Children's health

Joint pain in children – Juvenile rheumatoid arthritis

Joint Pain in children of any age may occur due to many different causes. It may be the result of natural growth and development of the child and may be accompanied by stiffness, reduced mobility. Joint pain can be the result of sprains, strains, fractures, sprains or conditions such as disease Osgood-Schlatter disease, which becomes more severe as a result of sports activities. Slightly damaged (twisted or stretched) muscles, tendons and ligaments, mostly, retain elasticity and ability to function and usually only require rest to heal. As in more severe tissue damage may be partially or completely torn, full recovery may require surgical treatment.

Juvenile rheumatoid arthritis

Pain in the joint can also be caused by arthritis (inflammation of the cartilage, tendons and ligaments), muscle inflammation (myositis), bacterial infection of the bone (acute arthritis; osteomyelitis) and sometimes tumors (bone cancer). With proper treatment the pain in the joint caused by the majority of causes, heal up and disappear without complications (dislocation of joints).

Joint is the moving part of the limb where two bones meet. The bones are held in place by ligaments (strong fabric bundles) and move the muscles and tendons (the latter attach muscle to bone). Pain in any of these parts is considered as pain in the joint.

Arthritis is the inflammation of one or more joints or members of tendons and ligaments (connective tissue). Inflammation symptoms: joint swelling, restricted movement, heat, pain and redness. More than 100 pathological conditions, such as infections and disorders of the blood, contribute to the development of arthritis.

Juvenile rheumatoid arthritisIf one joint affected, said monoarthritis, two or three joint – oligoarthritis, more than three – arthritis. Joint pain in bacterial lesions are not associated with exercise: they arise even in a state of physical rest man and intensify with movement. Thus there is swelling and redness around the joint, a feeling of stiffness – especially in the morning, marked change in the shape and configuration of the joint caused by inflammation of the joints, disorder of bone and cartilage on the joint surface and its accumulation in the cavity inflammatory fluid. Arise and common symptoms such as fatigue, fever, headache, weakness, irritability.

Causes of joint pain in children:

1. Septic joint inflammation (arthritis) : can be caused by streptococci, staphylococci, influenza viruses and other common infection. Usually suffer large joints. The disease suddenly begins with fever, then there is swelling of the joint, pain with motion, tenderness when touched. If identied, the child begins to limp.

2. Rheumatic fever: the disease is preceded by an acute infection of the upper respiratory tract. The classic form of rheumatism begins with fever and pain in the joints. Usually affects large joints: knee, ankle, elbow, wrist. Pain are volatile in nature, moving from one joint to another. Around the diseased joint may be red and swelling, however, irreversible changes do not occur. In the long course of the disease around the joint may appear rheumatic nodules. They look dense, lentil sized entities. Usually occur in areas exposed to pressure: elbow creases, wrists, forearms, elbows. On the skin of a patient with rheumatism of the child are a kind of rash: pale reddish, curved or ring-shaped spots, narrow strips. As the progression of the disease develop severe heart damage.

3. Chronic arthritis continue for at least 6 weeks. The most common form of chronic arthritis in children is juvenile rheumatoid arthritis, but besides him, there are about 50 more rare forms, including accompanying systemic lupus erythematosus (an inflammatory disease of the joints, skin and internal organs) and youth anciliary spondylitis (inflammatory arthritis of the spine).

Although the peak incidence occurs between the ages of 2 to 5 years, juvenile rheumatoid arthritis can begin at any age, from the first months of life and up to 16 years. Juvenile rheumatoid arthritis develops in girls almost 2.5 times more often than boys.

Although any joint, including the joints of the toes and hands, jaw and Achilles tendon may be afflicted, yet early in the disease most often affects the knee, ankle and elbow joints. Depending on what particular form of Juvenile rheumatoid arthritis has developed, the process may involve other organs, including eye, skin and heart. While in the absence of treatment for Juvenile rheumatoid arthritis more and more damages the body, medical care of the patient up to date, comprehensive, careful medical supervision using medications, physical therapy and, sometimes, surgical treatment, can provide a relatively normal life of the majority of sick children. However, even with the provision of the best treatment for all the symptoms can be controlled, and you should always expect the unexpected worsening of the disease.

