Articular syndrome in children Tashkent Medical Academy Department: Pediatrics

The following diseases are accompanied by changes in the joints: 1. rheumatic diseases 2. other connective tissue diseases 3. reactive arthritis 4. hematologic diseases 5. infectious diseases 6. Injuries, osteomyelitis 7. psychogenic arthropathy

Infectious arthritis Infectious arthritis direct penetration of viruses or bacteria into the joint cavity. agents: - Staphylococci - Streptococci - Gram. negative flora

Pathways: - Hematogenic - lymphatic - Iatrogenic

Clinic: - Acute onset - Heat - Pain - Swelling - Redness of the skin over the joint X-ray - Sealing of soft tissue of the joints - Expansion of the joint space Treatment: - Antibiotics - NSAIDs - Local treatment

Juvenile rheumatoid arthritis - Juvenile rheumatoid arthritis - a chronic inflammatory disease of the joints in children under 16 years of unknown etiology with a complex history. - The etiology is unknown

Predisposing factors: - Bacterial and viral infection - Psychological and physical injuries - Hyperinsolation - Hereditary predisposition Pathogenesis: Immunological mechanisms lies in base of the disease

Classification: - Arthritic form (65 - 75%) - Arthritic and visceral form - Combined form with other collagenosis

Articular form: Arthritis (mono - oligo - polyarthritis) Regional muscle hypotonia and hypotrophy Regional lymphadenopathy CAB-deficiency anemia, accelerated VS X-ray - epiphyseal osteoporosis, deformity of the articular surface Treatment: Antibiotici NSAID Local treatment

Articular-visceral form: - Symmetric polyarthritis, morning stiffness - Polilimfadenopathy - Systemic muscle hypotrophy and hyphotony - Prolonged fever Rash on skin Retardation in physical development - Viscerity (nephritis, pneumonitis, carditis, splenomegaly) - CBC - anemia I-II degree, stable acceleration of VS - X-ray - systemic osteoporosis, bone and cartilage destruction

Complications - contracture - ancylosis - Deformity of joints

Diagnostic criteria for JRA (1996) - Arthritis duration of 3 months or more - Arthritis is the second joint, which arose after 3 months or more after the defeat of the first - Symmetric damage in small joints - Joint contractures - Tenosynovitis or bursitis - Muscular Atrophy - Morning stiffness - Osteoporosis - Narrowing of the joint space - Violations of bone growth

Differential diagnosis Probable diagnosis with five points, is valid in the presence of the seven signs   Differential diagnosis - Rheumatic arthritis occurs in 2-3 weeks recovering from a sore throat and goes through 2-3 weeks without complications - Reactive arthritis depend on the specific disease, asymmetrical joint inflammation, a positive serologic test - Tuberculous arthritis - often begins as coxit, pain in the during of the day, history. A positive TB test, X-ray picture

Treatment: - NSAIDs (indometacin, ibuprofen, diclofenac, nimesil, meloxicam) - Corticosteroids (prednisone, hydrocortisone) Basic drugs - Quinoline (delagil, Plaquenil) - methotrexate - sulfasalazine - cyclosporine - immunotherapy - Local treatment

Juvenile spondyloarthritis ankilozand (B.M.Bekhterev 1892) - JAA - a chronic inflammation disease of the peripheral joints and vertebral, occurs mostly in boys - JAA - a complex multifactorial disease with genetic predisposition - HLA B27 is diagnosed in 70-80% of patients Clinic: - Inflammations of peripheral joints of the legs - Entesitis -Vertebral defeats - Eyes inflammation

Treatment: - Glucocorticoids - NSAID - Local treatment

Allergosepsis - Long-term temperature - The rash on the body - Hepatosplenomegaly - Polyarthritis or polyarthralgia

Felty's syndrome - Polyarthritis - Splenomegaly - Granulocytopenia - Thrombocytopenia - Anemia