What forms are there?
The disease combines several variants, which proceed differently and are treated differently. With oligoarthritis, no more than four joints become inflamed, most often the knees and ankles; this form is typical in younger girls and carries the greatest risk of eye damage. Polyarthritis affects five or more joints, including the small joints of the hands. The systemic form begins with high undulating fever, rash and swollen lymph nodes, and arthritis may follow later. Separately, there are variants with inflammation of the tendon attachment sites and with psoriasis.
- Oligoarthritis - up to four joints
- Polyarthritis - five joints or more
- Systemic form with fever and rash
- Enthesitis-associated arthritis
- Psoriatic arthritis
- Undifferentiated option
Causes and risk factors
The exact reason is unknown. It is believed that in a child with a certain genetic predisposition, an external factor, such as a past infection, triggers an abnormal immune response. Immune cells begin to inflame the synovial membrane of the joint, it thickens, secretes excess fluid, and the cartilage and bone are gradually damaged. The disease is not contagious, is not directly inherited, and does not occur from hypothermia or sports injury, although the injury sometimes draws attention to an already inflamed joint. The parents are not to blame for the development of the disease.
- Genetic predisposition
- Past infections as a trigger factor
- Dysregulated immune response
- The disease is not contagious
- Hypothermia and injury are not the cause
Symptoms
The main symptom is persistent swelling of the joint without obvious injury. The joint is enlarged, the skin over it is warmer, movements are limited, the child holds the limb in a semi-bent position. Morning stiffness is very typical: after sleep, the child moves slowly, limps, and after half an hour or an hour he walks. Babies may simply stop running, start asking to be held, or use one hand. In the systemic form, high fever with chills, a pale pink rash, enlarged liver, spleen and lymph nodes come to the fore. Inflammation of the eye usually occurs without complaints.
- Persistent joint swelling for more than 6 weeks
- Morning stiffness
- Lameness, sparing position of the limb
- Limitation of movement and decreased activity
- Fever and rash in the systemic form
- Long-term growth retardation
- Asymptomatic inflammation of the choroid
Diagnostics
There is no specific test to confirm the disease: the diagnosis is made clinically, excluding other causes of arthritis. Complete blood count, ESR and C-reactive protein show inflammatory activity but may be normal. Rheumatoid factor in children is often negative, and antinuclear antibodies are important as a marker of increased risk of eye damage. Ultrasound of the joints reveals effusion and thickening of the membrane, x-rays are needed to assess changes in the bone. It is mandatory to exclude infectious arthritis and oncohematological diseases and regular examinations by an ophthalmologist with a slit lamp.
- Complete blood count, ESR, C-reactive protein
- Rheumatoid factor and antinuclear antibodies
- Ultrasound of affected joints
- X-ray of joints according to indications
- Rule out infection and blood diseases
- Examination by an ophthalmologist with a slit lamp at the appointed time
Treatment and observation
The goal of modern treatment is complete remission and a normal life for the child. They start with non-steroidal anti-inflammatory drugs and the introduction of a glucocorticoid into the joint with limited damage. If the effect is insufficient, basic drugs are used, and if the course is active, genetically engineered biological agents are used. All treatment is prescribed and monitored by a pediatric rheumatologist, with regular tests. The most important part of therapy is physical therapy and movement: rest quickly leads to muscle atrophy and limited mobility. Swimming and feasible physical exercise are not prohibited, but useful.
- Nonsteroidal anti-inflammatory drugs
- Injection of glucocorticoid into the joint
- Basic therapy under test control
- Genetically engineered biological products
- Physical therapy and swimming
- Regular examination by an ophthalmologist
- Monitoring the growth and development of the child
- Routine vaccination in consultation with a doctor