Juvenile rheumatoid arthritis: clinic and course options. biological therapy

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

JA is one of the most common and most disabling rheumatic diseases in children. The incidence of JA ranges from 2 to 16 per 100,000 children under the age of 16. The prevalence of JA in different countries ranges from 0.05 to 0.6%. The prevalence of JA in children under 18 in the territory of 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 - 45 .8 and 12.6. Rheumatoid arthritis (RA) is more common in girls. Mortality is within 0.5-1%.

Classification

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

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

There are three more classifications of the disease: the classification of juvenile rheumatoid arthritis (JRA) of the American College of Rheumatology (AKP), the classification of JXA (juvenile chronic arthritis) of the European League against Rheumatism, the classification of JIA (juvenile idiopathic arthritis) of the International League of Rheumatological Associations (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 mode should be limited. Complete immobilization of the joints with the imposition of a splint is contraindicated; this contributes to the development of contractures, atrophy of muscle tissue, aggravation of osteoporosis, and the rapid development of ankylosis. Physical exercises contribute to the preservation of the functional activity of the joints. Useful cycling, swimming, walking. Running, jumping, active games are undesirable. It is recommended to maintain a straight posture when walking and sitting, to 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 intake of carbohydrates and fats, a protein diet is preferable.

Therapeutic exercise (LFK)

The most important component of the treatment of JA. Daily exercises are needed to increase the range of motion in the joints, eliminate flexion contractures, and restore muscle mass. In case of damage to the hip joints - traction procedures on the affected limb after a preliminary consultation with an orthopedist, walking on crutches. During the development of coxitis and aseptic necrosis of the hip joints, the movement of the patient without crutches is contraindicated. Physiotherapy exercises should be carried out in accordance with the individual capabilities of the patient.

Orthopedic correction

Static orthoses such as splints, splint, insoles and dynamic cuts in the form of light removable devices. For static orthoses, intermittent immobilization is necessary - 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, toilet. With severe osteoporosis in the thoracic and lumbar spine - wearing a corset or reclining system; with damage to the joints of the cervical spine - head holder (soft, hard).

2. Medical treatment

Several groups of drugs are used to treat JA: non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (GCs), immunosuppressants, and genetically engineered biological agents. The use of NSAIDs and GCs contributes to the rapid reduction of pain and inflammation in the joints, improves 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 in patients.

Glucocorticoids

Pulse therapy

Pulse therapy of GC is carried out with 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 the symptoms of the disease;
rapid elimination of the drug, short-term suppression of the adrenal glands, restoration of their function after 4 weeks.

Introduction 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;
the duration of the introduction of 30-40 minutes;
the drug is administered 1 time per day in the morning;
GC pulse therapy is carried out for 3-5 consecutive days.

Undesirable effects may develop when using GC pulse therapy.

Transfusion adverse events:

increased blood pressure (BP);
hyperglycemia;
redness of the face;
headache, dizziness;
taste change;
heartbeat;
euphoria.

Prolonged unjustified use of intravenous GCs causes the development of severe adverse events:

persistent increase in blood pressure;
severe steroid osteoporosis. Most pronounced in the thoracic and lumbar spine. Manifested by a decrease in the height of the vertebral bodies, compression fractures. Accompanied by symptoms of compression of the roots of the spinal cord;
steroid myopathy;
posterior capsular cataract;
skin changes (hypertrichosis, purulent skin infection, striae, skin trauma, rough scars, worsening wound healing, steroid acne on the face and trunk).

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, control the activity of systemic manifestations. However, a decrease in the dose of prednisolone and its cancellation, as a rule, lead to an exacerbation of the disease. And re-appointment of prednisolone at the initial dose in most patients is no longer effective enough.

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

In the case of oral administration of GC, 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. In the future, the dose of HA is gradually reduced to a maintenance one according to the scheme, with their subsequent cancellation. Prednisolone must be given with an adequate dose of methotrexate and/or cyclosporine (see "Treatment of juvenile arthritis with systemic onset"). Decreasing the dose of prednisolone should be slow, with a maintenance dose (0.1 mg/kg body weight) taken for at least one year.

Tactics for reducing the dose of oral GCs.

The rate of HA dose reduction should depend on its initial daily dose:

up to 15 mg - reduce by 1.25 mg 1 time in 3-4 days;
from 15 to 10 mg - reduce by 1.25 mg 1 time in 5-7 days;
from 10 mg to 5 mg - an alternating decrease. On even days, the child takes prednisolone at the initial dose, on odd days - 1/8 tablet less. This mode of administration is maintained for 7-10 days. In the absence of a withdrawal syndrome, 1/8 tablets can be canceled. Over the next 7-10 days, the child takes a constant (after the abolition of 1/8 tablet) dose of prednisolone;
from 5 mg to complete withdrawal - an alternating decrease. On even days, the child takes prednisolone at the initial dose, on odd days - 1/8 tablet less. This mode of administration is maintained for 14 days. In the absence of a withdrawal syndrome, 1/8 tablets can be canceled. For the next 4 weeks, the child takes a constant dose of prednisolone.

Dose reduction and withdrawal of prednisolone, as a rule, are accompanied by the development of a withdrawal syndrome, especially in patients who have received it for a long time. The withdrawal syndrome is manifested by myalgia, arthralgia, muscle tremors, fever, nausea, vomiting, and depression.

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

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

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

Undesirable phenomena:

short stature. It is not recommended to prescribe GC to children under the age of 5 years (especially up to 3 years), as well as in prepubertal age. The appointment of HA 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;
lag in sexual development;
arterial hypertension (isolated increase in systolic blood pressure (BP) or increase in systolic and diastolic blood pressure);
steroid osteoporosis. It develops in all patients treated for a long time with prednisolone. 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 be started as early as possible. Most pronounced in the thoracic and lumbar spine. Manifested by a decrease in the height of the vertebral bodies, compression fractures. Accompanied by symptoms of compression of the roots of the spinal cord;

obesity. It 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, striae, skin trauma, rough scars, worsening wound healing, steroid acne on the face and trunk);
development of hormone resistance:
- continuous relapses of the disease during treatment with maintenance doses of HA;
development of hormone dependence:
- exacerbation of the disease against the background of the withdrawal of GC;
withdrawal syndrome.

Intra-articular administration of HA

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

Excessive "passion" for local therapy is unacceptable. The introduction of HA is carried out no more than 1 time in 3-6 months in the same joint. Features of local HA 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 events 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;
pathology of blood coagulation;
ineffectiveness of the previous intravenous therapy.

After the introduction, 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, fatty necrosis, calcification;
tendon ruptures;
damage to the nerve trunks;
"post-injection" exacerbation;
erythema, sensation of heat.

In this regard, it is possible to refrain from intra-articular administration of HA. In the case of an adequate dose of an immunosuppressant and / or a biological agent, the activity of the articular syndrome, as a rule, decreases after 2-4 weeks of treatment, and it stops completely after 6-12 weeks of therapy. In the presence of pain and stiffness for this period, it is advisable to prescribe NSAIDs, as well as topical ointments and gels containing NSAIDs.

