling of the tissue in the joint area;
increase in joint volume;
pain on palpation;
disturbances in motor activity of the joint;
temperature.

Also, symptoms often appear along with redness, burning and itching, and swelling at the injection site.

Juvenile

Juvenile (rheumatoid) arthritis is characterized by chronic joint inflammation, the etiology of which is unknown. The disease occurs in patients under 16 years of age. The disease rapidly progresses, occurring both in the articular form and in the systemic form (involving internal vital organs).

In the articular form of juvenile arthritis, the following is observed:

symmetrical joint damage;
pain in the affected area;
swelling of the tissue around the sore joint;
hyperthermia;
skin rash;
increased volume of the liver and spleen.

The systemic form is characterized by:

high temperature, which is difficult to bring down;
flying joint pain;
enlarged lymph nodes;
skin rash;
enlarged spleen.

Poststreptococcal arthritis (rheumatism)

The disease is a consequence of a previous infection caused by streptococci, and has symptoms similar to infectious arthritis.

Diagnostics

You can suspect the presence of a pathology in a child if the inflammatory process in the joint was preceded by some infectious diseases, as well as by clinical manifestations.

visual inspection;
taking anamnesis;
general blood test (if the disease occurs, an increased level of leukocytes and ESR may be detected, but ARVI can provide such data));
general urinalysis (characterized by excess leukocyte levels);
rheumatic tests;
smears from the conjunctiva of the eye, cervical and urethra;
stool culture;
serological reactions for the detection of antibodies to intestinal pathogens;
linked immunosorbent assay;

study of periarticular fluid;
analysis for the detection of HLA-B27 antigen;
X-ray examination of the affected joint (knee, hip, etc.);
Ultrasound examination of the diseased joint, MRI.

Treatment of reactive arthritis

The main goal of treatment is to combat the infectious pathogen, for which children are recommended to take antibacterial drugs. The choice of medicines is made by the doctor, depending on what kind of infection caused the disease and its sensitivity. Macrolides are often used.

In order to save the child

for inflammation, treatment with non-steroidal anti-inflammatory drugs

, the most effective of which are:

Diclofenac;
Ibuprofen;
Naproxen;
Meloxicam.

Chronic or prolonged reactive arthritis is treated with immunomodulators aimed at functional restoration of the immune system.

Polyoxidonium;
Taktivin.

In cases where the disease worsens periodically, the mobility of the spine is limited, and inflammation affects the tendon junctions, then children are recommended to be treated with drugs that suppress the immune system, such as Sulfasalazine.

electrophoresis treatment;
ultraviolet irradiation;
laser therapy;
magnetotherapy.

Also, after treatment, the child is prescribed a course of exercise therapy aimed at restoring motor functions of the joint.

Juvenile rheumatoid arthritis: causes of diagnosis, symptoms (photos) and treatment in children

Juvenile rheumatoid arthritis is a chronic joint disease, the nature of which has not yet been established. It is only noted that the inflammatory process in the joints always lasts at least 6 weeks and develops in children and adolescents under the age of 16 years. Mostly girls suffer.

Juvenile rheumatoid arthritis (or juvenile rheumatoid arthritis for short) can develop into severe arthritis or ankylosing spondylitis. All these diseases have serious consequences and can lead to disability of the child. Therefore, treatment of juvenile rheumatoid arthritis should be carried out as early as possible.

Advice: parents should always carefully monitor the child; if he has a positive rheumatoid factor, then juvenile rheumatoid arthritis may occur. The slightest changes in gait, gestures, or coordination of movements are a reason to be examined by a rheumatologist to confirm or deny this.

Jurassic classification

Juvenile type of arthritis is a collective term that refers to all rheumatoid diseases in children. There is an official classification of law:

JRA M 08.0 – juvenile rheumatoid arthritis;
JPA – juvenile psoriatic arthritis;
JCA – juvenile chronic arthritis (seronegative polyarthritis M 08.3);
YSA M 08.1 – juvenile ankylosing spondylitis;
M 08.2 – juvenile arthritis with systemic onset;
M 08.4 – juvenile arthritis with pauciarticular onset;
M 08 8 – juvenile arthritis of other types;
M 08.9 – juvenile arthritis as an accompanying disease with other pathologies.

The diagnosis is made if the clinical picture of the child’s illness is as follows:

The disease lasts more than three months.
The child is not older than 16 years.
Joint inflammation appeared for the first time and does not apply to other nosological forms.

This classification is considered general; each term, taken individually, does not have its own definition and is most often indicated in the medical history as “inflammation of the joints of a chronic nature in children under 16 years of age.”