Distinguish 3 subgroups of juvenile rheumatoid arthritis that can be identified by characteristic signs and symptoms. It’s systemic (involving the entire body); poliartrita form (process involving 5 or more joints) and paulatina form (involving in the process less than five joints).

Initially George was widely known as still’s disease, named after the doctor who first accurately described it in 1896. The term “still’s Disease” is currently used to refer to systemic JRA, which affects about 20% of all children suffer from arthritis. The systemic form of Juvenile rheumatoid arthritis, which is most difficult to diagnose, often may begin with fever or rash and increases in liver size, spleen and lymph nodes. Despite the presence of pain in the muscles and heart, before the advent of joint inflammation can take many months.

Poliartrita form accounts for 35% of children suffer from arthritis. In this form often affects the small joints of the hands and feet, but also ankle, knee and hip joints. Usually there is a symmetrical joint involvement. So, if a particular joint on the left half of the body are affected, the corresponding joint of the right half of the body is also affected.

Approximately 45% of children suffering from Juvenile rheumatoid arthritis affected poularity form. Onset is often gradual nature: knee or ankle initially swell, and parents notice it, only when the child begins to limp. Pain in the joint are rare, especially in young children. May also develop uveitis (persistent inflammation of the middle choroid, iris and surrounding tissues with a network of tiny blood vessels in the middle of the eye), which can threaten vision, without proper treatment. Children with uveitis typically require regular supervision of an ophthalmologist (eye doctor) to monitor, did not develop if inflammation of the eye. This inflammation is often asymptomatic and is not accompanied by redness or other obvious signs.
In many cases, the JURA after a few months or years of active course of the disease is observed the spontaneous development of long-term remission (no active symptoms). In some cases, the symptoms re-emerge from time to time.

For arthritis characterized by the sequential appearance of pain, stiffness, warmth, redness, swelling and finally a slight decrease of the functional activity of one or more joints. Limited mobility of the affected joint can be caused by muscle spasms, or accumulation of fluid around the joint. In the case of systemic Juvenile rheumatoid arthritis malaise, including fever, rash, lethargy and loss of appetite, precedes involvement in the disease of the joints within the period of 6 months. If Juvenile rheumatoid arthritis progresses unchecked, it can lead to weakening and destruction of the joint with a strong limitation of the freedom and ease of movement. In case of such destruction of the ankle joint and foot, the child often develops pacing ploskostopye gait. Limping and dragging gait appear in the case of inflammation and swelling of the knees and hips. Joint damage may be accompanied by various other symptoms. Often there is a slight and constant temperature or, conversely, a high, reaching a peak of more than 38,8° C one or two times a day. Pale red or pink, usually not itchy, the rash becomes brighter during fever. Increase the size of the lymph nodes, liver and spleen. Sometimes there is loss of appetite and weight.

Causes of joint pain in children4. Serum sickness: is an allergic reaction to the introduction of therapeutic drugs (e.g., penicillin, aspirin, etc.). Usually occurs 6-12 days after the child’s contact with a precipitating factor. Manifested by pain in the joints (arthritis), fever, muscle aches, skin rash (urticaria), itching, swelling of the face and neck.

5. Injury joints: generally, pain was observed in one joint. He swollen, deformed, becomes red or cyanotic. Movement in the affected joint is limited, painful. A sharp pain occurs when the mechanical load on the joint. In young children 1 to 4 years of often traumatic subluxation of the elbow joint, for example in the fall, when their “drags” the hand of an adult. This annular ligament toiling in the place of its attachment to the radius bone of the forearm and clamped between the head of the humerus and radius. As a result, the child refuses to move her arm and holds her still slightly bent at the elbow and deployed in the forearm medially around its axis.

6. Tuberculous arthritis: most commonly affects the hip joint. Externally, the disease first manifested a slight limp and pain when walking, which gives the knee or mid thigh. Over time the movement of the hip is limited in all directions, seen around the joint swelling. Bad hip becomes bent, pressed to the other leg and slightly expanded inside. If the affected spine, the child complains of pain in the place of the body that is innervated by one of the patient area of the spinal cord. He can hardly lift lying on the floor objects, walking very carefully, on tiptoe, torso keeps stressed right. Likes to lie on his stomach.
Arthritis of the cervical spine is bending the neck, and the child is forced to support his head with his hands. If painful process covers the thoracic spine, develops a hump.

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