Cardiac and Visceral Signs of Connective Tissue Dysplasia in Children with Juvenile Rheumatoid Arthritis According to Ultrasound Examination Data

To study the cardiac and visceral signs of connective tissue dysplasia in children with juvenile rheumatoid arthritis, a comprehensive ultrasound examination of the abdominal cavity organs and echocardiography examination were conducted according to the standard protocol in 52 children aged from 5 to 16 years with the diagnosis of juvenile rheumatoid arthritis. The reference group consisted of 26 patients with autonomic dysfunction (vegetative-vascular dystonia). The incidence of such visceral dysplasia types as duodenogastric reflux, gastroesophageal reflux, and gallbladder malformations among children with juvenile rheumatoid arthritis was shown higher than in the reference group. The main cardiac sign of connective tissue dysplasia in patients with juvenile rheumatoid arthritis are an excessive chord of the left ventricle.

The Influence of Sanatorium-Resort Rehabilitation on the Cytokine Profile and Quality of Life Parameters in Juvenile Rheumatoid Arthritis

Aim. To study was to assess the dynamics of cytokine profile indicators and quality of life in patients with juvenile rheumatoid arthritis under the influence of the standard sanatorium-resort rehabilitation complex. Material and methods. At the stage of sanatorium rehabilitation, 112 patients aged from 8 to 17 years (mean age 13.2±3.7) with juvenile rheumatoid arthritis were examined. The dynamics of the main quality of life indicators were assessed using the CHAQ questionnaire (pediatric version). Changes in proinflammatory (TNF-α, IL-1, IL-6) and anti-inflammatory cytokines (IL-4, IL-10) were evaluated in correlation with quality of life indices. The control group consisted of 25 healthy equals in age. Results. In juvenile rheumatoid arthritis, the cytokine profile changes, expressed in significantly higher indices of both pro- and antiinflammatory cytokines associated with functional disorders and, as a consequence, lower quality of life indicators as compared with healthy equals in age. Under the influence of sanatorium-resort treatment, functional disorders decreased, quality of life increased, levels of TNF-α, IL-1 as well as anti-inflammatory cytokine IL-4 significantly (p<0,05) decreased. As for other both pro- and antiinflammatory cytokines, only non-significant tendency to decrease was registered. Conclusion. It has been established that before the beginning of sanatorium-resort treatment, the quality of life parameters were lower in patients with juvenile rheumatoid arthritis (JRA), while the values of both proinflammatory (TNF-α, IL-1, IL-6) and anti-inflammatory (IL-4, IL-10) cytokines were significantly (p<0,01) higher than in the control group. At the same time, changes in the studied parameters correlated with the activity of the inflammatory process and the severity of the functional insufficiency of the joints. There were noted the positive influence of the standard complex of sanatorium-resort treatment on the examined quality of life parameters and the tendency to normalization of cytokine profile indexes in patients with JRA.

Relationship of C-Reactive Proteins and Erythrocyte Sedimentation Rate with Active Disease in Patients with Juvenile Rheumatoid Arthritis

Objective: To determine the relationship between serum C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) with active disease in patients with juvenile rheumatoid arthritis (JRA). Methods: This is a cross-sectional analytical study conducted at the Department of Paediatrics, Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. All patients who met the MJA’s American College of Rheumatology (ACR) criteria were enrolled in the study. The ACR 20 improvement criteria were used to define the pardon of the disease, and those who met the ACR20 recovery criteria were included in the remission group. Laboratory tests such as PCR and ESR. Statistical analysis was performed using SAS software (version 10.3). Results: The study involved 90 patients, including 28 in the remission group (31.2%) and 62(68.88%) in the active disease group. There were 61.11% (n = 55) of females, and the ratio of males to females was 3: 4. The mean age of the subjects was 10.12 ± 3.39 years (4–17 years). Distribution of the age of admission by different subgroups, 13 patients (14.44%) aged 1-5 years, 31 patients (34.44%) aged 5-10 years, 40 patients (44.44%) aged 10-15 years and 6 patients (6.66%) were over 15 years old. The mean duration of the disease was 2.40 + 2.11 years (range = 0.3–7 years). The onset of the disease in 21 patients (23.33%) lasting one year (22.9%) from the onset of the disease, 48 patients (53.33%) presented one to five years from the onset of the disease, and 21 patients (23.33%) over five years. The most common type of arthritis was polyarthritis in 43 patients (47.77%), followed by oligo-arthritis in 31 patients (34.44%) and systemic onset in 12 patients (13.33%). The mean ESR was 41.03 + 27.80 mm / hour 1. (Range = 07-128 mm / hour 1) And mean CRP 16.1 + 13.80 mg / L (range = 6-47 mg / L). While the ESR was> 30 mm / 1 hour in 50 of the 90 patients (55.55%), 43 of these 50 patients (86%) were in the active disease group. Similarly, positive CRP was found in 58 patients (64.44%), of whom 52 (89.7%) belonged to the group with active disease. Compared with the remission and active disease groups, 33 patients of active diseases were female. In the active disease group, the mean age was 11.01 + 3.30 years, and the duration of the disease began at one year in patients. Polyarthritis was detected in 26/62 (41.9%) of patients in the active disease group. Conclusion: High CRP and ESR parameters are good for predicting active disease in JRA patients. Keywords: C-reactive protein, Juvenile rheumatoid arthritis, JRA and Erythrocyte mentation rate.