Symptoms of Jurassic

Juvenile rheumatoid arthritis is a separate nosological entity; its manifestations are very similar to adult rheumatoid arthritis. In children who have been ill for more than three months, the following characteristic symptoms can be noted:

Deformation of small joints of the hands;

Symmetrical polyarthritis of the joints of the arms and legs;

Formation of rheumatoid nodules;

The presence of destructive arthritis.

According to the results of the examination, seropositivity in the Russian Federation is revealed

How does juvenile arthritis occur in children?

Based on the nature of the flow, two forms of the Jurassic are distinguished:

Acute – the symptoms are very severe, frequent relapses are observed, the prognosis is unfavorable.
Subacute – the symptoms are the same, but less pronounced, and are more treatable.

According to localization, Jurassic can be:

Articular, affecting mainly ligaments, joints and muscles;
Articular-visceral, when other internal organs are affected - the heart muscle, liver and kidneys.

Juvenile rheumatoid arthritis can be rapidly progressive, moderately progressive or slowly progressive.

Reasons for the emergence of Jurassic

The following factors can trigger the development of juvenile arthritis:

Severe hypothermia.
Hereditary predisposition.
Injuries to joints and ligaments.
Incorrect drug therapy.
Viral or bacterial infection.

In some cases, excessive sun exposure causes illness.

How to recognize juvenile arthritis

Juvenile rheumatoid arthritis primarily affects large and small joints. At the same time, they are swollen, deformed, the skin is hot to the touch, the child complains of burning pain and stiffness in movements.

Typical localization for the Jurassic is the maxillotemporal joints and the cervical spine. Sometimes it looks like periarthritis of the shoulder, so it is important to make a correct diagnosis.

Such lesions are always accompanied by inflammation, gradual destruction of cartilage tissue and fusion of articular elements.

Extra-articular signs of the disease include:

febrile state with increased temperature;
joint pain, worse in the morning;
skin rashes;
hypertrophy of the lymph nodes, liver and spleen.

If the temperature drops, the child literally sweats, his underwear and bed linen get wet through. This Jurassic stage can last from several months to several years if a diagnosis is not made and treatment is not started. And only then joint damage will appear.

Note: red eyes in a child are a typical sign of Jurisprudence, although there is no direct connection between the eyes and joint inflammation.

Acute form of the disease

Acute juvenile rheumatoid arthritis is very difficult. All symptoms appear, the nature of the disease is systemic. Relapses often occur, and treatment is ineffective.

Arthritis in children in this form has the same symptoms as in acute form, but they do not appear as severely and often. At the developmental stage, one joint is affected first, most often the knee or ankle. If the child is very small, he becomes capricious, refuses to get up on his feet, and always asks to be held or sits.

Older children complain of “morning stiffness.” The child cannot get out of bed and perform simple household tasks independently. The gait changes: it becomes very slow, as if every step causes pain. He can remain in this state for up to an hour until the joints develop.

For this reason, parents and doctors often mistake the illness for a simulation, explaining that the child simply does not want to go to school or kindergarten. If the pediatrician claims that the child is faking, it makes sense to go to another, more attentive and qualified physician.

In girls of preschool and primary school age, rheumatoid eye damage is often manifested. This disease is called rheumatoid uevitis, unilateral or bilateral. Since the disease affects all the membranes of the eyeball, in just six months, vision sharply decreases until it is completely lost.

It is rare, but it happens that rheumatoid uevitis manifests itself earlier than the underlying disease - then it is very difficult to make a diagnosis.

In subacute rheumatoid arthritis, 2 to 4 joints are affected; this form of the disease is called oligoarticular.

Systemic juvenile rheumatoid arthritis

In this case, the disease is recognized by the following signs:

Severe fever that cannot be controlled;
Hypertrophy of the lymph nodes;
Hepatolienal syndrome – liver dysfunction;
Allergic rash of a polymorphic nature;
Various arthralgias.

In young children, the disease is characterized by Still's syndrome, in schoolchildren and adolescents - by Visseler-Fanconi syndrome.

If treatment is not started, secondary amyloidosis may develop, caused by the constant presence of immune complexes in the blood. Amyloid deposition begins on the walls of blood vessels and arteries, in the liver, kidneys, intestines and myocardium. As a result, the functioning of these vital organs is disrupted.

The kidneys are most affected, and large amounts of protein are found in the urine. Therefore, as a rule, with rheumatoid arthritis, children primarily suffer from kidney failure.

How is the diagnosis made?

