Often, after prolonged physical activity, children complain of fatigue or pain in their legs. After a short rest, the pain goes away as the muscle fibers relax and recover. If discomfort localized to the bend of the lower limb does not go away or appears with noticeable regularity, the cause may be arthritis of the knee joint in children. If the child has systematic complaints in this area, you should seek medical help as soon as possible.
Causes of pathology
The sources of the disease in the medical literature are divided into two groups: infectious and autoimmune (aseptic). The first group includes the following pathogens that can cause arthritis of the knee joint in children:
- coccal infections;
- coli;
- Candida fungi;
- protozoan microorganisms;
- tuberculosis bacillus.
An aggressive “agent” enters the joint zone from the outside (as a result of injury), and the primary form of the disease develops. If a microorganism or fungus enters the synovial cavity through the blood, a secondary infection occurs.
The second group is formed by autoimmune inflammatory reactions, when the patient’s body is affected for a long time by other infections or foreign proteins. In this case, your own immune system begins to attack the tissues of your own body. There are several forms of pathology:
- Reactive. Characterized by a reaction to streptococci, gonococci or chlamydia.
- Post-vaccination. It is formed after a routine vaccination, when an immune response is received by foreign proteins introduced with the solution.
- Allergic. Increased sensitivity to certain microscopic stimuli.
- Juvenile lesion. It has no clinical explanation, but the primary disorder occurs in the synovium.
- Systemic arthritic disorders. They act as a complication of other diseases (psoriasis, lupus, diabetes, etc.).
Unfavorable factors also include frequent or severe injuries, previous surgery, incorrect treatment of ARVI, genetic predisposition, and congenital damage to the described area.
Arthritis in children: causes, symptoms and treatment
We tend to think of arthritis as a disease of older people, but in fact, arthritis can occur even in babies. According to statistics, arthritis affects 1 child in 1,000, most often before the age of four. The diagnosis of childhood arthritis is made before the age of 16 years. It has been noticed that girls suffer from childhood arthritis 2-3 times more often than boys.
Arthritis in children can affect various joints: elbow, shoulder, knee, as well as ankle, feet, and lower back.
Despite the variety of etiologies for the development of childhood arthritis, all its types are painful and extremely dangerous, since arthritis in children can lead to serious joint deformities, complete loss of motor functions, negative effects on vital internal organs, and even disability. Especially if there is no correct treatment, and there is a lack of physical activity due to pain and decreased mobility.
All of the above explains the high relevance and social significance of effectively combating arthritis in children and adolescents.
Causes of arthritis in children
Often, it is not possible to establish a clear cause of arthritis in children, since a combination of several harmful factors plays a role, as well as a genetic predisposition to the disease.
The pathology can be autoimmune, that is, it occurs as a result of a disorder of the immune system, in which the body produces antibodies aimed at destroying its own healthy cells and tissues, including cartilage tissue and the joint as a whole.
Often the trigger for the pathological process is an infection. Then arthritis in children acts, in fact, as a complication after influenza, hepatitis, rubella, dysentery, mumps (mumps), salmonellosis, dermatitis and even chronic tonsillitis and sinusitis with a streptococcal pathogen.
So, the most common causes of arthritis in children can be:
- immunity disorders;
- metabolic failures;
- vitamin deficiency (in particular, lack of vitamin D);
- infections – viral, bacterial, fungal; both directly articular and systemic;
- allergies, diathesis;
- non-compliance with the vaccination schedule and rules;
- injuries.
Weak immunity, unsatisfactory sanitary and hygienic conditions, hypothermia, poor nutrition, and excessive physical activity contribute to the development of arthritis in children.
Symptoms of arthritis in children
Any signs of arthritis in a child require an immediate, correct diagnosis: it is very important to notice problems in the musculoskeletal system of a child or teenager in time so that the therapeutic measures taken become the most effective.
Varieties of arthritis in children, regardless of etiology and form of course, are characterized by a number of common processes and symptoms. Thus, there is inflammation of the joint shell and other articular structures, deterioration in the quality of the joint fluid, drying and gradual degeneration (destruction) of hyaline cartilage, a decrease in the articular lumen, inflammation and swelling of the soft tissues, redness of the skin, pain and limited movement.
You should be especially observant of infants who cannot speak: when they experience pain or discomfort, they become capricious, irritable, whiny, lose their appetite, and get tired quickly. There is a deficiency of body weight due to insufficient food intake.