Non-steroidal anti-inflammatory drugs

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

Treatment should be started 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 well-tolerated drugs, while limiting the maximum doses of acetylsalicylic acid, indomethacin, piroxicam.

With long-term course 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 with 1/2-1 glass of water. After taking NSAIDs for 15 minutes, it is advisable not to lie down in order to prevent esophagitis. The time of taking the drug may also depend on the time of the most pronounced symptoms, taking into account the chronopharmacology of the drugs. This allows you to achieve the greatest effect with a lower daily dose. With morning stiffness, it is advisable to take rapidly absorbed NSAIDs as early as possible or to prescribe long-acting drugs at night.

The most commonly used diclofenac sodium at a dose of 2-3 mg/kg of body weight per day. In severe systemic manifestations, the appointment of NSAIDs should be avoided, as they can provoke the development of macrophage activation syndrome. The dosing regimen of various NSAIDs is presented in Table. 5.

The most characteristic 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, hemorrhages, bleeding, perforation of stomach and intestinal ulcers;
liver damage - increased activity of transaminases and other enzymes. In severe cases, jaundice, hepatitis may develop;
kidney damage: interstitial nephritis - "analgesic nephropathy". Fluid retention in the body, swelling, increased blood pressure;
from the side of the central nervous system: headache, dizziness;
on the part of 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, more often from the digestive tract;
hypersensitivity reactions - the appearance of a rash, Quincke's edema, signs of bronchospasm, the development of anaphylactic shock, Lyell's syndrome and Stevens-Johnson.

Immunosuppressive Therapy

Immunosuppressive therapy should be differentiated, long-term and continuous, starting immediately after the verification of the diagnosis during the first 3-6 months of the disease. Cancellation 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 at doses above 100 mg/m 2 /week. In rheumatology, methotrexate is used at doses below 50 mg/m 2 /week and has a weak immunosuppressive and more pronounced anti-inflammatory effect. Methotrexate reduces the activity of the disease, laboratory indicators of activity, induces seroconversion in the Russian Federation.

Indications:

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

Treatment regimen:

Methotrexate is most commonly given 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. In connection with the possible intolerance of the simultaneous administration of methotrexate in large doses, it can be administered fractionally, with a 12-hour interval, in the morning and evening, or 2 times a week.
In most patients with systemic variant JA, methotrexate at doses of 10-15 mg/m 2 /week does not significantly affect the activity of systemic manifestations of the disease. In JA with systemic onset, methotrexate is used in doses of 20-25 mg/m 2 /week, and in case of ineffectiveness in the form of pulse therapy at a dose of 50 mg/m 2 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/m 2 /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.
With polyarthritis, methotrexate is used in doses of 15-25 mg/m 2 /week, with oligoarthritis - 10-15 mg/m 2 /week.
The effect is estimated after 4-12 weeks. At these doses, methotrexate does not have a pronounced immunosuppressive effect and stops the destruction of the joints in the event of a decrease in laboratory activity indicators. To reduce the side effects of the drug, folic acid 1-5 mg / day should be taken on days free from taking methotrexate.

Undesirable phenomena:

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;
accession of a secondary (bacterial, viral, fungal, protozoal) infection;
dysmenorrhea, oligospermia;
alopecia, ecchymosis, acne, furunculosis.

To stop adverse events with 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 old, a single dose is 0.1 mg / kg of 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 for adults of 5 mg, for children over 2 years old - at a daily dose of 0.2 mg / kg, the maximum daily dose is up to 5 mg.

Cyclosporine

Cyclosporine causes not only symptomatic improvement, but also has a basic antirheumatic effect. Therapy with cyclosporine causes a decrease in indicators of disease activity, the severity of pain and synovitis, the duration of morning stiffness, and an improvement in the functional ability of the joints. Cyclosporine inhibits the progression of the destructive process in the cartilage and bone tissue of the joints, stimulates reparative processes. Cyclosporine improves functional status, minimizes disability in systemic JA. Reduces the rate of growth of structural changes in the joints, regardless of the dynamics of laboratory indicators of activity. Stops 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:

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

Treatment regimen:

The choice of the initial dose, as well as the correction of the dosing regimen during treatment, is carried out taking into account clinical and laboratory parameters.
The daily dose for oral administration 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.
The first 4 weeks of therapy with cyclosporine 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.
Increasing the dose is carried out under the control of indicators of peripheral blood (the number of red blood cells, platelets, leukocytes) and biochemical parameters (the concentration of creatinine, urea, bilirubin, potassium, the content of transaminases in the blood serum).
Do not exceed a daily dose above 5 mg / kg / day.
In patients with necrosis of the femoral head or with the threat of its development, as well as with the development of hemophagocytic syndrome, the dose of cyclosporine may be increased already during the first 2-4 weeks of therapy. Safety indicators in this case should be monitored once every 7-10 days.
The effect develops in 1-3 months and reaches a maximum within 6-12 months.

Undesirable phenomena:

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;
increase in blood pressure;
kidney dysfunction - the so-called nephrotoxicity, leading to an increase in the concentration of creatinine and urea in the blood;
increase in the concentration of potassium and uric acid in the body;
excessive hairiness;
reversible dysmenorrhea and amenorrhea;
slight anemia;
rarely - muscle spasms, muscle weakness, myopathy, thrombocytopenia.

Cytotoxic agents: Cyclophosphamide, chlorambucil, azathioprine are rarely used to treat JA due to low efficacy and a high frequency 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, stops the progression of bone and cartilage destruction. Significantly improves the functional ability and quality of life of patients. Leflunomide is effective in both early and advanced stages of RA. It slows down the progression of joint destruction. The drug is not registered according to JRA indications. However, the efficacy and safety of the drug in children was studied in a double-blind, placebo-controlled study. Given the significant efficacy and low toxicity, leflunomide can be prescribed when methotrexate is ineffective under the supervision of experienced rheumatologists.

Indications:

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

Treatment regimen:

Doses. With a body weight above 30 kg: 100 mg 1 time per day for the first 3 days, then 0.6 mg / kg 1 time per 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/m 2 /week in case of insufficient effectiveness of leflunomide.

Undesirable phenomena:

increase in blood pressure;
diarrhea, nausea, vomiting, anorexia;
diseases of the oral mucosa (aphthous stomatitis, ulceration of the lips);
pain in the abdominal cavity;
abnormal liver function (increased levels of transaminases, alkaline phosphatase, bilirubin);
slight loss of body weight;
headache, dizziness, asthenia, paresthesia;
tendovaginitis;
increased hair loss, eczema, dry skin;
leukopenia;
rash, itching, allergic reactions, urticaria;
hypokalemia;
taste disorder;
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

NCCH, 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 work properly, when the body's own antibodies are perceived as foreign.

Such a reaction can be caused by several reasons, among which the genetic predisposition to arthritis of a different nature is in the first place.

The second place is occupied by a negative ecological environment and malfunctions 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 dramatically increases in patients older than 40 years.

