The number of cases of reactive arthritis in children has increased dramatically in recent times. Inflammation of the joint is considered to be reactive if it does not develop independently, and because any infection of the body caused by germs or viruses. In the first place is a chlamydia infection of the urinary tract, the second intestinal diseases. In response to the microorganisms, the child produced by protective complexes – antibodies, and they damage the body's own cells. Infectious diseases are contagious, the child may obtain pathogen airborne, airborne dust, by contact. Important role in the occurrence of arthritis is the condition of the microorganism – reduced immunity, comorbidities. At risk are children with a genotype of the gene HLA-B27, i.e., this disease is hereditary aggravated. Reactive arthritis is dangerous with its complications concerning joints (loss of motility), heart damage. Signs of reactive inflammation of the joint can easily be mistaken for the beginning of a severe systemic disease and Vice versa.
- In explaining the history it turns out that 1-3 weeks before the joint inflammation a child suffered an acute disease of the respiratory tract, genitourinary or intestinal infection.
- Reactive arthritis does not strike many joints, usually one or two (up to four).
- The asymmetric nature of the lesion.
- Often affects joints of the feet, especially the feet. The finger swells so that like a sausage and has a cyanotic color.
- Acute onset, characterized by fever, weakness, refusal of games.
- Severe pain in the joint. The child limps (with the defeat of the joints of the feet) holding the handle in a healthy (arthritis of joints of hands).
- Redness in the joint, swelling and local increase in temperature.
- Balloting of the patella, as if he raised accumulated in the joint cavity with fluid.
- Inflammation of the tendons at their attachment to the bone. Especially often suffer from calcaneal tuberosity, the area of the spinous processes of the spine, iliac bones.
- Possible pain in the spine.
- In some cases it is a rash on the skin, erosions of the oral mucosa, inflammation of the external genitalia, eyes, heart, peripheral nerves. The Reiter's syndrome is urethritis (inflammation of urethra), conjunctivitis (eyes) and arthritis.
- Duration of disease from several days to several weeks. In some children the illness becomes chronic.
In house conditions it is possible to suspect reactive arthritis if the inflammation of the joint was preceded by some infectious disease, and according to the characteristic clinical picture described above. Next, you should show the child the doctor, not yourself starting any treatment, because accurate diagnosis of reactive arthritis is made only after analysis and instrumental analysis. All children with suspected reactive arthritis should be sent to a rheumatologist.
The stages of diagnosis:
- History collection.
- Visual inspection.
- Clinical analysis of blood (may increase the number of leukocytes, ESR).
- Analysis of urine (also can be increased leukocytes).
- Biochemical blood test for antistreptolysin O (antibodies to strep), CRP, sialic acid, total protein, fibrinogen, uric acid, circulating immune complexes), rheumatoid factor.
- Smears from the urethra, cervix, conjunctiva of the eye (in the case of transferred urogenital infection can be isolated chlamydia.
- The sowing of a feces on discrepa (after intestinal infection possible seeding of pathogens – Salmonella, Shigella).
- Serological test for detection of antibodies to causative agents of intestinal infections.
- Reaction of immunofluorescence for detection of chlamydia antigens in the serum and synovial fluid.
- Enzyme-linked immunosorbent assay – detects antibodies to chlamydia in serum and joint fluid.
- Analysis of synovial fluid. Can be increased the number of different types of leucocytes (neutrophils – acute process, monocytes and lymphocytes in chronic).
- Identification of HLA-B27 in 90% of cases.
- Radiography of the joint. Signs of reactive arthritis – cysts endocrine gland, periarticular osteoporosis, inflammation of the periosteum, places of fastening of the tendons.
- Ultrasound of the joint, MRI allows visualization of soft tissue structures not visible on x-ray, the presence of articular effusion.
- Arthroscopy is conducted with the difficulty in identifying the causative agent. The doctor examines inside the joint and has the ability to take tissue for microscopic examination.
Need to see a doctor contact immediately if:
- the redness, swelling, hot skin in the region of the joint;
- if he complains of strong pain in the joint;
- when there is fever.
- The main goal of treatment – the fight against the infectious agent. To do this, an antibiotic is prescribed. The choice of antibiotic by the doctor depending on what infection the child's susceptibility, as well as taking into account peculiarities of children's organism. Used macrolides, fluoroquinolones less often. To help antibiotics, to reduce inflammation come nonsteroidal anti-inflammatory drugs (NSAIDs), and sometimes hormones – glucocorticoids. Hormones children are injected intra-articular in severe exacerbations.
- In protracted or chronic course of the process used immunomodulators – means for normal operation of the immune system.
- If reactive arthritis is increasing, restricted mobility of the spinal column, inflammation of the attachments of the tendons, the doctor prescribes a drug that suppresses the immune system.
- With remission of acute inflammation physiotherapy appointed electrophoresis with various drugs, ultraviolet irradiation, magnetotherapy, laser treatment, amplipuls.
- Physical therapy aims to restore mobility in the joint.
Any specific prevention of reactive arthritis does not exist. The prevention of the disease include:
- Maintaining a healthy lifestyle.
- Compliance with child personal hygiene (washing hands after visiting public places, before eating).
- Timely readjustment of foci of infection.
- If parents are sick with chlamydia, they should be treated.
- Identification of carriers of the gene HLA-27 in parents when planning a baby.
If signs of reactive arthritis can not self-medicate before you should consult doctor.
To what doctor to address
With the appearance of swelling and pain in the joint of the child necessary to show a rheumatologist as these symptoms can occur in different diseases. If at the same time affects the eyes and urethra — you should consult with your ophthalmologist and urologist.