You can suspect that a child has problems with joints if his condition and mood change for the worse precisely when performing active movements. In addition, the baby's gait may change, he begins to limp, for example, if he develops a chronic form of arthritis, which is characterized by pain in the legs.
In general, diagnosing arthritis in young children is difficult, since it is not always clearly clear what exactly is bothering the child.
In addition to the general symptoms, different types of arthritis are characterized by specific distinctive signs. Let's take a closer look at what types of childhood arthritis exist and their characteristics.
Classification of arthritis in children
The concept of “arthritis in children” is quite broad and combines several types of the disease. Arthritis is differentiated by etiology, pathogenesis, and clinical picture.
The most commonly used classification of arthritis in children, taking into account the cause of its occurrence:
- juvenile rheumatoid arthritis,
- juvenile ankylosing spondylitis,
- rheumatoid arthritis,
- reactive arthritis.
Juvenile rheumatoid arthritis is a potentially dangerous systemic disease of an autoimmune nature, actively progressing. The statistics are very alarming: 25-30% of sick children and adolescents lose motor skills and become disabled.
Rheumatoid arthritis in children has two forms - articular and articular-visceral (systemic), when the heart or lungs are affected, vasculitis, polyserositis, myocarditis, iridocyclitis, uveitis (inflammation of the eyes), anemia, an enlarged liver or spleen, etc.
The exact cause of rheumatoid arthritis in children has not been established, but a common trigger for the disease is a severe acute respiratory viral infection (ARVI) or a bacterial-viral infection.
It has been revealed that rheumatoid arthritis most often affects young children: 1-4 years old, but the onset of the disease is also possible in adolescence.
In addition to the symptoms common to all arthritis, rheumatoid arthritis in children can be suspected if the following symptoms are present:
- Usually large joints (knees, ankle, hip, wrist joints) are susceptible to inflammation, less often - small ones (phalanxes of the fingers);
- there is a symmetrical pathological increase and distortion of shape (irreversible), the presence of rheumatoid nodules;
- lymph nodes are often enlarged;
- morning stiffness and pain when trying to move (not always), forced posture to make you feel better;
- severe arthralgia (pain) in the active phase, in which even touching the sheet is painful, crunching in the joints;
- lameness if the disease affects the lower limbs;
- inflammation lasts approximately 1.5 months;
- The child’s body temperature may rise strongly and persistently (sometimes up to 39-40°C).
Damage occurs to the synovial membrane of the joint, saturated with immune cells, with the deployment of a large-scale inflammatory reaction and the triggering of the pathogenesis mechanism of juvenile rheumatoid arthritis in children. The body's response is to produce altered immunoglobulins. The immune system recognizes them as foreign and produces antibodies - the so-called rheumatoid factors.
Diagnosis must be immediate, since rheumatoid arthritis in children is fraught with disability! A rheumatologist first performs an external examination, and then prescribes additional tests to confirm the assumption that rheumatoid arthritis is developing in a child, while ruling out diagnoses such as lupus erythematosus, Lyme disease, and oncology.
- Blood tests (the level of antinuclear antibodies, rheumatoid factor, C-reactive protein is examined). An increase in ESR (erythrocyte sedimentation rate) and leukocytes in clinical analysis indicate inflammation.
- X-ray allows you to see a decrease in bone mineral density (osteopenia, osteoporosis), the smallest bone damage (erosions), and a narrowing of the joint lumen.
- Nuclear magnetic resonance and computed tomography (CT) are modern, fairly accurate research methods that reveal to the doctor a picture of pathological changes, including the scale and magnitude of damage.
Bechterew's disease (juvenile ankylosing spondylitis) is an autoimmune hereditary pathology of bone tissue, rapidly leading to ossification of joints and loss of normal mobility. It is chronic.
Specific and typical symptoms:
- sudden and sharp onset of pain not only in the joints of the legs, but also in the back; may spread to the buttocks and lumbar area;
- feverish states, at the peak rashes may appear;
- asymmetrical lesion (unlike rheumatoid arthritis);
- significant increase in swollen joint;
- morning stiffness (a typical symptom of various types of arthritis in children);
Experts note that ankylosing spondylitis often goes hand in hand with Crohn's disease, uveitis, and ulcerative colitis.
Laboratory and technical methods are used for diagnosis:
- blood tests (and with an increased ESR and leukocyte count, the rheumatoid factor will be negative!);
- radiography, which reveals not only the destruction of bone and joint structures, but also deposits of calcium salts in diseased joints and intervertebral discs;
- immunogenetic research reveals a special complex of genes (HLA-B27).