Features of the clinical course

The characteristic signs of the disease include:

inflammation is accompanied by an asymmetric lesion of the articular joints. As a rule, at the initial stage of the development of arthritis, 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 with a deeper examination of the patient, there is no severe deformity of the joints and rheumatoid nodes characteristic of all arthritis;
in rare cases, diagnosis 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 rheumatoid polyarthritis is much easier than other forms. With timely therapy, the prognosis for recovery is favorable.

Development of juvenile seronegative polyarthritis

Seronegative juvenile arthritis, which affects children from 1 to 15 years old, most often girls, has been singled out as a separate group. The disease occurs acutely, most often with a sharp increase in body temperature, painful swelling in the joints and general intoxication of the body.

First of all, juvenile arthritis symmetrically affects the ankle, elbow, hip and knee joints. The child is worried about pain when moving. Subsequently, muscle atrophy, contractures, and lymphadenitis are noted.

Polyarthritis of the seronegative form in childhood is treated in a hospital with bed rest and drug therapy. In acute symptoms, juvenile arthritis involves taking antihistamines (Loratadin, Erius, etc.), as well as NSAIDs (Ibuprofen, Butadione, etc.) with simultaneous physiotherapy and vitamin therapy. Surgery is performed only when absolutely necessary.

During remission, the child is recommended a rehabilitation course of spa treatment, gymnastics and massage. It is important to bear in mind that in order to prevent the development of juvenile arthritis, it is necessary to do all vaccinations, according to age and the vaccination schedule.

lechuspinu.ru

Treatment approaches

The treatment of rheumatoid arthritis is a rather laborious task that requires a competent approach from the doctor using modern therapeutic methods and an individual approach to patients.

At the moment, three main types of treatment for this disease have been developed:

The use of pharmacological preparations;
Non-drug treatment;
Rehabilitation.

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

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

How to treat rheumatoid arthritis? Suppression of immune activity is the primary task of the doctor in the management of such patients. Controlled immunosuppression is a very difficult task, requiring 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 the clinical manifestations of the pathological process. The severity of the effect of the application 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 activity of immune cell proliferation, as well as delay the development of the erosive process.
At the same time, the application non-steroidal anti-inflammatory drugs It is characterized by a rapid decrease in the intensity of the pain syndrome and an improvement in joint mobility, while 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 arthritis will not decrease. Preparations from this group do not affect the main factor of pathogenesis (autoimmune process), therefore, inhibition of joint destruction is not observed during their use.
Glucocorticosteroid drugs can influence both the suppression of immune activity and the decrease in the synthesis of inflammatory mediators. In the course of clinical studies, data were obtained on a decrease 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 taking can be felt already a few hours after intravenous or intramuscular administration. At the same time, monotherapy with glucocorticosteroids without the appointment of cytostatics and NSAIDs does not have a sufficient level of effectiveness, as a result of which combined use is recommended.

The group of non-drug treatment includes physiotherapy, diet, therapeutic exercises. Also, the 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 affect the pathogenesis of the disease.

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

Important! Where to be treated? A rheumatologist deals with the treatment of systemic diseases. If you suspect rheumatoid arthritis, you should consult a rheumatologist at the clinic. When the diagnosis is confirmed, treatment takes place on the basis of a rheumatological hospital. As the condition progresses, consultation with a traumatologist and physiotherapist may be required.

Spa treatment and subsidized medicines

The right to receive subsidized medicines can be used by any citizen who has any disability group and has not lost the right to receive social services in terms of drug provision. This right is protected by Federal Law #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 preparations for a certain group of people has been developed, which allows you to demand vital medicines for yourself and your loved ones. This group includes persons 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 require government assistance in purchasing drugs. The list of preferential drugs includes methotrexate, glucocorticoids and other drugs from the basic therapy of rheumatoid arthritis. 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, the regional budget assumes financial costs.

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

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

The list of preferential drugs that can be prescribed to patients with rheumatoid arthritis:

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 preparation of a solution for injection; solution for injection in graduated syringes
Leflunomide	coated tablets
Sulfasalazine	pills
infliximab	lyophilized powder for solution for intravenous administration
Rituximab	concentrate for solutionfor infusion
Abatacept	lyophilisate for solutionfor infusion

Also, citizens who are included in the privileged category can apply for treatment in a sanatorium at the expense of the state. The duration of spa 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 use 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 an instructor of physiotherapy exercises (LFK). Physical exercises can relieve the severity of pain and alleviate the general well-being of patients.

In some forums, it is also advised to engage in therapeutic fasting, visit Dr. Bubnovsky's clinic, or take ASD 2, but the effectiveness of these treatments is extremely doubtful and needs to be verified.

Details of preferential spa treatment should be obtained from the attending doctor of the medical organization where the patient is observed.

State specifics

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

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

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

If you do not treat the disease, then the pathological process spreads to larger joints (knee, elbow, shoulder). Less commonly, the disease affects the spine and hip joints. Treatment of all joints simultaneously is carried out with the regular intake of basic drugs.

Classification

It is customary to classify the stage of severity of rheumatoid arthritis 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. There is also periarticular osteoporosis, which manifests itself in the form of increased radiographic transparency of bone tissue. The narrowing of the joint space indicates the activity of the disease and the imminent transition to the next stage. A typical manifestation of rheumatoid arthritis at this stage is a mild or complete absence of symptoms. The first stage can last for years and at the same time does not bother the patient at all. In addition, it should be noted that the above described changes are not specific and may appear in other rheumatological diseases.
At the second stage bone is more involved in the pathological process. Radiologically, cystic areas of enlightenment in the area of the epiphyses of the metacarpal and phalangeal bones, an increase in the narrowing of the joint space, an unexpressed marginal deformity of the bones, and the appearance of erosions in the joints can be noted. 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 does not develop.
At the third stage X-ray signs fixed at the previous stage will increase. Severe destruction is observed in most joints of the hands and feet. At this stage, there is a significant deformation, 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 the fusion of the articular ends occurs, due to which the joint becomes immobile, both for passive and active movements. A pronounced deformation, reduction in size or destruction of the bone tissue of the hands is also added.

seronegative type

Of great diagnostic value in the diagnosis of rheumatoid arthritis is the analysis of the level of rheumatoid factor. Based on this analysis, two forms of the disease were identified - seronegative and seropositive. In the first case, the rheumatoid factor will be elevated, and in the second case it will 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 articular 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. Specific arthropathy in juvenile arthritis is not observed, so the destruction of the same joints will occur as in the usual form of the disease. Eye complications are also common in Still's disease:

Cataract;
Iridocyclitis;
Corneal degeneration.

As a result, I would like to say that despite the unfavorable prognosis and the high probability of developing disability, rheumatoid arthritis can and should be fought. Treatment is lifelong and includes a number of expensive drugs, but most patients are eligible for state assistance. In addition, it should be mentioned that thanks to radiography, it is possible to monitor the progression of the disease, so patients are advised to have regular x-ray examinations. Rheumatoid arthritis can develop at almost any age, so if you find similar symptoms in yourself or your loved ones, you should consult a doctor.

artrozmed.ru

According to the number of affected joints, they distinguish:

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 - the first and second. 80% of children suffering from type 1 oligoarthritis are girls. The disease begins at a young age, usually affects 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 problems with vision for life and in 20% of cases - with joints.

