Dzhus M. Clinical and pathogenetic substantiation of management of patients with juvenile rheumatoid arthritis from adolescence to adulthood

The dissertation is devoted to the improvement of the supervision and management of patients with JRA at the stage of transitional medical care and in adulthood by substantiating the concept of planned, consistent, integral observation, examination and treatment of such patients in adulthood through a comprehensive study of immunological and genetic markers, general and psycho-emotional state, the BMD, the long-term articular and extra-articular damages and prediction of their occurrence in young adults with JRA. It has been established that the development of long-term articular damages is related to the cumulative dose of GC, the duration of GC treatment and the appointment of 3 DMARDs, while extra-articular damage - with the cumulative dose of GC, the duration of GC and DMARDs treatment and receiving more than 3 DMARDs or more than 2 IBs. For diagnosis of low mineral density it is recommended to use both the Z- and T-scores in order to avoid underestimation. It was substantiated to keep the JRA diagnosis in adulthood and not to change it during a lifetime as it is a separate, unique disease with its immunological and immunogenic manifestations, which is different from rheumatoid arthritis, and requires special care, observation and treatment of the patient by a rheumatologist aware with clinical features of JRA. The influence of immunologic and immunogenic markers on the clinical course and the long-term effects of JRA in adulthood were determined. The study of the state of BMD, psycho-emotional state, gender differences and the effect of aggressive course of disease and disease activity were distinguished. The algorithm for clinical care and management of patients in adulthood was developed, depending on the immunologic and immunogenetic markers and the established long-term damages of JRA.