In order to accurately diagnose the disease, the doctor may prescribe the following examinations and tests:

Radiography. The images can reveal osteoporosis (bone tissue loses density), bone erosion, and decreased spaces between joints.
MRI, CT and YRT. Using these diagnostic methods, the doctor can determine how severely damaged the cartilage tissue and bones are.
Laboratory tests of urine and blood. The results show the level of ESR, leukocytes in the blood, which indicates the presence of an inflammatory process, as well as the level of protein in the urine. In addition, you should donate blood for the presence of rheumatoid factor (RF), antinuclear bodies, and determine the level of C-reactive protein.

Based on the results of tests and examinations, complex therapy is prescribed.

How to treat Jurassic

The treatment program for children is drawn up depending on the form of the disease and the condition of the joints. During the “quiet” period, dieting is mandatory. Food should be low in calories, rich in vitamins and polyunsaturated fatty acids. Saturated fatty acids and allergenic foods should be completely avoided.

The effect of various medications on the patient’s condition;
Nature of immunopathology;
The nature and development of osteochondral destruction.

Non-steroidal anti-inflammatory drugs and glucocorticosteroids are used. Therapy is aimed at stopping the inflammatory process, relieving pain and maintaining the functionality of the joints. All this allows the child to lead a full active life.

Basic treatment includes the use of the following medications:

NSAIDs - these drugs are effective, but can cause a number of complications and side effects, so they are used with caution.
Glucocorticosteroids are used in short courses to minimize the effect on the growth and development of children.
Selective inhibitors - with their help they relieve inflammation and pain.
Basic LVs in the early stages of rheumatoid arthritis.

If the disease is caused by an infection, a course of antibiotic therapy is necessary. If the disease has an immune complex etiology, plasmaphoresis is used. For very severe pain, medications are administered intra-articularly.

In some cases, immunotherapy gives positive results. Immunoglobulin is administered intravenously by drip. It is important to follow the technique of administering the drug. In the first 15 minutes, 10-20 drops of the drug are administered every minute, then the speed increases. You can repeat the procedure every month.

In severe forms of the disease and advanced cases, when conservative treatment methods have proven ineffective, surgery is performed - joint replacement.

As for the treatment of rheumatoid uevitis, this complication is treated jointly by a rheumatologist and an ophthalmologist. For local treatment, a combination of GCS and mydriatics is used. If after a two-week course of such therapy no results are observed or the pathology progresses, cytostatics are prescribed.

They begin to be used after confirmation of an acute or seropositive form of rheumatoid arthritis in a child.

Features of treatment, complications and consequences of the disease

In the fight against the symptoms of the disease, proper nutrition of the child is very important. Salt intake should be minimized. This means that the diet should not contain sausages, hard cheeses, pickles, and homemade food should also be salted very sparingly. This reduces the intake of sodium into the body.

To maintain calcium balance, the menu should include nuts, dairy products, and calcium and vitamin D supplements are also recommended.

To maintain muscle tone and joint mobility, a set of gymnastic exercises is prescribed. Massage, various physical procedures, trips to resorts and sanatoriums are very useful as supportive and preventive measures.

Advice: if a child has been diagnosed with this, you should not limit him from communicating with peers and playing sports. He may well attend various sections and take part in outdoor games. Then, in case of exacerbation of the disease, complications and consequences will be minimized.

It is noted that the disease occurs in a milder, milder form if the child leads an active lifestyle. In weak, lethargic children, on the contrary, the symptoms are always more pronounced.

But: at the same time, it is strictly forbidden to force the child to move, do exercises, etc. He himself must regulate the intensity of physical activity. If discomfort and pain occur during physical activity, then it is necessary to review and adjust exercise therapy and other sports.

If treatment was started late, was carried out in bad faith, or was completely absent, then what is the risk of juvenile rheumatoid arthritis? First of all, the fusion of articular elements will progress. And this leads to their complete dysfunction, immobility, and, as a consequence, the child’s disability.

The effect on the kidneys, liver and heart leads to the development of chronic pathologies of these organs, which also negatively affects the general condition of children. With advanced rheumatoid uevitis, the child may become completely blind. It should be remembered that destroyed joint tissues are not restored. But surgery is not always possible.

Even if you cannot completely get rid of rheumatoid arthritis, this diagnosis will remain for life; you can live it actively, without standing out from other people. But only on condition that treatment was started in a timely manner and carried out carefully and comprehensively.

Many people know that osteoporosis is a disease of old age that develops mainly in women after 45 years of age. But not everyone knows that there is such a thing as juvenile osteoporosis, which is observed in children and adolescents.