Oligoarthritis of the second type affects mainly boys. It develops later than type 1 oligoarthritis. In this case, large joints are affected, most often the hips. 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 in children who have had oligoarthritis of the second type, spondyloarthropathy persists (a disease of the joints and places of attachment of tendons to bones).

Polyarthritis is divided into positive and negative for rheumatoid factor. Both girls are the ones who suffer the most. Rheumatoid factor-negative polyarthritis can develop in children at any age and affects any joint. Occasionally, 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 children and affects any joint. Occasionally it is accompanied by sacroiliitis. In 50% of cases, severe arthritis persists for life in children who have had this disease.

60% of children with systemic rheumatoid arthritis are boys. The disease can develop in a child at any age. Any joint can be affected. Rheumatoid factor is absent. In 25% of cases, severe arthritis persists for life in those who have been ill.

By 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. Acute onset is more typical for generalized articular and systemic forms of the disease with a relapsing course. With a more common articular form, mono-, oligo- or polyarthritis develops, often symmetrical in nature, with the predominant involvement of large joints of the extremities (knee, wrist, elbow, ankle, hip), sometimes small joints (2nd, 3rd metacarpal phalangeal, proximal interphalangeal).

There are swelling, deformity 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), limitation of mobility, change in gait. Small children become irritable and may stop walking. There are cystic formations, hernial protrusions in the affected joints (for example, a cyst of the popliteal fossa). Arthritis of the small joints of the hands leads to a fusiform deformity of the fingers. In juvenile rheumatoid arthritis, the cervical spine (pain and stiffness in the neck) and TMJ ("bird's jaw") are often affected. The defeat of the hip joints usually develops in the later stages of the disease.

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

The systemic form is characterized by pronounced extra-articular manifestations: persistent febrile hectic fever, polymorphic rash on the limbs 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, while taking on a chronic relapsing course. Still's syndrome is more often observed in preschool children, it is characterized by polyarthritis with damage to small joints. Wissler-Fanconi syndrome usually occurs at school age and proceeds with the dominance 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, growth retardation. Type I oligoarthritis is accompanied by chronic iridocyclitis with the risk of vision loss, type II oligoarthritis is accompanied by spondyloarthropathy. The progression of juvenile rheumatoid arthritis leads to persistent deformity of the joints with partial or complete limitation of their mobility and early disability.

israel-clinics.guru

Seronegative polyarthritis: methods of treatment

The main difference between seronegative polyarthritis and other groups of rheumatoid arthritis are negative rheumatic tests. This greatly complicates the diagnosis and seronegative rheumatoid arthritis 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 a common disease called rheumatoid arthritis.

What is rheumatoid arthritis?

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

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

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

Painful joints begin to react painfully to palpation, swelling appears, stiffness develops, an increase in skin temperature is observed. If the stiffness and stiffness of the joints manifests itself in the morning and lasts more than 1 hour, then this is almost 100% evidence of the occurrence and development of processes associated with 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 a 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, obstruction of the upper respiratory tract, pneumosclerosis) and the cardiovascular system;
neurological disorders;
eye damage;
osteoporosis.

Key features of seronegative rheumatoid arthritis

As it became clear, seronegative polyarthritis is a form 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 onset 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 immunity as a foreign particle. The body begins to actively produce antibodies, which are precisely detected in laboratories.

The rheumatoid factor is involved 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.

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

Specificity of diagnosing seronegative rheumatoid arthritis

Seronegative polyarthritis is more acute than seropositive. Often there is a fever with temperature fluctuations of 3-4 ° C, chills. There is a noticeable increase in lymph nodes, weight loss, muscle atrophy, anemia. Unlike seropositive arthritis, which is characterized by symptoms of symmetrical polyarthritis, seronegative polyarthritis affects the joints in an asymmetric pattern. Initially, large joints begin to be involved in the disease, then the pathological process passes to the hands and feet. The wrists and wrist joints are most affected.

The main distinguishing feature of seronegative polyarthritis is that the Waaler-Rose reaction does not reveal rheumatoid factor. There is no significant increase in ESR and other indicators of the inflammatory process. A higher level of IgA is characteristic in comparison with seropositive rheumatoid arthritis. The asymmetry of erosive lesions is detected by radiography. With the help of this study, it is possible to identify a discrepancy between severe lesions of the carpal joints and not very pronounced changes in the small joints of the hand.

Features of the treatment of seronegative polyarthritis

Medicine has not yet found effective methods to fully cure polyarthritis. Modern methods of treatment are aimed at pain relief, reducing inflammation, 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 in the treatment of patients in the acute inflammatory period (pain, swelling of the joints and fever). NSAIDs minimize inflammation and reduce pain. Side effects of NSAIDs include gastrointestinal upset, 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 (prednisone, hydrocortisone and dexamethasone) are of primary importance in the treatment of rheumatoid arthritis. These are synthetic analogs of hormones produced by the adrenal glands. Corticosteroids can be given 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 lowered or the drug is discontinued.

Seronegative polyarthritis is more difficult to respond to basic therapy than seropositive one. More often develops, such a side effect as secondary amyloidosis. 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 that of the seropositive variant.

Doing self-medication with rheumatoid arthritis is categorically contraindicated. The correct group of drugs can be prescribed only by a highly specialized doctor (a rheumatologist, and even better, an arthrologist). Surgical intervention is used only at an advanced stage of arthritis. Optimal treatment includes not only medication, but also FLC, a balanced diet, and a healthy lifestyle. Traditional medicine also facilitates the course of the disease, but should only be used 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 occurrence of a feverish state, swelling and soreness of the joints, intoxication of the body testify to the inflammatory process. First, the disease affects the knee, elbow, ankle, hip joints, then goes to the cervical spine, wrist, jaw, joints.

The lesion is most often symmetrical. In the joints there is an accumulation of exudate. The child complains of pain during movement. Muscular atrophy, hypotension, contractures are noted. The radiograph shows the presence of an increased neoplasm of bone tissue from the side of the periosteum with simultaneous resorption.

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

Treatment for juvenile seronegative polyarthritis must be carried out in a hospital. Strict adherence to bed rest, the use of antibiotics in the acute period are shown. Mostly used NSAIDs (aspirin, butadione, amidopyrine), antihistamines. Glucocorticoid drugs are used in courses of 1-2 weeks, prednisolone is mainly prescribed. In schoolchildren with an acute course of the disease, indomethacin, brufen, delagil, chloroquine can be used. With juvenile polyarthritis (seronegative), in combination with basic therapy, physiotherapy, vitamin courses, plasma transfusion, and aloe are effective measures. In remission, sanatorium treatment, therapeutic massage and gymnastics are useful measures. On consultation with an orthopedist, surgical intervention is possible.

