Central rheumatic disease in children today – juvenile idiopathic (or rheumatoid, as it was called earlier) arthritis. Other diseases or rarer or less dangerous.
In Russia, according to the 2007 juvenile arthritis hurt by 45.8 per 100 000 children. Alas, the downward trend in incidence is not observed, rather the contrary. But while it is difficult to say, since it requires a register of patients, and it is being created.
The word – chief freelance children's specialist-a rheumatologist of the Department of health of Moscow, Professor of the Department of childhood diseases of the First MGMU named after I. M. Sechenov, the head of the Moscow city center rheumatic on the basis of MGDB No. 1 Elena Grabovoi.
Elena Nechaenko, "AiF.Health": the age At which most often occurs juvenile arthritis?
Elena Zholobova: the onset of the disease mostly occurs in the age of 4-6 years, but can occur very early, at 5-6 months.
A rheumatologist: "Rheumatoid arthritis can be at any age" – How dangerous is the disease?
– The disease affects primarily the joints, but may suffer other organs. The most serious and frequent is the eye disease with the development of rheumatoid uveitis. Most often it occurs in girls, early age, have damaged an isolated joints. The effects of uveitis can be blurred vision up to complete blindness. The horror that the eye lesions may be asymptomatic. Until the end of the last century, 60% of children with juvenile rheumatoid arthritis became disabled. Today, thanks to early diagnosis and early treatment in most cases it can be prevented.
– What has a greater impact on the development of the disease?
– Before the end of reasons for this, like any other autoimmune disease, is not clear. Primary prevention either. It is believed to be multifactorial disease. That is important as heredity, and environmental factors. It is known that if a child has relatives 1st line of kinship (parents, siblings) with this disorder, the risk of developing it was significantly higher than in the population.
Environmental factors are triggers. Observed that juvenile arthritis often develops after an infection, stress, trauma, and rare after wrong vaccination (against some illness). It is therefore very important to protect children from infections to follow a favorable psychological climate in the family and be attentive to vaccination. But, unfortunately, often the disease occurs on the background of complete health.
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– What symptoms may indicate juvenile arthritis?
– Most often in the onset of the disease affected joints (single or joint). They swell, become swollen, at the site of inflammation over the joint temperature rises, you experience redness, pain. Violated movement – for example, a child refuses to bear weight on leg, begins to limp. These changes can be seen by both therapist and parents.
– What should the parents find the child's symptoms?
Most important to a favorable prognosis of treatment is for the child not later than 3 months from the onset of the disease got to the rheumatologist. It early and correct treatment allows you to transfer disease in long-term remission for years, even decades. But parents often go wrong. Don't refer to a rheumatologist, but only to the surgeons, orthopedists. Or worse, self-medicate, which is very dangerous. For example, a warm-up procedure at the debut of juvenile arthritis can only worsen the condition. As well as putting a splint on the injured limb then may be formed contracture (immobility of the joint).
– What research is needed? Maybe the blood for rheumatoid factor?
– Needed in the first place the examination of the rheumatologist. Some clear criteria for the diagnosis of juvenile arthritis does not exist. The basis for diagnosis is the presence of a child under 16 years of symptoms of arthritis that persist for 6 weeks. The fact is that sometimes viral, post-vaccination reactive arthritis that can last for a short time and held by themselves or by treatment with nonsteroidal anti-inflammatory drugs. If the arthritis persists longer than 2-5 weeks, you should always consult a rheumatologist. But the blood test for rheumatoid factor is significant only in adults. In children, only in 1-2% of cases.
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–As is the case with the pediatric rheumatologists?
– In Moscow there are district surgeons working in two counties. There is a children's rheumatology centre at the hospital. And three large Federal center: the children's rheumatology Department of the First Moscow state medical University, Scientific center of children's health, children's Department, Institute of rheumatology. You can get there by direction or by coming in person. District rheumatologists and Morozov take the free, the Federal centers operate on a commercial basis. Rheumatologists there are in other cities. If the standard treatment works, to go to the capital makes no sense. The Federal centers should contact only if you want additional examination and individual selection of therapy.
Legs hurt. How to treat JRA – How to treat juvenile arthritis?
– The standard method is the prescription of methotrexate, preferably in the form of injection (subcutaneous or intramuscular). Injections are made once a week. Often parents, having examined the instructions to the drug, fear of side effects. And so even sometimes refuse treatment. To not do this. First, any self-respecting manufacturer must indicate to all, even very rare, the possible side effects. And secondly, in some diseases are used much higher doses of drugs than in rheumatology, especially a child's. Like any medication, methotrexate can cause side effects, but they are extremely rare, and in cooperation with their doctor can avoid or reduce their severity. The ineffectiveness of methotrexate and we, and all over the world are now used genetically engineered biological drugs. They are very expensive (on average from 30 to 70 thousand rubles). But their efficiency reaches 90%. This treatment is fully paid by the state. Children receiving these drugs, do not differ from healthy peers, engage in sports, dance, and subsequently create a family. Early treatment leads to the fact that 60% of the patients are in stable remission. Two years later, this remission you can try to reduce, and then completely cancel the treatment. 30-40% of patients have a good chance to be in persistent drug-free remission.