How the disease develops

At a young age, human bones are formed due to cartilage tissue (lengthening of the skeleton) and the appearance of bone tissue (expansion of bones).

There are two groups of causes of osteoporosis at a young age:

Increased deformation of bone tissue.
Reducing the rate of skeleton formation.

It was recently discovered that this balance can be disrupted at any stage of a person’s life. There is such a thing as congenital osteoporosis. It can occur as a result of intrauterine developmental disorders. It can be induced:

fetal prematurity;
a case of intrauterine hypoxia or malnutrition with impaired functionality of the placenta;
bearing twins or repeat births within a short period of time;
chronic illness of the mother or work that does not meet hygiene standards during pregnancy;
various poisonings during pregnancy.

Symptoms of juvenile osteoporosis may develop in the first year of a child's life. The following factors may influence this:

disruptions in the functioning of the intestines;
feeding children with unadapted formula;
lack of solar radiation and hypovitaminosis (especially insufficient vitamin D);
failure to comply with hygiene standards.

In children of puberty, the disease can be caused by:

consumption of alcoholic beverages and tobacco products;
unbalanced diet;
sedentary lifestyle;
chronic diseases of the gastrointestinal tract, liver and kidneys;
pathologies accompanied by inflammation (collagenosis, tuberculosis);
exposure to radiation and toxins;
prolonged immobility for any reason.

Effect of medications

Osteoporosis at a young age can be caused not only by various pathologies and diseases, but also by the influence of certain medications. The development of osteoporosis in children can be triggered by:

glucocorticosteroid hormones, which are usually prescribed for the treatment of autoimmune and inflammatory diseases;
anticonvulsants, which are used for epilepsy;
chemotherapy substances;
certain antibiotics;
substances that reduce stomach acid (antacids), which are used to suppress heartburn.

Often, osteoporosis in children does not have any specific symptoms. Only in the case when the bone tissue is significantly affected, the child may complain of pain in the area of the spine, legs, and rapid fatigue when standing or sitting. At first the pain goes away when the child takes a certain position, but later it becomes constant and aching.

It is often assumed that a teenager has osteoporosis after a second fracture that occurred without any particular trauma. The most common sites of bone tissue disruption are the vertebral bodies, femoral neck, humerus and ulna. If a child makes a sudden movement, severe pain and symptoms of a reshaped limb may occur.

A compression fracture is typical of the vertebrae, for which displacement is not typical.

Symptoms that may indicate osteoporosis in a child:

short stature compared to other children of the same age;
posture reform, which consists of rounding the chest area, straightening the arch in the lower back, protruding belly;
When the spine is curved to one side, asymmetric folds of skin may appear on one of the sides of the body.

If congenital osteoporosis occurs, the most pronounced radiological symptoms are:

decreased density and thinning of the outer bone layer;
unusual shape of the vertebrae (“fish vertebrae”).

Symptoms of osteoporosis at a young age can be confused with symptoms of rickets. Today, in order to diagnose osteoporosis in children, bone mineral density is measured. The technique is called densitometry.

Goals and methods of treatment

Therapy is very helpful for treating children diagnosed with juvenile osteoporosis, but only if you contact specialists in a timely manner. The treatment has the following objectives:

Relieves symptoms and stabilizes the patient's condition.
Restores the balance between the formation of bone tissue and its destruction.

To accomplish the first task, a course of symptomatic therapy is prescribed as treatment, which consists of the following:

prescribing a special diet for the child, rich in proteins, calcium and phosphorus;
development of a set of physical exercises, which should be performed no earlier than a quarter after the start of complex treatment. Otherwise, there is a high probability of numerous disorders in the skeleton;
if pain is present among the symptoms of the disease, treatment includes prescribing painkillers and wearing a special support corset.

During treatment, the following medications can be used to combat the causes of the disease:

substances to suppress the resorption of bone tissue. These are calcitonins of natural and artificial origin and estrogens;
drugs that induce bone formation. They include growth hormone and steroids;
means to normalize the general condition of the patient. Vitamin D is most often used during treatment.

Since treating children with hormonal substances may not have the best effect on the children’s health, preference is given to drugs from the latter group. To prevent osteoporosis at an early age, children can be given medications containing magnesium, calcium and vitamin D.

This disease belongs to one of the varieties of arthritis, but with the only difference: there is no C-reactive protein in the patient’s blood. Seronegative rheumatoid arthritis can develop regardless of age and gender, and in the absence of timely treatment, complications of varying severity are possible.

Factors provoking the development of seronegative polyarthritis

This disease belongs to the autoimmune group, which means that the immune system does not function properly, when the body’s own antibodies are perceived as foreign.

