Arthritis at children – etiologichesk diverse group of the rheumatic diseases proceeding with inflammatory defeat of all elements of joints. Arthritis at children is shown by local changes (reddening, a swelling, pain, restriction of mobility in a sore joint) and the general symptoms (temperature increase of a body, refusal of outdoor games, weakness, the child's capriciousness). The diagnosis of arthritis at children is established on the basis of given the anamnesis, laboratory researches, ultrasonography, a X-ray analysis, KT, MPT of joints. Treatment of arthritis at children includes medicamentous therapy, physiotherapy exercises, physical therapy, massage, a temporary immobilization of a joint.
Arthritis at children
The concept "arthritis at children" unite various by origin and to the course of a disease, proceeding with an articulate syndrome and arising at children's age. In pediatrics and the nursery rheumatologyof arthritis comes to light at each thousand child. Importance of studying of a problem of arthritises at children is defined by its social importance, namely – high degree of an invalidization of young patients who as a result of a disease often lose elementary functions of self-service and cannot do without the help of adults.
Classification of arthritis at children
The most frequent forms of arthritises at children are: rheumatic arthritis, juvenile rheumatoid arthritis, juvenile ankiloziruyushchiya spondiloartrit, the jet arthritises and arthritises associated with an infection.
Rheumatic arthritis is one of displays of rheumatism at children (along with revmokardity, small horey, ring-shaped eritemy, rheumatic small knots) and etiologichesk is connected with the postponed streptococcal infection (quinsy, scarlet fever, pharyngitis).
Juvenile rheumatoid arthritis is characterized by chronic inflammatory damage of joints of an unknown etiology; arises at children aged up to 16 years; has steadily progressing current; sometimes is followed by involvement of internals. Rheumatoid arthritis at children can proceed in an articulate form (as monoarthritis, an oligoartrit or polyarthritis) or a system (articulate and visceral) form with damage of heart, lungs, reticuloendothelial system, from vaskulita, poliserozity, uveity etc.
Juvenile ankiloziruyushchiya spondiloartrit (Bekhterev's disease) proceeds with a chronic inflammation of a backbone and peripheral joints. In 10-25% of cases the disease is debuted at children's age.
Jet arthritises at children – group of aseptic inflammatory diseases of the joints developing as a result of the postponed extra articulate infection. At children carry postenterokolitichesky and urogenital arthritises to jet arthritises. Some authors carry a syndrome of Reuters to jet arthritises.
Infectious arthritises at children, include the articulate syndromes which developed owing to viral, bacterial, fungal, parasitic infections, Lyme's disease. At infectious arthritis activators get directly into a joint cavity with current of a lymph, blood, as a result of manipulations or injuries.
The arthritis reasons at children
The etiology of juvenile rheumatoid arthritis is definitely not established. Among the reasons of this form of arthritis at children heredo-familial predisposition, and also influence of various exogenous factors is considered (a viral and bacterial infection, articulate injuries, proteinaceous medicines, etc.). In response to external influences in an organism of the child IgG which are perceived by immune system as autoantigena that is followed by development of antibodies (anti-IgG) are formed. At interaction with autoantigeny antibodies form immune complexes, the having damaging effect on a sinovialny cover of a joint and other fabrics. As a result of the difficult and inadequate immune answer the chronic progressing disease of joints - juvenile rheumatoid arthritis develops.
Juvenile ankiloziruyushchiya spondiloartrit is a multifactorial disease in which development the big role is taken away from hereditary predisposition and to infectious agents (a klebsiyella and other enterobakteriya).
Postenterokolitichesky jet arthritises at children are connected with the postponed intestinal infection: iyersiniozy, salmonellosis, dysentery. Urogenital jet arthritises, as a rule, are a consequence of the urinogenital infection (an uretrit, cystitis) caused by a hlamidiya or an ureaplasma.
Infectious arthritises at children can be connected etiologichesk with a viral infection (a rubella, an adenoviral infection, epidemic parotitis, flu, viral hepatitis), vaccination, a nasopharyngeal infection of a streptococcal etiology (chronic tonsillitis, antritis, pharyngitis), tuberculosis, gonorrhea, skin infections (mycoses, dermatitis), etc. Developing of arthritis at children is promoted by adverse social conditions (insanitary conditions, dampness indoors), frequent overcoolings, insolation, the weakened immunity.
Arthritis symptoms at children
Juvenile rheumatoid arthritis
At an articulate form of arthritis at the child one or several joints can be surprised (more often symmetric) that is followed by their morbidity, hypostasis and hyperaemia. Involvement in pathological process of large joints is usually noted (knee, talocrural, luchezapyastny), small joints of legs and hands suffer less often (interphalanx, plusnefalangovy). Morning constraint in joints, gait change is observed; children up to 2 years can absolutely cease to go.
At the sharp course of arthritis at children body temperature can increase to 38-39 °C. The articulate form of arthritis at children quite often proceeds with uveity, limfadenopatiy, polymorphic rash on skin, increase in a liver and spleen.
