Treatment of rheumatoid arthritis in children

Juvenile rheumatoid arthritis( abbreviated JRA) refers to chronic inflammatory joint diseases. This disease occurs in children no older than 16 years, moreover, it meets with a complex pathogenesis and unknown etiology. In some cases, the disease involves the internal organs of a person, which leads to disability, since the disease usually progresses. JRA stands at the first place among the prevalence of rheumatic diseases in children.

Complex therapies are used to treat this ailment, which are carried out in stages. During the exacerbation of the patient's illness, it is necessary to rely on the hospital for full treatment. In the inactive period of the disease the patient is observed outpatiently, and also is treated in a sanatorium. In an outpatient setting, one usually has to be treated for a long time. Sick children get outpatiently complex therapy, consisting of medical treatment, massage courses, exercise therapy, physical therapy. A positive result can be achieved only if the treatment is carried out under the supervision of a medical worker for a long time without interruption.

Sometimes during an exacerbation of the disease the doctor prescribes NSAIDs, in severe cases, in addition to NSAIDs, immunosuppressants and glucocorticoids( cyclosporine, quinoline derivatives, methotrexate, penicillamine) are prescribed. We will not describe all drugs prescribed for this disease, we note only the main ones, the duration of application and their dosage.

Treatment with

Non-steroidal anti-inflammatory drugs

  • Diclofenac is a daily dose of a maximum of 100 mg( 3 mg / kg), which are taken in 2 divided doses.
  • Indomethacin - daily dose is calculated based on the total weight of the child - 3 mg / kg body weight. So, for example: the dose for young children is 25 mg( dose per day), that is half a tablet twice a day. For older children, the daily dose can be 100 mg, this is two 50 mg tablets.
  • Acetylsalicylic acid is a daily dose of a maximum of 3 g, and the whole dose is calculated based on the weight of the patient - from 60 to 80 mg / 1 kg. The medicine is taken three times a day, necessarily after a meal. Duration of treatment - from a month to three.
  • Ibuprofen - daily dose ranges from 200 mg to 1000 mg, it all depends on the age of the patient - 40 mg / kg.
  • Naproxen - daily dose ranges from 250-750 mg. The duration of taking this drug can go up to several years. Children under 10 years of age are not recommended for this drug.

Glucocorticoids

  • Betamethasone( diprospan), methylprednisolone( metipred) - intraarticular preparations, which can be injected into a single joint a maximum of 5 times, with a 5-day interval. If necessary, the course is repeated. The dose is given based on the size of the joint.
  • Prednisolone - the maximum dose per day is 1 mg / kg.

Basis preparations

  • Methotrexate - the drug is taken a week 2-3 r. Based on each m2 of the surface of the trunk 2.5-7.5 mg.
  • Quinoline: chloroquine( delagil, hingamin) - before going to bed once a day for 125-250 mg and hydroxychloroquine( plakvenil) - once a day to 300 mg after dinner before going to bed.
  • Sulfasalazine - twice a day for 0.5-1 g( daily dose).
  • Cyclosporine is a daily dose of about 3 mg / kg twice daily. In this case, monitoring the level of creatinine in the blood. If the level exceeds the norm by 30%, then the drug is stopped or its dosage is reduced.
  • Penicillamine is taken on an empty stomach at a dose of 60-125 mg. Doses are consumed in 1 dose. Duration of treatment up to 2 months.

The course of treatment with basic drugs can go up to several years, it all depends on the symptoms of the disease. Basic therapy can reduce the need for glucocorticoids and NSAIDs( thereby reducing the development of such effects), improve the quality of life, improve long-term prognosis, reduce disability, extend life expectancy.

Immunotherapy

Pentaglobin, intraglobin, sandoglobulin - Ig is administered intravenously. The daily dose is 0.4-2 g / kg. Duration of treatment is 45 days. The first 15 minutes the rate of administration of the drug per minute is at least 10, but not more than 20 drops, then the rate increases to 2 ml. Droppers are repeated as necessary every 4 weeks.

Local therapy

Therapy is based on the treatment of the affected joint - the drug, mainly the glucocorticoid is injected into the joint. The temporary immobilization of the joint is carried out with the help of removable longi, exercise therapy, physiotherapy, massage. Skeletal traction is imposed in the presence of contractures, mechanotherapy is performed on special equipment.