This reaction can be caused by several reasons, among which the first place is a genetic predisposition to arthritis of various types.

Features of the clinical course

Characteristic signs of the disease include:

inflammation is accompanied by asymmetric damage to the articular joints. As a rule, at the initial stage of arthritis development, large joints (knees and elbows) are involved in the pathological process, and as the disease progresses, small joints (hands, feet) are involved;
this polyarthritis differs from other forms in the absence of morning stiffness of movements, and upon deeper examination of the patient, severe deformation of the joints and rheumatoid nodes characteristic of all arthritis are not observed;
in rare cases, diagnostics reveals visceritis and vasculitis. With a complicated course of the disease, disturbances in the functioning of the renal system are possible.

However, it should be noted that polyarthritis of a rheumatoid nature is much easier than other forms. If therapy is started in a timely manner, the prognosis for recovery is favorable.

Development of juvenile seronegative polyarthritis

Treatment

Seronegative rheumatoid arthritis is poorly responsive to basic therapy and immunosuppressants. In addition, when choosing an effective treatment, the possibility of side effects should be taken into account.

Polyarthritis provides the following treatment:

prescription of glucocorticosteroids (Dexamethasone, Triamcinolone, Prednisolone, etc.);
NSAIDs (Ortofen, Diclofenac, Ibuprofen);
group of sulfonamides (Sulfasalazine, Salazopyridazine);
immunosuppressants (Remicade, Methotrexate);
antibiotics (Minocycline, Amikacin).

Like any polyarthritis, the seronegative form requires mandatory adherence to a therapeutic diet, as well as acceptable forms of gymnastics and massage.

It must be remembered that prior to starting therapy, a preliminary consultation with a doctor is required, which will allow further avoidance of undesirable consequences. Self-administration of medications is unacceptable!

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Why does the disease appear?

The mechanism of occurrence of rheumatoid polyarthritis is the appearance of erosion on the surfaces of the joint, which during the development of the disease leads to deformation and destruction of the joints.

In order to understand what rheumatoid polyarthritis and the affected joints look like, you can look at the photo. At the moment, the etiology of the disease has not yet been fully studied. What is known for certain is that the causes of rheumatoid polyarthritis are various influences of pathogenetic autoimmune changes.

An increased level of leukocytes in the blood signals the infectious nature of the disease, as indicated by an increase in ESR. In such cases, the infection causes immune disorders in people who have a genetic predisposition to the disease.

In the body of patients suffering from rheumatoid arthritis, the appearance of immune complexes is noted, which have the ability to be deposited in joint tissues, provoking their inflammation and damage.

Important! The outcome of rheumatic arthritis is disability. According to medical statistics, about 70% of patients become disabled. Moreover, disability occurs too early. Complications associated with infectious processes that develop against the background of rheumatoid polyarthritis and renal failure are often the causes of death.

Treatment of rheumatoid polyarthritis involves relieving pain with medications, slowing the progression of the disease, and restoring damage through surgery.

Diagnosis of rheumatoid polyarthritis at the earliest stages of its development allows us to minimize the harm that juvenile rheumatic arthritis can cause to the body.

Symptoms of the disease appear with significant physical exertion. Particularly striking signs of the disease are observed during hormonal changes in the body.

Seronegative and seropositive polyarthritis

Rheumatoid polyarthritis was discovered during excavations on the skeletons of people buried more than 4500 BC. Scientists recorded this fact in the photo. The document that listed the symptoms of the disease dates back to 123 AD.

Medical statistics claim that the disease affects about 0.5-1.0% of the world's population. Moreover, among elderly patients, only 5% suffer from this disease. Therefore, rheumatoid polyarthritis of the joints is called “juvenile”, that is, youthful. Although you need to understand that there is juvenile rheumatoid arthritis, which affects the joints of children.

It is characteristic that the disease is more common among the female half of humanity. For every man suffering from this disease, there are on average three sick women. The disease is most often diagnosed at the age of 30-35 years.

Inflammation of the joints occurs due to the depletion of connective tissue of the cartilage. Since rheumatoid polyarthritis is an autoimmune disease, there are three main factors that contribute to the occurrence of the disease.

Hereditary predisposition, that is, a genetic tendency to develop autoimmune reactions. Most often it is observed in carriers who belong to the MHC II class: HLA – DR1, DR4.

The infectious factor includes triggers of rheumatic diseases. Among them are:

hepatoviruses – the causative agent of hepatitis B;
paramyxoviruses – measles, mumps and some others;
retroviruses – T-lyphotropic virus;
herpes viruses are the causative agent of herpes zoster and herpes simplex.