For the prevention of the disease, adherence to the schedule of necessary vaccinations is of great importance, in order to avoid the spread of streptococcal infection, proper care of the child is necessary.

According to ICD10, seronegative rheumatoid arthritis refers to inflammatory polyarthropathies (class M diseases), has the code M06.0. The disease is associated with damage to the joints. The seronegative form means the absence in the results of a blood test of one of the main criteria in diagnosis - rheumatoid factor. Pathology is dangerous by the development of complications that can lead to disability of the patient. The article will help to recognize the disease, learn modern methods of treatment.

Etiology of the disease

Seronegative arthritis is a joint disorder that impairs the functioning 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. By 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 is also in the severity of the course of the disease. The first form is less prone to complications, the patient rarely has an extra-articular lesion, the symptoms are more easily tolerated than the second form. With seropositive arthritis, the patient often has stiffness, curvature of the fingers, morning stiffness of the joints, and erosive changes.

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

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

The patient has dysfunction of the joints;
There is a deformity of the hip joint;
Contracture develops (narrowing, contraction);
There is tight mobility in the work of the joints in the morning;
The appearance of extra-articular lesions;
Interphalangeal, metatarsophalangeal, metacarpophalangeal joints are affected.

The disease has several stages of course:

At the initial (first) stage, doctors diagnose only periarticular osteoporosis (bone density decreases, mineralization decreases over time);
After that, in addition to osteoporosis, there is a narrowing of the connective gap;
At the third stage of development, bone erosion is added to the previous symptoms;
The fourth stage combines the signs of the first three, manifested by the presence of ankylosis of the compounds.

Scientists have been figuring out for many years what becomes the decisive factor in the onset 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 body's immune system;
Injuries;
hereditary factor;
Infectious lesions of the joints;
Allergic reaction;
Viral diseases;
External adverse factors (smoking, polluted environment).

Symptoms, comorbidities

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

The following symptoms indicate the disease:

Damage to the joints, manifested in a change in their shape and soreness;
Increased fatigue;
Enlarged lymph nodes;
Slimming;
According to the general blood test, there is an acceleration of ESR, signs of anemia;
Body temperature, keeping at around 37.0-37.5 degrees;
increased sweating;
Fever in an acute course;
General weakness;
Inflammatory process in the internal organs;
Absence of rheumatoid nodes;
Decreased appetite.

With untimely diagnosis and treatment, 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 stiffness of the joints in the morning, erosion and osteoporosis, 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 is manifested by severe pain due to the inflammatory process, 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 is manifested by the following symptoms:

General intoxication of the body;
soreness;
Sudden increase in body temperature;
Swelling in the joints.

It is possible to distinguish juvenile seronegative polyarthritis by brightly flowing symptoms, an acute course. Pathology symmetrically affects the hip, elbow, ankle, knee joints. It is difficult for children with this diagnosis to walk, pain occurs when moving.

Diagnostics

Due to the fact that the symptoms of seronegative rheumatoid arthritis are less pronounced, it is more difficult to recognize in the diagnosis. Doctors after collecting an anamnesis conduct a mandatory x-ray examination. It helps to detect minimal changes in the shape of the foot invisible to the eye, the presence of osteoporosis, the predominance of ankylosing.

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

Treatment

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

The first group of basic anti-inflammatory drugs includes: azathioprine, sulfasalazine, penicillamine, cyclosporine, etc. NSAIDs include Diclofenac, Nimesulide, Celecoxide. They are designed to relieve pain, relieve swelling. Among synthetic and biological drugs, Rituximab, Infliximab, Tocilizumab are used. Glucocorticoids allow you to maintain remission longer, help you achieve positive results in treatment faster. Used drugs: Metipred, 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 complex of treatment must include:

Physiotherapy;
Mode (limitation of strong physical exertion, rejection of bad habits);
Compliance with a diet (polyunsaturated fatty acids, fresh vegetables and fruits should prevail in the menu);
Physiotherapy.

Non-traditional methods of treatment

Your doctor may recommend home remedies for seronegative rheumatoid arthritis. Good help in non-traditional therapy is the manufacture of natural ointments and tinctures for rubbing. They help to quickly relieve pain, swelling, and allow you to maintain a long-term remission.

Turpentine and honey ointment are popular. They can be used not only by adults, but also by children from 12 years old. To prepare turpentine ointment, it is necessary to mix camphor (3 g.), Olive oil (150 ml.), Turpentine (150 ml.), Alcohol (70%) well. 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. The products are thoroughly mixed: 150 ml. flower honey, half a glass of vodka, 15 g of salt, 200 ml. black radish juice. The resulting ointment is rubbed 2 times a day until the complete disappearance of pain and swelling.

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. The resulting solution is blotted with cotton fabric, applied to the sore spot. The compress relieves pain well. Apply 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, use medication and non-drug methods, folk remedies in treatment. With the right treatment, patients can achieve a stable stage of remission.

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

Fig.2. General view of the patient on the background of infliximab therapy.

Fig.3. Functional capacity of the wrist joints before infliximab therapy.

Fig.4. The functional ability of the wrist joints is not the background of infliximab therapy.

Fig.5. Functional capacity of the knee joints before infliximab therapy.

Fig.6. The functional ability of the knee joints is not the background of infliximab therapy.

Fig.7. Functional capacity of the knee joints before infliximab therapy.

Fig.8. The functional ability of the knee joints is not the background of 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 markedly. Due to inflammation in the joints, which manifest itself against the background of various infections (flu, SARS), including the digestive organs and the genitourinary system, this problem slowly comes 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, progressing due to immune dysfunctions. Inflammation is more likely to affect the knee, ankle, lumbar spine, and metatarsophalangeal joints of the big toes. Different from adults, the development and course of the disease is observed in children with disease of the hip joint. Less common are lesions of small carpal joints.

In children, pain in the affected area occurs more often not with motor activity, but with pressure on the joint and periarticular region. So, for the disease, a characteristic feature is soreness in the area of \u200b\u200bthe connection of the Achilles tendon and the heel bone. Young children may retain their usual mobility, be active, but complain of pain when pressure is applied to it.
place.

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

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

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

Features of the defeat of 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 have only symptoms of ordinary conjunctivitis (as a complication of SARS), which is why doctors cannot associate such manifestations with joint disease for a long time. It is only after inflammation of the urethra joins the symptoms that 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;
soreness with various movements, pressure on the joint;
joint deformity.

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 often observed with inflammation of the hip, knee joint).

In this article, we tell you why it appears and what is dangerous about dorsal disc protrusion.
How to identify and treat protrusion of the lumbar spine, you can learn 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 distinctive signs and causes.

Infectious

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

Symptoms of infectious arthritis are pronounced, developing rapidly.

fever;
headache;
lethargy;
loss of appetite.

a volumetric increase in the joint in which inflammation develops (for example, a clear increase in the knee joint);
skin hyperthermia;
joint pain, sharply increasing with movement.

Viral

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

Usually, 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 diseased joint;
temperature increase (local);
pain on movement or palpation;
a slight decrease in motor activity in the joint.

