Juvenile polyarthritis, rheumatoid factor negative
The following factors must apply to classify joint inflammation in children and adolescents as juvenile polyarthritis without rheumatoid factor:Five or more joints must be affected by inflammation within a six-month period. In addition, they must be excluded: In this subtype of polyarthritis, 80% of girls between the ages of 2 and 16 years are affected. At the beginning of the disease, there are often no pronounced symptoms.
There is only a slight swelling with effusion and a slight overheating. Only the degree of movement is usually conspicuously restricted. Typical for the clinical picture is a symmetrical infestation of the toes, fingers and wrists, but cervical vertebral joints and the temporomandibular joint can also be affected.
Diagnosis: The blood count may show a slight increase in inflammation values (BSG, C-reactive protein). In the course of the disease of juvenile polyarthritis without rheumatoid factor a pronounced osteoporosis of the joints may occur. Irregular growth occurs because the inflamed joints often mature faster.
In the course of the disease, there is usually less growth with a regression of the musculature. Destruction of the joints occurs rather rarely and only in the later course of the disease.
- Psoriasis in the child or first degree relatives,
- HLA-B27 positive arthritis,
- Inflammatory bowel disease
- Other rheumatic diseases
Treatment
The goals of the treatment are clearly defined. The aim is to relieve the pain and to bring the inflammation under control as far as possible. In addition, one tries to avoid joint damage and to achieve a normal growth development of the child.
The most dangerous is uveitis, which can occur in both forms. If not treated, it can lead to visual impairment and even blindness. Depending on the severity of the disease, the treatment is individually adapted to the child.
Both physiotherapy and medication are used. In physiotherapy, the restricted movement possibilities are to be increased again through intensive training. Bad posture should be avoided or improved and the muscles are trained.
The treatment can be completed by cold or heat therapy as well as electrical treatment. Studies prove the positive effect of sports. School sports can be carried out to a limited extent, jumping and running should rather be avoided.
Often, physiotherapy alone is not enough and medication must be used. In the beginning, diclofenac, ibuprofen or indometacin are often administered. They belong to the group of non-steroidal anti-inflammatory drugs and have anti-inflammatory and analgesic effects.
They should be prescribed in about six to ten weeks. If there is no improvement at the end of this period, other medicines must be used. These include glucocorticoids.
They work very well, but also have many side effects. They are often injected into the joint and thus have a good local and less systemic (body-wide) effect. In severe cases of juvenile polyarthritis, basic therapeutics (Disease modifying anti rheumatic drugs or DMARDs) come into play.
They can be prescribed in combination with glucocorticoids and non-steroidal anti-rheumatic drugs. However, it takes two to three months before the effect is felt. Methotrexate, sulfasalazine, or azathioprine are often given for up to nine months to achieve effective disease control.
Only recently on the market are biologicals in such a way specified, which are called also DCARDs “Disease Controlling Anti Rheumatic Drugs”. These include Etanercet, Tocilizumab, Infliximab, Adalimumab, Anakinra and Rituximab, which all intervene differently in the inflammation chain and block it. They work very well and can be prescribed for severe forms of juvenile polyarthritis that could not be controlled on methotrexate or other DMARDs. All topics on internal medicine can be found under Internal Medicine A-Z.
- Rheumatism
- Rheumatic fever
- Rheumatoid Arthritis
- Reactive Arthritis
- Arthritis
- Joint Pain
- Enbrel®
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