Trigger factor. A child who is fed breast milk for a long time is more protected from the occurrence of rheumatoid arthritis than an infant who is bottle-fed.

It has been observed that juvenile arthritis appears half as often in those children who receive natural breast milk for two years. And in this case, the question does not arise about how to treat seronegative (absence of rheumatoid markers in the blood) or seropositive (rheumatoid markers in the blood) juvenile polyarthritis of the joints and its symptoms.

The triggers of the disease are arthritic infections living in the patient’s body. The development of inflammation in polyarthritis is influenced by T-helper type I. Autoantigens that induce autoimmunization have not been reliably established.

The likelihood of polyarthritis due to a malfunction of T-lymphocytes is not the only hypothesis.

Symptoms of polyarthritis and variants of its course

Doctors distinguish several types of rheumatic arthritis. The most common are the following:

Classic option. It is characterized by a slow flow. The disease develops simultaneously affecting all small joints.
During the course of the disease, large diarthrosis are affected, most often the knees.
Pseudoseptic variant of polyarthritis. The disease is accompanied by hyperhidrosis, fever and loss of body weight.
Articular-visceral type. With this form of arthritis, rheumatic vasculitis occurs, affecting the lungs, heart and central nervous system.

Note! Juvenile seronegative or seropositive polyarthritis can begin its development in any joint, although the small joints of the lower and upper extremities are most often affected.

Symmetry is usually noted, that is, the joints of both arms or legs are affected at the same time. The more joints are involved in the inflammatory process, the more difficult it is to cure juvenile polyarthritis.

In addition to joint disorders, other symptoms are present:

Loss of appetite.
Stiffness in the joints in the morning.
The appearance of flu-like symptoms.
Weakness.
Depression.
Sharp muscle pain.
Pain when sitting.
Violation of the excretory function of the salivary glands.

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Treatment approaches
Specifics of the condition
Classification
Seronegative type

Today, medicine identifies a whole group of diseases, the cause of which is a violation of the body’s immune response. With this pathological process, immune cells begin to attack their own tissues, which leads to serious consequences for internal organs and the osteoarticular apparatus. Treatment, prevention and diagnosis of this group of diseases is studied by a branch of medicine called rheumatology, and rheumatoid polyarthritis is considered the most common pathology.

What kind of disease is this? This is a systemic pathological process, predominantly affecting connective tissue and accompanied by chronic inflammation of the joints. Basically, rheumatoid polyarthritis negatively affects the interphalangeal, metacarpophalangeal, ankle, knee and wrist joints. At the last stage of the pathological process, mobility in the joint may completely disappear. ICD-10 code – M05.

The reasons that force the body to attack itself have not yet been identified, but factors have been identified that increase the risk of developing malfunctions in the immune system. This group of “provocateurs” includes acute respiratory viral infections, acute tonsillitis, and infectious mononucleosis. According to research 1% of the world's population is diagnosed with this disease, and women are much more likely than men. After 50 years, the risk of morbidity increases significantly and can reach 5%. Rheumatoid polyarthritis in children does not occur as often as in adults and, as a rule, before the age of 16.

Treatment approaches

Treatment of rheumatoid polyarthritis is a rather labor-intensive task that requires a competent approach from the doctor using modern therapeutic methods and an individual approach to patients.

Currently, three main types of treatment for this disease have been developed:

Use of pharmacological drugs;
Non-drug treatment;
Rehabilitation.

Since rheumatoid polyarthritis is an autoimmune disease, its progression can only be stopped by influencing two levels of pathogenesis:

Suppress immune activity.
Block the release and synthesis of inflammatory mediators.

Immunosuppressive drugs are used to reduce activity and reduce clinical manifestations of the pathological process. The severity of the effect of use varies from insignificant to persistent remission for several years. In addition, a successful course of treatment will be characterized by inhibition of the destruction of the affected joints. Drugs from this group are able to suppress the proliferation activity of immune cells, as well as delay the development of the erosive process.
At the same time, application non-steroidal anti-inflammatory drugs is characterized by a rapid decrease in the intensity of pain and improvement in joint mobility, and the effect is felt already in the second hour after administration. It must be said that despite the subjective improvement in the patient’s condition, the activity of rheumatoid polyarthritis will not decrease. Drugs from this group do not affect the main factor of pathogenesis (autoimmune process), therefore inhibition of joint destruction is not observed when used.
Glucocorticosteroid drugs are able to influence both the suppression of immune activity and the reduction of the synthesis of inflammatory mediators. Clinical studies have provided evidence of a reduction in the severity of joint destruction and an improvement in the well-being of patients with long-term use of these drugs in small dosages. The effect of administration can be felt just a few hours after intravenous or intramuscular administration. At the same time, monotherapy with glucocorticosteroids without the use of cytostatics and NSAIDs does not have a sufficient level of effectiveness, as a result of which combined use is recommended.