Post-vaccination

Occurs a few weeks after vaccination against the background of a post-vaccination reaction (temperature, intoxication). In children, there is a "volatility" of the lesion (one day one joint hurts, another day another). Often the course of the disease is benign, and the symptoms disappear within 10-14 days after the first manifestations (it happens that on their own).

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

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

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 is rapidly progressing, proceeding both in the articular form and in the systemic form (with the involvement of internal vital organs).

In the articular form of juvenile arthritis, there is:

symmetrical joint damage;
pain syndrome in the affected area;
swelling of the tissue around the diseased joint;
hyperthermia;
skin rash;
enlargement 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;
enlargement of the spleen.

Post-streptococcal arthritis (rheumatism)

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

Diagnostics

It is possible to suspect the presence of 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;
collection of anamnesis;
a general blood test (in case of a disease, an increased level of leukocytes, ESR can be detected, however, ARVI can give such data));
general urinalysis (characterized by an excess of the norm of the content of leukocytes);
rheumatic tests;
smears from the conjunctiva of the eye, cervical and urethra;
sowing feces;
serological tests for the detection of antibodies to pathogens of intestinal infections;
linked immunosorbent assay;

examination of the periarticular fluid;
analysis for the detection of the 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 the treatment is to fight the infectious agent, for which children are recommended to take antibacterial drugs. The choice of medicines is made by the doctor, depending on which infection caused the disease, its sensitivity. Macrolides are often used.

To save a child

from inflammation, they are treated with non-steroidal anti-inflammatory drugs

, the most effective of which are:

Diclofenac;
ibuprofen;
Naproxen;
Meloxicam.

Chronic or protracted 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, the inflammation affects the junctions of the tendons, 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 the motor functions of the joint.

Juvenile rheumatoid arthritis: causes of diagnosis, symptoms (photo) 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. Girls are predominantly affected.

Juvenile rheumatoid arthritis (or Jura for short) can progress to 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.

Tip: 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, coordination of movements are a reason to be examined by a rheumatologist to confirm or deny the Jura

Jura classification

Juvenile arthritis is a collective term for all rheumatoid diseases in children. There is an official classification of the Jura:

JRA M 08.0 - juvenile rheumatoid arthritis;
JPA, juvenile psoriatic arthritis;
JuHA, juvenile chronic arthritis (seronegative polyarthritis M 08.3);
JCA M 08.1 - juvenile ankylosing spondylitis;
M 08.2 - juvenile arthritis with a 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 in 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.
Articular inflammation arose for the first time and does not apply to other nosological forms.

Such a classification is considered general, each term, taken separately, does not have its own definition and is most often indicated in the case history as "chronic inflammation of the joints in children under 16 years of age."

Jura symptoms

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

Deformation of the small joints of the hands;

Symmetric polyarthritis of the joints of the arms and legs;

The formation of rheumatoid nodules;

The presence of destructive arthritis.

According to the results of the examination, seropositivity for the Russian Federation is manifested

How does juvenile arthritis progress in children?

According to the nature of the flow, two forms of the Jura are distinguished:

Acute - the symptoms are very strong, frequent relapses are observed, the prognosis is unfavorable.
Subacute - the same symptoms, but less pronounced, treatable better.

By localization, the Jura happens:

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.

Causes of the Jura

The trigger for the development of juvenile arthritis can be such factors:

Severe hypothermia.
hereditary predisposition.
Joint and ligament injuries.
Inappropriate drug therapy.
Viral or bacterial infection.

In some cases, excessive exposure to the sun becomes the cause of the disease.

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 pains and stiffness in movements.

Typical localization for the Jurassic is the maxillotemporal joints and the cervical spine. Sometimes similar to periarthritis of the shoulder, so it is important to correctly diagnose.

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

Extra-articular signs of the disease include:

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

If the temperature drops, the child literally sweats, his underwear and bed linen get wet through. This stage of the Jura can last from several months to several years if not diagnosed and treated. And only then will damage to the joints appear.

Note: red eyes in a child are a typical sign of the Jura, 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 are manifested, the nature of the disease is systemic. Often there are relapses, treatment is ineffective.

Arthritis in children in this form has the same symptoms as in acute, but they are not so severe and often manifest. 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 stand up, all the time either asks to be held or sits.

Older children complain of "morning stiffness". The child cannot get out of bed and do simple household chores on his own. The gait changes: it becomes very slow, as if every step hurts. In this state, it can be up to an hour, until the joints are developed.

Often, for this reason, parents and doctors take the disease as a simulation, explaining this by the fact that the child simply does not want to go to school or kindergarten. If the pediatrician claims that the child is pretending, it makes sense to go to another, more attentive and qualified physician.

In girls of preschool and primary school age, Jura is often manifested by rheumatoid eye damage. This disease is called rheumatoid uevitis, unilateral or bilateral. Since the disease affects all the shells of the eyeball, in just six months, vision is sharply reduced to its complete loss.

Rarely, 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.

Juvenile systemic 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 Wieseler-Fanconi syndrome.

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

The kidneys suffer the most, and a large amount of protein is 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 detect osteoporosis (bone tissue loses density), bone erosion, and a decrease in the gaps between the joints.
MRI, CT and NRT. Using these diagnostic methods, the doctor can determine how badly damaged cartilage 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, determination of the level of C-reactive protein.

According to the results of analyzes and examinations, complex therapy is prescribed.

How is jura treated

The treatment program for children is compiled depending on the form of the disease and the condition of the joints. In the "quiet" period, diet is mandatory. Food should be low-calorie, 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;
The 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 such drugs:

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

If the disease is provoked by an infection, it is necessary to conduct a course of antibiotic therapy. If the disease has an immunocomplex etiology, plasmapheresis is used. With very severe pain, drugs are administered intraarticularly.

In some cases, immunotherapy gives a positive result. Immunoglobulin is administered intravenously by drip. It is important to observe the technique of drug administration. In the first 15 minutes, 10-20 drops of the drug are injected every minute, then the rate increases. You can repeat the procedure every month.

In severe forms of the disease and advanced cases, when conservative methods of treatment were ineffective, a surgical operation is performed - joint arthroplasty.

As for the treatment of rheumatoid uevitis, this complication is treated jointly by a rheumatologist and an ophthalmologist. For local treatment, a combination of corticosteroids 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 kept to a minimum. This means that the diet should not contain sausages, hard cheeses, pickles, homemade food should also be salted very moderately. Thus, the intake of sodium in the body is reduced.

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

To maintain muscle tone and joint mobility, a set of gymnastic exercises is prescribed. As supportive and preventive measures, massage, a variety of physiotherapy, trips to resorts and sanatoriums are very useful.

Tip: do not limit the child, if he has been diagnosed with a similar diagnosis, in communicating with peers and playing sports. He may well attend various sections and take part in outdoor games. Then, in case of an exacerbation of the disease, complications and consequences will be minimized.