Rheumatoid arthritis in children is an inflammatory disease of connective tissue that appears against the background of rheumatism. Develops after infection of the body with group streptococcus. And during tonsillitis, scarlet fever, pharyngitis, ARVI. Children and adolescents aged 5-15 years are especially susceptible; adults suffer much less frequently, and they usually experience relapses rather than primary cases.
Rheumatoid arthritis is a systemic disease that can affect the entire child’s body, and most importantly the heart. The disease is very dangerous: its complications include heart failure, rheumatic chorea, damage to the heart valves with the development of acquired heart disease.
Characteristic signs of rheumatoid arthritis in children:
- pain is usually severe, mobility is impaired;
- the temperature rises significantly;
- rheumatoid inflammation is usually observed in large joints;
- joints become inflamed on both sides of the body, symmetrically;
- the joint area swells, turns red, and becomes hot;
- the inflammatory process can last up to 7 days;
- At the end of the acute period, the pain goes away and mobility returns.
Rheumatoid arthritis in a child can become chronic, so treatment should never be delayed. First, you need to be diagnosed for rheumatoid arthritis in your child.
The doctor may assume a diagnosis based on a visual examination, and then prescribe examinations to clarify it.
Blood tests are required:
- general, which shows an increase in the number of leukocytes and ESR,
- for the presence of antibodies to streptococcus (ASLO - antistreptolysene O);
It is practiced to prescribe an ECG and ultrasound of the heart, since with rheumatism there is a possibility of inflammation of the heart - rheumatic carditis.
X-rays, as a rule, are not performed, since they do not show any deviations.
Reactive arthritis in children (arthropathy, infectious-allergic arthritis) is a non-purulent inflammatory reaction in the joints that occurs against the background of past infections: gastrointestinal, urogenital, respiratory (for example, sore throat), usually after 2-5 weeks. The disease, in essence, is a response of the immune system to an infectious pathogen (ureaplasma, salmonella, chlamydia, streptococci).
Reactive arthritis is most often diagnosed in adults, but it can occur even in infants.
With reactive arthritis in children, many extra-articular signs of the disease are observed: erythema nodosum, balanitis, balanoposthitis, conjunctivitis, damage to the oral mucosa (glossitis, erosions) and even cardiac inflammation (pericarditis, myocarditis).
A third of patients experience a triad of symptoms: arthritis, urethritis, conjunctivitis. Reactive arthritis is characterized by an acute onset, with weakness, drowsiness and fever. As a rule, 2-3 joints in the knees, feet or ankles are affected asymmetrically, they become swollen, red, painful, and the lower back and heel area may also hurt. Muscle pain is sometimes the first sign of impending reactive arthritis in a child.
This type of arthritis rarely leads to a severe deterioration in mobility and activity, but is dangerous because it can cause complications of the urinary tract and eyes and become chronic if the pathology is not properly treated.
Diagnosis is carried out through a study of the medical history and a comprehensive examination. There are no special laboratory methods, since there are no specific markers. But at the same time, a scoring system has been developed to confirm the diagnosis of rheumatoid arthritis in children.
Among the nonspecific tests, a clinical blood test is prescribed, showing the presence or absence of an inflammatory process in the body (ESR). Stool cultures and urine tests can help detect infections in the intestines and urinary tract. Consultation with an ophthalmologist is often recommended. Other tests may be ordered to rule out other types of arthritis.
Infectious (septic) arthritis in children is associated with the penetration of infection (this can be viruses or bacteria, as well as fungi, mycoplasma) into the joint along with blood, usually after traumatic injuries or medical interventions. The most common arthritis in children is caused by Staphylococcus aureus and Streptococcus B.
Infectious arthritis in children, which is of a bacterial nature, usually develops acutely and is manifested by a deterioration in well-being and appetite, temperature changes, and is accompanied by headaches. All this indicates intoxication of the body. The joint is swollen, reddened, painful, and the pain intensifies during movements, and the redness moves to different places (armpits, groin). Infectious viral arthritis in children lasts no more than two weeks and is completely cured. Infectious arthritis of tuberculous etiology is characterized by pale skin on the surface of the diseased joint, the formation of fistulas and cheesy discharge. Tuberculous arthritis in children causes thickening of the skin over the joint and muscle atrophy. If the disease is neglected, it can become chronic and lead to polyarthritis, that is, damage to many joints.
Parents should be alarmed by the following signs: fatigue, increased evening temperature, night sweats. A significant symptom is pain - during exercise, later and at rest. All of these are reasons to immediately consult a doctor.