Important! Where to get treatment? A rheumatologist treats systemic diseases. If you suspect rheumatoid polyarthritis, you should consult a rheumatologist at the clinic. Once the diagnosis is confirmed, treatment takes place at a rheumatology hospital. As the condition progresses, consultation with a traumatologist and physiotherapist may be required.

Spa treatment and discounted medications

Important! If for any reason a patient is denied access to free medications, then the complaint should be addressed to the deputy chief physician responsible for the distribution of preferential medications or directly to the head physician of the medical institution at the place of residence.

List of preferential medications that can be prescribed to patients with rheumatoid polyarthritis:

Prednisolone	eye drops; ointment for external use; pills
Methylprednisolone	pills
Hydrocortisone	eye ointment; ointment for external use; pills
Dexamethasone	eye drops; pills
Methotrexate	pills; concentrate for the preparation of solution for injection; injection solution in graduated syringes
Leflunomide	film-coated tablets
Sulfasalazine	pills
Infliximab	lyophilized powder for the preparation of solution for intravenous administration
Rituximab	concentrate for solution for infusion
Abatacept	lyophilisate for solution for infusion

Grilled meat;
Spinach;
Sausage;
Beans, beans;
Sorrel.

Details of preferential sanatorium-resort treatment must be obtained from the attending doctor of the medical organization where the patient is being observed.

Specifics of the condition

Classification

It is customary to classify the stage of severity of rheumatoid polyarthritis based on the X-ray picture:

First stage characterized by an increase in the density and thickness of the soft tissues around the finger joints. Periarticular osteoporosis is also noted, manifested in the form of increased radiological transparency of bone tissue. Narrowing of the joint space indicates the activity of the disease and the imminent transition to the next stage. A typical manifestation of rheumatoid polyarthritis at this stage is mild or complete absence of symptoms. The first stage can last for years and does not bother the patient at all. In addition, it should be noted that the changes described above are not specific and may appear in other rheumatological diseases.
At the second stage The bone is more involved in the pathological process. Radiologically, one can note cyst-like areas of clearing in the area of the epiphyses of the metacarpal and phalangeal bones, an increase in the narrowing of the joint space, unexpressed marginal deformation of the bones and the appearance of erosions in the joints. This stage is divided into two stages - erosive and non-erosive. The first erosive changes are recorded in the metacarpophalangeal joints of the index and middle fingers, the wrist and metatarsophalangeal joints of the 5th finger. This stage is characterized by the absence of subluxations. Significant deformation and ankylosis of the joints do not develop.
At the third stage X-ray signs recorded at the previous stage will increase. Severe destruction is observed in most joints of the hands and feet. At this stage, significant deformation is noted, as well as dislocations and subluxations of some joints.
Fourth stage has the same symptoms as the third, but with the addition of ankylosis of the joints. Ankylosis is a pathological condition in which fusion of the articular ends occurs, causing the joint to become immobile for both passive and active movements. Severe deformation, reduction in size or destruction of the bone tissue of the hands is also added.

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Alternative title:

Chronic nonspecific polyarthritis, infectarthritis

Disease code:

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Causes of pathology

Pauciarticular juvenile arthritis is considered an autoimmune disease, so the role of hereditary factors in the occurrence of pathological failure in the body is great. Why the own immune system begins to perceive the cells of the synovial membrane as foreign and how to deal with them is still unclear, but the factors that trigger the destructive mechanism can be considered:

Hypothermia;
Prolonged uncontrolled exposure to the sun and ultraviolet irradiation;
Joint injury;
Vaccination;
Past infections: bacterial and viral;
Metabolic disorders;
Allergic diseases and tendency to anaphylaxis: Quincke's edema, urticaria, eczema, neurodermatitis, bronchial asthma, etc.

Manifestations of the disease

Clinicians distinguish two subtypes of pauciarticular juvenile arthritis: persistent and widespread, although this division is conditional. The classification distinguishes between pauciarticular arthritis of the first type (it is characterized by damage to one, less often two joints, with the obligatory involvement of the knee) and the second type (up to four joints associated with damage to internal organs).