It is noted that the disease proceeds in a milder, milder form if the child leads an active lifestyle. In weak, lethargic children, the symptoms, on the contrary, 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 the treatment was started late, was carried out in bad faith, or was completely absent - then what threatens juvenile rheumatoid arthritis? First of all, the fusion of articular elements will progress. And this leads to their complete dysfunction, immobility, as a result - the disability of the child.

Effects on the kidneys, liver and heart lead to the development of chronic pathologies of these organs, which also negatively affects the general condition of children. With advanced rheumatoid uevitis, the child can become completely blind. It should be remembered that the destroyed articular tissues are not restored. And the operation 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 the 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 (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 bone deformity.
Decreased rate of skeletal formation.

Not so long ago, it was found that this balance can be disturbed at any stage of a person's life. There is such a thing as congenital osteoporosis. It can occur as a result of a violation of intrauterine development. It can be induced:

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

Symptoms of juvenile osteoporosis can 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 an unadapted mixture;
lack of solar radiation and hypovitaminosis (especially insufficient amount of vitamin D);
non-compliance with hygiene standards.

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

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

The influence 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. To provoke the development of osteoporosis in children can:

hormones of a glucocorticosteroid nature, which are usually prescribed for the treatment of autoimmune and inflammatory diseases;
anticonvulsants, which are used for epilepsy;
chemotherapy agents;
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 affected to a large extent, the child may complain of pain in the region of the ridge, legs, quickly onset fatigue in a standing position or while sitting. At first, the pain disappears when the child takes a certain position, but in the future it becomes constant and aching.

Often, the presence of osteoporosis in a teenager begins to be assumed after a repeated fracture that happened without much trauma. The most common places of violation of the integrity of the bone tissue are the vertebral bodies, femoral neck, humerus and ulna. If the child makes a sudden movement, there may be acute pain and symptoms of an altered limb shape.

For vertebrae, a compression fracture is typical, for which displacement is not typical.

Symptoms for suspecting osteoporosis in a child:

low growth compared to other children of the same age;
posture reformation, which consists in rounding the chest region, straightening the deflection in the lower back, protruding abdomen;
when the spine is bent to one side, asymmetric skin folds may occur on one of the sides of the body.

If congenital osteoporosis occurs, the most prominent radiological findings are:

decrease in 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, bone mineral density is measured to diagnose osteoporosis in children. The technique is called densitometry.

Goals and methods of treatment

The therapy helps very well for the treatment of children diagnosed with juvenile osteoporosis, but only if you turn to specialists on time. Treatment aims to:

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

To perform the first task, a course of symptomatic therapy is prescribed as a treatment, which is as follows:

prescribing a child a special diet rich in proteins, calcium and phosphorus;
development of a complex 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 violations in the skeleton;
if pain is present among the symptoms of the disease, treatment includes the appointment of painkillers and the wearing of a special supporting corset.

During treatment, the following medicines can be used to combat the causes of the development 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 STH and steroids;
means to normalize the general condition of the patient. Vitamin D is the most commonly used during treatment.

Since the treatment of children with the use of hormonal substances may not have the best effect on the health of children, preference is given to drugs from the last group. To prevent osteoporosis at an early age, children can be given preparations 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 therapy, complications of various 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 work properly, when the body's own antibodies are perceived as foreign.

Such a reaction can be caused by several reasons, among which the genetic predisposition to arthritis of a different nature is in the first place.

Features of the clinical course

The characteristic signs of the disease include:

inflammation is accompanied by an asymmetric lesion of the articular joints. As a rule, at the initial stage of the development of arthritis, 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 with a deeper examination of the patient, there is no severe deformity of the joints and rheumatoid nodes characteristic of all arthritis;
in rare cases, diagnosis 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 rheumatoid polyarthritis is much easier than other forms. With timely therapy, the prognosis for recovery is favorable.

Development of juvenile seronegative polyarthritis

Treatment

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

Polyarthritis involves the following treatment:

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

Like any polyarthritis, the seronegative form provides for the mandatory observance of a therapeutic diet, as well as acceptable forms of gymnastics and massage.

It must be remembered that prior to the start of therapy, a preliminary consultation with a doctor is required, which will help to avoid undesirable consequences in the future. Self-administration of medicines is unacceptable!

lechuspinu.ru

Why does the disease appear

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

In order to understand what rheumatoid arthritis and affected joints look like, you can look at the photo. At the moment, the etiology of the disease is not yet fully understood. It is only known for certain that the causes of rheumatoid arthritis are all possible influences of pathogenetic autoimmune changes.

An increased level of leukocytes in the blood signals the infectious nature of the disease, this is also indicated by an increase in the 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, there is the appearance of immune complexes that have the ability to be deposited in joint tissues, provoking their inflammation and damage.

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

Treatment of rheumatoid arthritis consists in relieving the pain syndrome with drugs, slowing down the course of the disease and restoring damage by surgical intervention.

Diagnosis of rheumatoid arthritis at the earliest stages of its development allows minimizing the harm that juvenile rheumatic arthritis can bring to the body.

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

Seronegative and seropositive polyarthritis

Rheumatoid arthritis was discovered during excavations on the skeletons of people buried over 4500 BC. This fact was recorded by scientists in the photo. The document, which listed the symptoms of the disease, is dated as early as 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 arthritis of the joints is called "juvenile" that is, youthful. Although you need to understand that there is precisely 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. Diagnose the disease most often at the age of 30-35 years.

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

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

The infectious factor includes triggers of rheumatic ailments. Among them stand out:

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

trigger factor. A child who is breastfed 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 twice as rarely in those children who receive natural breast milk for two years. And in this case, the question does not arise of how to treat seronegative (absence of rheumatoid markers in the blood) or seropositive (rheumatoid markers in the blood are found) juvenile arthritis of the joints and its symptoms.

The triggers of the disease are arthritogenic infections living in the patient's body. The development of inflammation in polyarthritis is influenced by type I T-helpers. 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 fever. The most common are the following:

Classic variant. It is characterized by a slow flow. The disease develops with damage to all small joints simultaneously.
In the course of the disease, large diarthroses are affected, most often it is the knees.
Pseudoseptic variant of polyarthritis. The disease is accompanied by hyperhidrosis, fever and weight loss.
Articular-visceral type. In 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 from 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 simultaneously affected. The more joints involved in the inflammatory process, the more difficult it is to cure juvenile arthritis.

In addition to disorders in the joints, there are other symptoms:

Loss of appetite.
Stiffness in the joints in the morning.
The occurrence of symptoms according to the type of influenza condition.
Weakness.
Depression.
Sharp muscle pains.
Pain while sitting.
Violation of the excretory function of the salivary glands.

sustav.info

Treatment approaches
State specifics
Classification
seronegative type

To date, 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 on the part of the internal organs and the osteoarticular apparatus. Treatment, prevention and diagnosis of this group of diseases is studied by a section of medicine called rheumatology, and rheumatoid arthritis is considered the most common pathology.

What is this disease? This is a systemic pathological process that mainly affects the connective tissue and is accompanied by chronic inflammation of the joints. Basically, rheumatoid arthritis 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.

