Panko N. Early manifestations and prediction of evolution of juvenile rheumatoid and reactive arthritides in children

The dissertation contains the new solution of questions concerning the improvement of differential diagnosis between JRA and the ReA and the forecasting of possible variants of evolution of these diseases from the first months of their appearing. The results of the study of clinical manifestations of early stages of JRA compared with ReA in children aged from 2 to 18 years are demonstrated. It is pointed up that the particular importance for the differential diagnosis of JRA and ReA is the joints of debut, the order of their involvement, the speed of arthritis distribution. The role of several etiologic factors for ReA is defined. The mycoplasmal and chlamydial ReA have more similar clinical manifestations with JRA because inherent in JRA morning stiffness of joints, local muscular hypotrophy, involvement of small joints of hands, transformation to the chronic process can be present. It is reported that the decrease of carbonyl proteins level mainly appears in patients with JRA in the face of considerable activation of the inflammatory process on the first 18 months of disease development. Children both with JRA and ReA have the same violations of intensity lipid peroxidation which is associated with a decrease in antioxidant protection of the blood. The variations in the immune system relating to various units - cellular, humoral, phagocytic, disturbances in cytokine status are analyzed. The inherent feature for JRA is permanent disability in the immune response and the increase of IL-6 at all stages of the disease. Immunological shifts in ReA are less long-term and are found from the individual units. Important meaning in diagnosis of JRA is noted to have positive a-CCP test, especially in combination with positive RF, they are most frequently defined in children after 12 years old. There is tendency to rapid development of destructive changes in the joints in those patients with JRA. The criteria of differential-diagnostic algorithm between JRA and ReA with regard to their initial manifestations are described. The algorithms for predicting the course of the evolution of JRA and ReA are proposed.