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Arthritis in children

 Arthritis in children

Arthritis in children


Arthritis in children is a chronic disease that primarily affects the joints of children under the age of 16 and lasts for at least 6 weeks. It is the most common childhood rheumatology disease.

Arthritis in children

Development of disease

Clinical picture

Prevalence and diagnosis

Forms of disease

Therapeutic approach

Forecast

Development of disease

Certain genetic factors and common infectious, most common viral diseases predispose the child to developing arthritis.

It is thought that the underlying arthritis in children or juvenile idiopathic arthritis (JIA) is an autoimmune mechanism, but not all pathophysiological processes have been fully established so far. causes that lead to illness. There is no doubt that it is the activation of the patient's immune system in such a way that his own tissues begin to be recognized as foreign, ultimately leading to inflammation and damage to them. Certain genetic factors and common infectious, most common viral diseases predispose the child to developing arthritis.

 

Clinical picture

An inflamed joint is painful and swollen, and skin redness is often seen above the joint. These disorders are accompanied by limited mobility of the wrist, and children avoid using the affected limb because of pain, often limping or refusing to walk. In the morning after waking up after a night's rest or after a long rest, the symptoms are more pronounced.

 

Joint inflammation can occur gradually or abruptly and affect one or more joints. In the beginning of the disease, the so-called large joints of the extremities (knee, elbow, hock and wrist) and is often symmetrical in distribution. In the later course of the disease, inflammation may also include the smaller joints (knuckles, thumb).

 

Prevalence and diagnosis

The typical age of onset is the preschool period between the first and third years of life, twice as often in girls.

Arthritis in children is a relatively common disease, but no clear incidence has been identified. The estimated incidence is between 5-20 patients per 100,000 children. The typical age of onset is the preschool period between the first and third years of life, twice as often in girls.

 

The diagnosis is made primarily on the basis of the clinical picture and the length (minimum 6 weeks) of the signs and symptoms of the disease. Laboratory findings (blood count, inflammatory reactants: C-reactive protein, sedimentation) are usually neat or only minimally elevated above the child's age reference value and are therefore not crucial in the diagnosis but help in monitoring the course of the disease and responding to treatment.

 

Immunoassays - Rheumatic factor (RF) and antinuclear antibodies (ANA) detect the existence of antibodies and their positivity helps in the classification and prognosis of juvenile idiopathic arthritis. Patients with positive ANA-arthritis have a higher risk of developing chronic iridocyclitis (inflammation of the iris and airy body of the eye).

 

Forms of disease

Juvenile idiopathic arthritis is divided into several subtypes:

 

oligoarticular shape - is the most common of all forms of arthritis in children, with a maximum of four joints affected in the first 6 months of the disease. It usually occurs up to the age of 6 and is more common in girls. The course of the disease is variable, the prognosis is good unless polyarthritis develops.

polyarticular shape - affects about a quarter of patients, is characterized by inflammation of five or more joints in the first 6 months, and based on RF we divide it into two subtypes: RF-negative and RF-positive. The latter is a rather rare form of arthritis, predominantly affecting girls over the age of 10 with inflammation of the small joints of the extremities and worse prognosis.

systemic form (Still's disease) - in addition to locomotor, other organ systems are affected. Affects boys and girls of any age equally. It is characterized by fever, a tiny pink rash usually in the evening, enlarged spleen and liver, enlarged lymph nodes, inflammation of the duct (pleuritis) or heart (pericarditis). Signs of joint involvement usually occur last in the series, but may also occur at the very beginning of the disease.

psoriatic arthritis - along with arthritis, skin changes characteristic of psoriasis occur: foci on the elbows and knees in the form of red scaly deposits.

enthesitis associated with arthritis - this form is characterized by arthritis of the large joints of the most common lower extremities associated with inflammation of the tendons for bone. Most patients are positive for the cell marker HLA B27. It mostly affects boys after the age of 6. The course of the disease is variable; from complete retraction to progression to small joints of the spine, pelvis and sacroiliac joints.

Therapeutic approach

Intraarticular administration of corticosteroids has been shown to be extremely effective in treating arthritis in children, with little systemic drug absorption.

The goal of treatment is to suppress pain, stop inflammation to prevent permanent joint damage, loss of function and disability, and achieve stable remission of the disease.

 

Since it is a chronic disease with unpredictable course and outcomes, it is very important to educate parents and provide psychological support to both patients and immediate family members. Following the introduction of biological therapy into pediatric treatment algorithms, there are very few patients with permanent functional impairments and radiographically visible joint changes.

 

The pharmacological approach to treating JIA consists of several steps. In the first place are non-steroidal anti-inflammatory drugs (NSAIDs), which are the first line of therapy and also part of almost every therapy plan. They are analgesic and anti-inflammatory. The side effect of this therapy may be irritation of the gastric mucosa until the development of gastritis and bleeding. However, children are generally well tolerated with this treatment group. Proton pump inhibitors may be added as needed to prevent gastritis.

 

Disease modifying anti-rheumatic drugs (DMARDs) have an anti-inflammatory effect after prolonged use. Typical representatives of this group are methotrexate and sulfasalazine. Methotrexate is usually administered subcutaneously with weekly applications. The introduction of therapy requires the control of hepatic transaminases to prevent the possible development of toxic hepatitis in a timely manner. It is advisable to introduce folic acid with methotrexate in order to minimize the risk of side effects.

 

Corticosteroids are very powerful anti-inflammatory drugs, but their longer systemic use is linked to a number of side effects. Intraarticular administration (joint application) has proven to be extremely effective with little systemic drug absorption.

 

Biological drugs have been increasingly prevalent in the treatment of rheumatological diseases in the past ten years, including in the pediatric population. Their introduction into therapeutic algorithms significantly reduced the number of patients with severe functional impairments. The principle of their action, unlike the previously mentioned therapeutic groups, is specific and targeted against specific molecules or cellular markers. Therapy is generally well tolerated, especially in the first few years of treatment.

 

Forecast

Some forms of arthritis in children show a greater tendency to develop ophthalmic complications, therefore, regular ophthalmologist examinations are recommended, even during periods of disease without active arthritis.

The length of treatment is not clearly defined, as the disease has an unpredictable course in which remission and exacerbation periods can alternate. Complete cessation of treatment can usually only be considered after the signs of arthritis have subsided for a minimum of 6-12 months.

 

Some forms of arthritis in children show a greater tendency to develop ophthalmic complications, therefore, regular ophthalmologist examinations are recommended, even during periods of disease without active arthritis. The outcome of juvenile idiopathic arthritis is good in the long term; it is estimated that about 40% of patients after 8-10 years do not require active treatment. RF-positive polyarticular arthritis in children often has a progressive course.

 

Because it is a chronic disease, it is of the utmost importance that the immunologists / rheumatologists and parents have good cooperation, good education and availability of therapy. The child should be allowed to attend school regularly, have adequate physical activity and have a childhood with as few restrictions as possible.


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