Tverdokhlib T. Prognosis of the course of reactive arthritis in children, depending on local immunity and intestinal microflora

The thesis presents a new solution to the problems of predicting the course of reactive arthritis in children. It is established that intestinal microflora determines the development of ReA and defines the nature of immunological reactivity. Anamnesis studies revealed risk factors that determine the formation of a large intestine biofilm in the pre- and postnatal period (26.0% of the mothers had inflammatory gynecological diseases, 29.3% had cesarean delivery, 40.0% had at risk of interruption 66.0% of children were on artificial and early mixed feeding). In the acute period, all (100%) patients with ReA have violations of intestinal microbiocenosis. A reliable direct connection of the sIgA level was detected with a degree of dysbiosis. After 9-12 months from the onset of the disease, there was a significant decrease in the sIgA level, compared with baseline data. Children which had a recurrent and protracted course of ReA, a significant increase in the level of sIgA is observed, compared with the group in the reconvalescence phase. The lysozyme studies in the blood serum of patients with ReA in the acute period revealed a significant its deficiency in comparison with the norm. There was close feedback of the degree of dysbiosis. After 9-12 Months after the onset of the disease, normalization of the lysozyme level was noted. When comparing it in children in the period of reconvalescence and in patients with a prolonged and recurrent course of ReA, the least had a significant decrease in lysozyme content. The highest prognostic significance is found in the level of lysozyme in the blood serum, sIgA in saliva, indices of the T-, B-system immunity, phagocytic function. The developed prognostic algorithm and mathematical model allow the clinician with a reliability of ?95% and 90.9% to predict the outcomes of ReA, which will allow individualize the appointment of treatment and rehabilitation measures and increase their effectiveness in this category of patients.