The articulate and visceral (system) form of arthritis at children is characterized by artralgiy, limfadenopatiy, persistent high fever, polymorphic allergic rash, a gepatosplenomegaliya. Development of myocarditis, a poliserozit (a perikardit, pleurisy), anemias is characteristic.
Progressing of arthritis at children leads to development of permanent deformation of joints, partial or full restriction of mobility, an amiloidoz of heart, kidneys, a liver, intestines. 25% of children with juvenile rheumatoid arthritis become disabled people.
Juvenile ankiloziruyushchiya spondiloartrit
The symptomatology includes articulate a syndrome, ekstraartikulyarny and general manifestations. Damage of joints at this type of arthritis at children is presented mono - or oligoartrity mainly joints of legs; has asymmetric character. More often at a disease knee joints, instep joints, plusnefalangovy joints of the I toe are surprised; more rare – coxofemoral and talocrural, joints of the top extremities, grudino-clavicular, grudino-costal, pubic joints. Development of entezopatiya, an akhillobursita, rigidnost of a backbone, a sakroileit is characteristic.
The anchylosis of intervertebral joints and damage of coxofemoral joints becomes the disability reason at advanced age.
Jet arthritises at children
Jet arthritises at children develop in 1-3 weeks after an intestinal or urinogenital infection. Articulate manifestations are characterized mono - or oligoartrity: the swelling of joints, pains amplifying at the movement, change of skin color over joints (hyperaemia or a tsianotichnost). Development of entezopatiya, bursit, tendovaginit is possible.
Along with damage of joints, at jet arthritis at children numerous extra articulate manifestations take place: damage of eyes (conjunctivitis, Irit, iridotsiklit), mucous oral cavities (glossit, erosion mucous), genitals (balanit, balanopostit), skin changes (a knotty eritema), damages of heart (perikardit, myocarditis, aortit, premature ventricular contraction, AV-blockade).
The general displays of jet arthritis at children include fever, a peripheral limfadenopatiya, a hypotrophy of muscles, anemia.
Infectious arthritises at children
At arthritises of a bacterial etiology the symptomatology at children develops sharply. At the same time the general condition of the child considerably suffers: fever, a headache, weakness, a loss of appetite are expressed. Local changes include increase in the affected joint in volume, hyperaemia of skin and local temperature increase, morbidity in a joint at rest and its sharp strengthening at the movement, the compelled position of an extremity relieving pain.
The course of viral arthritises at children is rapid (1-2 weeks) and is usually completely reversible.
Tubercular arthritis at children proceeds against the background of subfebrilny fever, intoxication; more often in the form of monoarthritis with damage of one large joint or a spondilit. Pallor of skin over the affected joint, ("a pale tumor"), formation of fistulas with allocation of white kazeozny masses is characteristic.
Diagnosis of arthritis at children
In view of the polisimptomny course of arthritises at children, many experts participate in diagnosis of a disease: pediatrician, children's rheumatologist, children's ophthalmologist, children's dermatologist, children's nephrologist, children's cardiologist, etc. When collecting the anamnesis pay attention to communication of arthritis at children with the postponed rheumatism, bacterial and viral infections, features of a clinical current.
The basis of tool diagnosis of arthritis at children is made by ultrasonography of joints, a X-ray analysis, KT or MPT of joints and a backbone. As the most characteristic features of arthritis at children serve narrowing of articulate cracks, an anchylosis of joints, bone erosion, symptoms of osteoporosis, an exudate in a cavity of joints.
For specification of an etiology of arthritis at children laboratory researches are conducted: definition of ASL-O, of a rheumatoid factor, SRB, anti-nuclear antibodies, IgG, IGM, IGA, complement; PTsR and IFA identification of hlamidiya, mycoplasmas, ureaplasmas, etc.; bacteriological research calla and urine; immunogenetic inspection. An important role in differential diagnosis of arthritises at children is played by a diagnostic puncture of a joint, a research of sinovialny liquid, a biopsy of a sinovialny cover.
Tubercular arthritis is diagnosed for children on the basis of the anamnesis, a X-ray analysis of a thorax, data on performing vaccination of BTsZh, results of reaction to Mant.
Treatment of arthritis at children
Complex therapy of juvenile rheumatoid arthritis and ankiloziruyushchy spondiloartrit at children assumes courses of drug treatment, physical therapy, massage, LFK, mechanotherapy. During the periods of an aggravation NPVS, glucocorticoids (including pulse therapy methylprednisolonum), immunodepressants, biological agents are appointed. Local treatment of arthritis at children includes intra articulate introduction of medicines, a temporary immobilization of joints, carrying a corset.
Approach to treatment of jet and infectious arthritises at children provides performing etiotropny, pathogenetic and symptomatic therapy. Specially picked up antibacterial medicines, immunomodulators, NPVS, glucocorticoids are used. Treatment of tubercular arthritis at children is carried out with participation of the children's phthisiatrician by means of antitubercular medicines.
At any forms of arthritises at children driving the bicycle, swimming, a kinezioterapiya, a balneoterapiya, sanatorium treatment are useful.