Dissomic disorders associated with juvenile rheumatoid arthritis: impact on quality of life

Dyssomnic disorders (DD) associated with juvenile rheumatoid arthritis (JRA) are some of the most common conditions that are difficult to endure and that lead to deconditioning. This study aimed to assess prevalence and structure of DD, their relationship with clinical picture peculiarities and contribution to deterioration of the quality of lives of JRA patients. At the 1st stage, we assessed prevalence of DD in a continuous sample of JRA patients and healthy children aged 8–16 years. At the 2nd stage, we assessed DD structure, features associated with gender and age, connections to the key clinical characteristics of JRA and quality of life of the patients. In the context of the study, we used the SDSC sleep quality scale, the PedsQL 4.0 quality of life model, and the Ritchie index. DD develop in JRA patients 3.3 times more often than in healthy children (in 178 (72.3%) and 93 (22.2%) children, respectively). The DD registered were sleep initiation and maintenance disorders (54 cases, 22.0%), respiratory disorders (32 cases, 13.0%), sleep-to-wakefulness transition disorders (31 cases, 12.6%), excessive sleepiness disorders (38 cases, 15.4%), combinations thereof (23, 9.3%). Girls had sleep initiation and maintenance disorders more pronounced (p = 0.003), boys were more prone to excessive sleepiness (p = 0.008). The severity of DD increases with patients' age (r = 0.69; p = 0.001) and JRA onset age (r = 0.71; p = 0.001); they are also more severe in polyarticular JRA patients (r = 0.32; p = 0.048). We have clarified the relationship between DD and indicators of inflammatory (r = 0.56; p = 0.001) and Ritchie indices (r = 0.44; p = 0.005), duration of morning stiffness (r = 0.49; p = 0.029). The proven connection between DD and JRA entails the need for routine checks for DD in such patients, and, when discovered, DD should call for personalized therapeutic and diagnostic approach rather than be regarded as one of the JRA syndromes.

Influence of Peloid Therapy on the Condition and Functional Activity of the Glands of Internal Secretion in Juvenile Rheumatoid Arthritis (Clinical and Experimental Study)

The aim of the study was to assess the dynamics of hormones of the pituitary-gonadal-thyroid axis in patients with juvenile rheumatoid arthritis under the influence of peloid therapy and to establish the corresponding morphological changes in the pituitary gland, gonads and the thyroid gland of white Wistar rats with induced adjuvant arthritis during peloid therapy. Material and methods. 46 patients with juvenile rheumatoid arthritis were examined during their rehabilitation at sanatoria. The effect of peloid therapy on the pituitary-gonadal-thyroid axis was evaluated based on the changes in the levels of the main hormones LH, FSH, estradiol, testosterone, TSH, T3, T4. The control group consisted of 15 healthy age-mates. Morphological changes in the pituitary, testes, ovaries and thyroid gland were studied in 24 white Wistar rats with adjuvant arthritis. Results. In juvenile rheumatoid arthritis, the pituitary-gonad-thyroid axis is activated, which is manifested by a decrease in the production of FSH, LH, TSH, testosterone in boys of all age groups and estradiol both in girls regardless of their age and in boys 12–17 years of age. At the same time, an increase in secretion of T3, T4 was observed. The most pronounced deviations were noted in patients with a systemic form of the disease, with a high degree of severity and duration of the disease. The inclusion of mud therapy into the program of sanatorium rehabilitation leads to positive changes in the levels of the studied hormones. The experiment with induced adjuvant arthritis revealed reversible ultrastructural and tinctorial changes in the thyrotropocytes and gonadotropocytes of the pituitary gland, as well as impaired differentiation and partial destruction of the structural elements in the thyroid gland and gonads. The course of peloid therapy had a positive effect on the condition of the thyroid gland and gonads in the experimental animals, which was manifested by the restoration of structural and functional organization. Conclusion. Peloid therapy has a positive effect on the functional activity of the pituitary-gonadal thyroid axis in patients with juvenile rheumatoid arthritis, which has been confirmed by experimental data.