The specialist conducts a physical examination and may also prescribe x-rays, CT scans and MRIs.
In addition, joint puncture is performed, followed by cytological and microbiological studies of the samples taken. Blood must be taken - clinical analysis and biochemistry.
Treatment of arthritis in children
It is necessary to treat arthritis in children immediately in order to prevent the disease from becoming chronic and not to start the pathological process before serious complications appear.
If a child has signs of joint disease, he should be shown to a rheumatologist. You may need to consult an orthopedist, cardiologist, infectious disease specialist, or ophthalmologist.
If the baby experiences a fever or persistent severe pain, hospitalization or bed rest may be prescribed. When the exacerbation is stopped, treatment will continue at home with periodic visits to the doctor.
Therapy is based on an integrated approach, which is recognized as the most effective. The choice of specific treatments depends on the type and specific characteristics of the child’s arthritis.
Treatment of all types of arthritis in children is based on general and specific methods and has similar stages:
- activation of the immune system, normalization of metabolic processes and blood circulation;
- removal of inflammation and decay products from the body; stimulation of the supply of joints with nutrients;
- relieving inflammation, pain, muscle spasm;
- restoration of joint elements and return of motor functions.
Significant components of the treatment complex are:
- medicines,
- physiotherapy,
- physiotherapy,
- massage.
Drugs are prescribed individually, including: non-steroidal anti-inflammatory and glucocorticoid drugs, immunomodulators, analgesics, vitamins. For some forms of arthritis in children, antibiotics, antirheumatic and antitumor drugs are indicated.
Treatment with pharmaceuticals must be prescribed and strictly supervised by a doctor! Many medications are potent and can cause an undesirable reaction in the body when taken. If there are any doubtful signs, it is necessary to show the child to a doctor. The task of parents is to follow the instructions, monitor the dose and regularity of use of the medicine.
In severe cases, surgery may be prescribed (performed under anesthesia). Indications for intervention include severe joint deformities, rapid development of arthritis in a child involving other organs in the pathology, and purulent processes. The operation involves washing and disinfecting the joint cavity, removing inflammatory exudate, and in extreme stages - removing or replacing part of the tissue.
Physiotherapy for arthritis in children is very useful and safe. Often several methods are used simultaneously. The following methods are common: electrophoresis, ultrasound, therapeutic mud, paraffin therapy, inductothermy, exposure to pulsed currents. Magnetic therapy is effective, and the magnetic pulse field is perfectly combined with all other medications and physiotherapeutic agents, enhances the overall effect, has a mild and gentle effect and can be used even during exacerbations (in modern devices).
Professional massage has a positive effect on muscles and joints.
Special therapeutic exercises can significantly improve the condition of joints and general well-being. In the non-acute phase and in the absence of severe pain, swimming, cycling, and walking will be useful. Regularity is important. In this case, excessive physical activity (football, jumping, running) is contraindicated.
In some cases, it is recommended to wear orthopedic devices: orthoses, splints, insoles, but intermittently, otherwise muscle tissue atrophy may occur.
In addition, a special low-calorie diet is recommended with limited fluid and carbohydrates, excluding allergenic, fried, salty, and smoked foods. Food should be rich in calcium and vitamin D.
To help the main treatment complex, folk recipes can be used (in consultation with the doctor): tinctures of horsetail, hops, tansy, thistle decoction, clay compresses, pine baths.
Manifestations of knee arthritis in children
If pathology develops in a child in the first years of life, it is very difficult to determine the disease, since the baby is not yet able to clearly explain what is bothering him. If a child frequently exhibits whims, you should pay attention to the accompanying manifestations:
- screaming or crying for no apparent reason, “out of the blue”;
- reluctance to walk or play outdoor games;
- the desire to be held by an adult as often as possible;
- loss of appetite.
As the disease develops, other symptoms appear, which an older child can tell their parents about:
- increasing pain during physical activity or when touched;
- swelling of the bend of the leg, redness and increased local body temperature;
- headaches;
- weakness and severe fatigue;
- stiffness of movements;
- feeling of discomfort in the muscles;
- visible deformation of the joint;
- limping, which over time develops into lameness and gait disturbances.
In the preschool period, arthritis of the knee joint in children is manifested by severe pain that begins at night. The puberty period is characterized by morning attacks, which are accompanied by an increase in temperature and swelling of the bend of the leg. This is due to severe intoxication, which is manifested by fatigue, lethargy and muscle tension, pain.
