Features of the Current Course of Juvenile Idiopathic Arthritis in Children and Adolescents (Clinical Picture, Diagnosis, Treatment)

The research is devoted to the clinical and immunological study of juvenile idiopathic arthritis (JIA) — a chronic autoimmune pathology in children and adolescents. The work analyzes the prevalence, etiology, and clinical manifestations of the disease, as well as the features of immune status and the balance of pro-inflammatory and anti-inflammatory cytokines (TNF-α, IL-8, IL-10) in the blood serum of affected children. The aim of the dissertation is to develop additional diagnostic criteria and optimize basic therapy based on the obtained clinical and immunological data.

The results of the research, for the first time, make it possible to establish the role of cytokine imbalance in the formation of clinical and immunological manifestations of JIA, as well as to substantiate an individual approach to the selection and monitoring of the effectiveness of basic drugs, taking into account the immune status and cytokine profile of the patient. The practical significance of the work consists in the implementation of the obtained results into the diagnostic and therapeutic practice of the pediatric department of the Samara Regional Clinical Cardiological Dispensary and polyclinics of the city and region.

Relevance of the Problem

Juvenile idiopathic arthritis is the most severe and disabling form of chronic pathology in children and adolescents. Early diagnosis and treatment of idiopathic arthritis in children is one of the most relevant problems of pediatrics.

Currently, in the Russian Federation, as worldwide, there is a trend toward a steady increase in the prevalence of rheumatic diseases both in the general population and in the pediatric population (Baranov A.A., Alekseeva E.I., 2004).

Since 1999, the prevalence of rheumatic diseases among children in the Russian Federation has increased by 30%: from 132.9 per 100,000 children under 18 years of age in 1999 to 170.7 per 100,000 in 2003 (Baranov A.A., Alekseeva E.I., 2004).

One of the features of rheumatic diseases in children is the early development of disability, the degree of which, as well as the quality of life of the child and the possibility of his or her subsequent social, psychological, and professional adaptation, are determined precisely by the timeliness of initiation and adequacy of the treatment conducted.

Given the significance of this problem, the World Health Organization declared 2000–2010 the "Decade of Bone and Joint Diseases." The initiators of the "Decade," in addition to the WHO, were the United Nations and more than 700 public organizations.

The goal of the "Decade" is to change the existing situation, draw the attention of the general public of all countries of the world to patients suffering from rheumatic diseases, and improve their quality of life (Sharapova O.V., Korsunsky A.A., 2004).

The use of existing methods of treatment of juvenile idiopathic arthritis does not exclude relapses and disease progression and often does not prevent disability in children. Conducting immunodiagnostics allows monitoring the immune status of the patient, differentiating the approach to the prescription of basic drugs, and assessing their effectiveness.

Objective of the Research

Based on the study of clinical and immunological indicators and cytokines in blood serum (TNF-α, interleukin 8, 10), to develop additional criteria for diagnosis and optimization of treatment of children with various variants of juvenile idiopathic arthritis.

Tasks of the Research

1. To study immunological indicators in comparison with the clinical picture of juvenile idiopathic arthritis and to identify the most informative ones for determining the prognosis of the course of various variants of juvenile idiopathic arthritis.

2. In children with juvenile idiopathic arthritis, to study the levels of cytokines in blood serum at various stages of JIA development.

3. Based on clinical, immunological, and cytokine indicators, to develop additional criteria for the diagnosis of juvenile idiopathic arthritis.

4. Based on the analysis of clinical, immunological, and cytokine indicators, to optimize basic therapy of JIA.

For the first time, additional criteria for the diagnosis of juvenile idiopathic arthritis in children have been developed based on clinical and immunological and cytokine indicators.

For the first time, the role of pro-inflammatory and anti-inflammatory cytokines in the formation of clinical and immunological manifestations of juvenile idiopathic arthritis has been determined.

For the first time, the prescription of basic drugs for children with JIA has been optimized based on immunological status and cytokine indicators.

Practical Significance

The necessity of assessing immunological and cytokine indicators for the diagnosis of juvenile idiopathic arthritis has been demonstrated.

Based on the dynamics of immunological and cytokine indicators, the prescription of basic therapy for children with JIA has been optimized.

The results of the conducted research are used in the diagnosis and treatment of juvenile idiopathic arthritis in the pediatric department of the Samara Regional Clinical Cardiological Dispensary and in polyclinics of the city and region.

Provisions Presented for Defense:

1. Changes in immunological status are largely determined and realized through a pronounced imbalance between pro-inflammatory cytokines (TNF-α, IL-8) and anti-inflammatory cytokines (IL-10) in children with juvenile idiopathic arthritis.

2. The choice of a basic drug should be made taking into account the clinical and immunological variant of the course of juvenile idiopathic arthritis and the phase of the disease.

3. Monitoring the effectiveness of treatment with basic drugs should be carried out taking into account the immune status and cytokine indicators in the blood serum of children with juvenile idiopathic arthritis.

Validation of the Work

The main provisions were reported and discussed at: the conference of young scientists and specialists of Samara State Medical University "Graduate Readings — 2003," "Graduate Readings — 2004" (Samara, 2003–04), the XI All-Russian National Congress "Man and Medicine" (Moscow, 2004), the XII All-Russian National Congress "Man and Medicine" (Moscow, 2005), regional conferences on pediatric cardiorheumatology (Samara, 2003–04).

Volume and Structure of the Dissertation

The dissertation is presented on 113 pages of typed text and is illustrated with 11 tables and 16 figures. It consists of an introduction, a review of literary sources, methods and materials of research, a clinical characterization of patients, two chapters of own observations, a conclusion, conclusions, and practical recommendations. The list of sources used includes 146 items, of which 98 are domestic and 48 are foreign authors.