Modern basic therapy of juvenile arthritis as a method of rehabilitation and disability prevention

Authors:

Makarova Olga Vladimirovna – PhD in Medical Sciences (Cand. Med. Sci.), Associate Professor of the Department of Therapy 1, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: olgamak2012@mail.ru, https://orcid.org/0000-0002-1849-0648.

Shigapova Svetlana Aleksandrovna – Head of Bureau No. 22 – branch of the Main Bureau of Medical and Social Expertise for the Chelyabinsk Region of the Ministry of Labor of Russia, physician for medical and social expertise, 13 Bocharova Street, 456915 Satka, Russian Federation; e-mail: buro22@74.gbmse.ru.

Stolov Sergey Valentinovich – Grand PhD in Medical sciences (Dr. Med. Sci), assistant professor, Head of the Department of Therapy 1, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: sv100lov@gmail. com; https://orcid.org/0000-0002-3431-1224.

Rodionova Anna Yuryevna – PhD in Medical Sciences (Cand. Med. Sci.), Associate Professor of the Department of Therapy 1, Albrecht Federal Scientific and Educational Centre of Medical and Social Expertise and Rehabilitation, 50 Bestuzhevskaya Street, 195067 St. Petersburg, Russian Federation; e-mail: a.rod84@mail. ru, https://orcid.org/0000-0002-0186-7621.

Annotation:

Introduction. Juvenile arthritis can lead to severe joint deformities with impaired body functions and limitations of life activities, impaired growth and development of children, social maladjustment.
Aim – to analyze clinical and expert characteristics in children with juvenile arthritis receiving different types of basic therapy and referred for medical and social examination.
Materials and methods. Medical and expert documents of 65 children with juvenile arthritis aged 3 to 17 years referred for medical and social examination were studied. Group 1 – 35 children receiving standard basic therapy with methotrexate (sulfasalazine, leflunomide according to indications); Group 2 – 30 children receiving genetically engineered biological drugs together with methotrexate.
Results. In the 1st group, moderate activity of the inflammatory process persisted in 2/3 of cases; the knee, ankle, metacarpophalangeal joints of the hands were predominantly involved; in half of the cases, minor effusion in the joints was detected. Education in schools and kindergartens according to adapted programs for children with musculoskeletal disorders was required in 22.8 % of cases, in the remaining cases there were no restrictions on motor activity. In the 2nd group, the inflammatory activity indicators were normal, minor effusion in the joints was noted in less than half of the cases; large joints were predominantly involved in the pathological process; children studied in general educational institutions according to general programs. In both groups of patients, moderate dysfunctions of the body and limitations of life of the 1st degree in one or two categories (ability to self-care, learning) were determined during the medical and social examination.
Discussion. Differences in the degree of activity of the inflammatory process, the frequency of joint effusion, and the localization of the pathological process in the joints were revealed between the groups. Modern approaches to the treatment of juvenile arthritis allow monitoring the course of the disease, carrying out rehabilitation measures and preventing disability. The inclusion of genetically engineered drugs in the basic therapy in severe cases of the disease makes it possible to avoid early structural and functional disorders in the joints, which is the prevention of the progression of juvenile arthritis and early detection of severe disability.
Conclusion. In accordance with the realities of today, there is a need to develop adequate criteria for medical and social expertise in juvenile arthritis, since the criteria in force today are becoming irrelevant.

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