Arthritis in children
Juvenile rheumatoid arthritis
In the articular form of arthritis in a child, one or more joints (usually symmetrical) may be affected, which is accompanied by pain, swelling and hyperemia.
Large joints (knees, ankles, wrists) are usually involved in the pathological process; small joints of the legs and arms (interphalangeal, metatarsophalangeal) are less commonly affected. There is morning stiffness in the joints, a change in gait; Children under 2 years of age may stop walking completely. In acute arthritis in children, body temperature can rise to 38-39°C. The articular form of arthritis in children often occurs with uveitis, lymphadenopathy, polymorphic skin rash, enlarged liver and spleen.
The articular-visceral (systemic) form of arthritis in children is characterized by arthralgia, lymphadenopathy, persistent high fever, polymorphic allergic rash, and hepatosplenomegaly. The development of myocarditis, polyserositis (pericarditis, pleurisy), and anemia is typical.
The progression of arthritis in children leads to the development of persistent joint deformation, partial or complete limitation of mobility, amyloidosis of the heart, kidneys, liver, and intestines. 25% of children with juvenile rheumatoid arthritis become disabled.
Juvenile ankylosing spondylitis
Symptoms include articular syndrome, extra-articular and general manifestations. Joint damage in this type of arthritis in children is represented by mono- or oligoarthritis, mainly of the joints of the legs; is asymmetrical in nature. More often the disease affects the knee joints, metatarsal joints, metatarsophalangeal joints of the first toe; less often - hip and ankle joints, joints of the upper extremities, sternoclavicular, sternocostal, and pubic joints. The development of enthesopathies, achillobursitis, spinal rigidity, and sacroiliitis is characteristic.
Extra-articular symptoms in ankylosing spondylitis often include uveitis, aortic insufficiency, nephropathy, and secondary renal amyloidosis. The cause of disability in older age is ankylosis of the intervertebral joints and damage to the hip joints.
Reactive arthritis in children
Reactive arthritis in children develops 1-3 weeks after an intestinal or genitourinary infection. Articular manifestations are characterized by mono- or oligoarthritis: swelling of the joints, pain that increases with movement, discoloration of the skin over the joints (hyperemia or cyanosis). The development of enthesopathies, bursitis, and tendovaginitis is possible.
Along with damage to the joints, with reactive arthritis in children there are numerous extra-articular manifestations: damage to the eyes (conjunctivitis, iritis, iridocyclitis), oral mucosa (glossitis, mucosal erosions), genital organs (balanitis, balanoposthitis), skin changes (erythema nodosum) , heart damage (pericarditis, myocarditis, aortitis, extrasystole, AV block).
Common manifestations of reactive arthritis in children include fever, peripheral lymphadenopathy, muscle wasting, and anemia. Reactive arthritis in children in most cases undergoes complete reversal. However, with a long or chronic course, the development of amyloidosis, glomerulonephritis, and polyneuritis is possible.
Infectious arthritis in children
With arthritis of bacterial etiology, symptoms in children develop acutely. At the same time, the general condition of the child noticeably suffers: fever, headache, weakness, and loss of appetite are expressed. Local changes include an increase in the affected joint in volume, skin hyperemia and a local increase in temperature, pain in the joint area at rest and its sharp increase during movement, forced position of the limb, relieving pain. The course of viral arthritis in children is fleeting (1-2 weeks) and usually completely reversible.
Tuberculous arthritis in children occurs against the background of low-grade fever and intoxication; more often in the form of monoarthritis affecting one large joint or spondylitis. Characterized by pallor of the skin over the affected joint (“pale tumor”), the formation of fistulas with the release of white caseous masses.
Examination by a pediatric rheumatologist
Diagnosis of knee arthritis in children
If symptoms of the disease appear systematically, you need to contact a specialist who treats the musculoskeletal system. If necessary, doctors from other specialties will be involved in the examination and restorative manipulations. As primary tests, laboratory tests of blood and urine are prescribed, which make it possible to determine the presence of an inflammatory process. Next, the pathogen is identified if the disease is caused by non-autoimmune causes.
As a hardware diagnostic, radiography is used, which helps to determine the arthritic lesion by indirect signs (on the image there are darkening in the articular area, an unclear contour, narrowing of the interosseous space, erosive inclusions). If there is insufficient information, additional screenings are carried out:
- introscopy;
- collection of biomaterial for study;
- IR thermography;
- arthro-pneumography;
- Ultrasound
- computer scanning;
- MRI.
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