Until now, the causes that cause the body to attack itself have not been identified, but factors have been identified that increase the risk of developing failures in the immune system. This group of "provocateurs" includes SARS, acute tonsillitis, infectious mononucleosis. According to research 1% of the world's population make this diagnosis, and women are much more likely than men. After 50 years, the risk of morbidity increases significantly and can reach 5%. Rheumatoid arthritis in children is not as common as in adults and usually occurs before the age of 16.

Treatment approaches

The treatment of rheumatoid arthritis is a rather laborious task that requires a competent approach from the doctor using modern therapeutic methods and an individual approach to patients.

At the moment, three main types of treatment for this disease have been developed:

The use of pharmacological preparations;
Non-drug treatment;
Rehabilitation.

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

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

Immunosuppressive drugs are used to reduce activity and reduce the clinical manifestations of the pathological process. The severity of the effect of the application 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 activity of immune cell proliferation, as well as delay the development of the erosive process.
At the same time, the application non-steroidal anti-inflammatory drugs It is characterized by a rapid decrease in the intensity of the pain syndrome and an improvement in joint mobility, while 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 arthritis will not decrease. Preparations from this group do not affect the main factor of pathogenesis (autoimmune process), therefore, inhibition of joint destruction is not observed during their use.
Glucocorticosteroid drugs can influence both the suppression of immune activity and the decrease in the synthesis of inflammatory mediators. In the course of clinical studies, data were obtained on a decrease 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 taking can be felt already a few hours after intravenous or intramuscular administration. At the same time, monotherapy with glucocorticosteroids without the appointment of cytostatics and NSAIDs does not have a sufficient level of effectiveness, as a result of which combined use is recommended.

Important! Where to be treated? A rheumatologist deals with the treatment of systemic diseases. If you suspect rheumatoid arthritis, you should consult a rheumatologist at the clinic. When the diagnosis is confirmed, treatment takes place on the basis of a rheumatological hospital. As the condition progresses, consultation with a traumatologist and physiotherapist may be required.

Spa treatment and subsidized medicines

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

The list of preferential drugs that can be prescribed to patients with rheumatoid arthritis:

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 preparation of a solution for injection; solution for injection in graduated syringes
Leflunomide	coated tablets
Sulfasalazine	pills
infliximab	lyophilized powder for solution for intravenous administration
Rituximab	concentrate for solutionfor infusion
Abatacept	lyophilisate for solutionfor infusion

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

Details of preferential spa treatment should be obtained from the attending doctor of the medical organization where the patient is observed.

State specifics

Classification

It is customary to classify the stage of severity of rheumatoid arthritis 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. There is also periarticular osteoporosis, which manifests itself in the form of increased radiographic transparency of bone tissue. The narrowing of the joint space indicates the activity of the disease and the imminent transition to the next stage. A typical manifestation of rheumatoid arthritis at this stage is a mild or complete absence of symptoms. The first stage can last for years and at the same time does not bother the patient at all. In addition, it should be noted that the above described changes are not specific and may appear in other rheumatological diseases.
At the second stage bone is more involved in the pathological process. Radiologically, cystic areas of enlightenment in the area of the epiphyses of the metacarpal and phalangeal bones, an increase in the narrowing of the joint space, an unexpressed marginal deformity of the bones, and the appearance of erosions in the joints can be noted. 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 does not develop.
At the third stage X-ray signs fixed at the previous stage will increase. Severe destruction is observed in most joints of the hands and feet. At this stage, there is a significant deformation, 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 the fusion of the articular ends occurs, due to which the joint becomes immobile, both for passive and active movements. A pronounced deformation, reduction in size or destruction of the bone tissue of the hands is also added.

artrozmed.ru

Alternative title:

Polyarthritis chronic nonspecific, infectarthritis

Disease code:

www.medsovet.info

Causes of pathology

Pauciarticular juvenile arthritis is considered an autoimmune disease, so the role of hereditary factors in the occurrence of a pathological failure in the body is great. Why the own immune system begins to perceive the cells of the synovial membrane as alien 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 radiation;
Joint injury;
Vaccination;
Past infections: bacterial and viral;
Exchange disorders;
Allergic diseases and a tendency to anaphylaxis: Quincke's edema, urticaria, eczema, neurodermatitis, bronchial asthma, etc.

Manifestations of the disease

Clinicians distinguish between two subtypes of pauciarticular juvenile arthritis: persistent and advanced, although this division is arbitrary. The classification distinguishes 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 debut occurs at an early age, when the child does not know how to speak well, clearly localize the pain, describe his feelings, the visit to the doctor occurs already at the height of the disease, when the symptoms of intoxication and inflammation in the joint come first. The knee is most commonly affected. Characterized by pain, swelling, discoloration of the skin, a local increase in temperature. The pain increases gradually, the child limps, spares the limb, refuses the usual active games, cries.
Of the non-specific symptoms, there may be a decrease in appetite and weight loss, swollen lymph nodes, weakness, rash, a slight increase in body temperature, drowsiness and irritability. On the part of the musculoskeletal sphere, due to the transition of inflammation to the 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 join. Subsequently, with the course of the pauciarticular form of the disease, deformity, growth retardation, and limb shortening occur.

Diagnostic measures

The pauciarticular juvenile variant of JRA is quite difficult to differentiate from other ailments, since the 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, carry out:

Complete blood count - shows the presence of an inflammatory reaction in the body (leukocytosis, elevated ESR, shift of the formula to the left, anemia);
Complete urinalysis - helps to exclude infection of the genitourinary system and systemic complications from the kidneys;
Biochemical studies: the presence or absence of acute-phase inflammation proteins - CRP, ceruloplasmin, total protein, albumins, antistreptolysin-O and others;
Immunological and cytological examination reveals the presence or absence of specific immune complexes, immunoglobulins, antinuclear and rheumatoid factors;
Radiography, 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 therapeutic and diagnostic method that detects the presence of fluid, allowing it to be sampled for microbiological examination, as well as to inject medicinal substances directly into the inflammation site;
Ultrasound scanning of the joints and internal organs - 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 of narrow specialists is mandatory: an ophthalmologist, a neurologist, a cardiologist.

Treatment Methods

Treatment for pauciarticular juvenile arthritis should be comprehensive, including both drug support and diet and exercise dosing. Etiotropic (directed to the cause) therapy in this case is impossible, since the cause of the disease is unknown. The drugs 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) - 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 a pathogenetic therapy that prevents further destruction of one's own cells and tissues. These include several groups of drugs:

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 gives a good effect: ultrasound, magnetotherapy, laser. During the period of remission, applications with paraffin or mud are shown.

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

ethnoscience

Recipes for combating diseases of the musculoskeletal system have been known since antiquity and can be used as concomitant basic medical care.

Forecast and prevention

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

To achieve remission, you must:

Avoid taking immunostimulants, interferons;
Avoid prolonged exposure to the sun;
Prohibited ultraviolet radiation, vaccination;
It is required to lead a healthy lifestyle, sanitize foci of chronic infection, regularly engage in moderate exercise.