The onset is gradual, and therefore many parents do not pay attention to changes in the child’s condition for a long time. Since the onset occurs at an early age, when the child cannot speak well, clearly localize pain, or describe his sensations, a visit to the doctor occurs already at the height of the illness, when the symptoms of intoxication and inflammation in the joint come first. The knee is most often affected. Characterized by pain, swelling, changes in skin color, and local increase in temperature. The pain increases gradually, the child limps, spares a limb, refuses the usual active games, and cries.
Nonspecific symptoms may include decreased appetite and weight loss, enlarged lymph nodes, weakness, rash, slight increase in body temperature, drowsiness and irritability. From the musculoskeletal side, due to the transition of inflammation to adjacent muscles and tendons, the development of hernial protrusions and cysts, tendonitis, bursitis, etc. is possible. Symptoms of damage to the eyes and other organs are added. Subsequently, as the pauciarticular form of the disease progresses, deformation, growth retardation, and shortening of the limb occur.

Diagnostic measures

The pauciarticular juvenile variant of JRA is quite difficult to differentiate from other ailments, since a slow onset, devoid of bright characteristic manifestations, can be disguised as other arthropathies, acute respiratory diseases and even diseases of the gastrointestinal tract. For diagnosis the following is carried out:

General blood test - shows the presence of an inflammatory reaction in the body (leukocytosis, increased ESR, shift of the formula to the left, anemia);
General urine test - helps to exclude infection of the genitourinary system and systemic complications of the kidneys;
Biochemical studies: the presence or absence of acute-phase inflammatory proteins - CRP, cerulloplasmin, total protein, albumin, antistreptolysin-O and others;
Immunological and cytological examination allows us to identify the presence or absence of specific immune complexes, immunoglobulins, antinuclear and rheumatoid factors;
X-ray, computed tomography - confirm the diagnosis, reveal the degree of damage to cartilage and bone tissue, the presence of growths, ankylosis, etc.
Magnetic resonance or magnetic nuclear tomography is a modern diagnostic method that reveals pathological changes in all tissues, the presence of fistulas, hernias, etc.
Joint puncture is used as a diagnostic and treatment method that detects the presence of fluid, allowing you to take a sample for microbiological examination, as well as administer medicinal substances directly to the site of inflammation;
Ultrasound scanning of joints and internal organs is used as a concomitant method to detect the presence of effusion in the cavity, or the onset of changes and complications in other organs.

Patients with juvenile pauciarticular arthritis are treated by a rheumatologist, but consultation with specialized specialists is mandatory: ophthalmologist, neurologist, cardiologist.

Treatment methods

Treatment for pauciarticular juvenile arthritis should be comprehensive, including both drug support and diet and dosing of physical activity. Etiotropic (cause-directed) therapy is impossible in this case, since the cause of the disease is unknown. The medications used affect the mechanism of autoimmune reactions, relieve inflammation, swelling, and improve the general condition.

The most widely used non-steroidal anti-inflammatory drugs (NSAIDs) are nemisulide, ibuprofen, nurofen, meloxicam, in the form of tablets, injections or local external agents (ointments, gels, compresses).
Sometimes they are used in combination with analgesics (analgin, baralgin) or glucocorticosteroids (prednisolone, dexamethasone).

Immunosuppressants are used as pathogenetic therapy to prevent further destruction of one's own cells and tissues. These include several groups of medicinal substances:

Gold preparations - auranofin;
Sulfasalazine;
Methotrexate;
D-penicillamine;
ANF inhibitors – imfliximab, etanercept, golimumab.

During an exacerbation, the patient should be provided with rest, the load is increased gradually, carefully dosed, selecting physical therapy exercises individually. Physiotherapy has a good effect: ultrasound, magnetic therapy, laser. During the period of remission, applications with paraffin or mud are indicated.

Surgical intervention is carried out only in cases of severe disabling deformities and severe shortening of the limbs.

ethnoscience

Recipes for combating diseases of the musculoskeletal system have been known since ancient times and can be used as a companion to basic medical care.

Prognosis and prevention

The pauciarticular variant of JRA is a chronic disease that cannot be cured. But it will be possible to achieve long-term remission with timely and correct treatment. The prognosis in most cases is quite favorable. The later the disease begins, the greater the chance of a benign course; when it debuts at an early age, half of the patients gradually develop complications (deformations, contractures, decreased and loss of vision), leading to disability and a deterioration in the quality of life.

To achieve remission it is necessary:

Avoid taking immunostimulants, interferons;
Avoid prolonged exposure to the sun;
Ultraviolet irradiation and vaccination are prohibited;
It is required to lead a healthy lifestyle, sanitize foci of chronic infection, and regularly engage in moderate physical exercise.