Case history in rheumatology. Diagnosis: rheumatoid arthritis

This file is taken from the Medinfo collection http://www.doktor.ru/medinfo http://medinfo.home.ml.org

Email: [email protected] or [email protected] or [email protected]

FidoNet 2:5030/434 Andrey Novicov

We write essays to order - e-mail: [email protected]

Medinfo offers you the largest Russian collection of medical abstracts, case histories, literature, training programs, and tests.

Visit http://www.doktor.ru - Russian medical server for everyone!

Department of Faculty Pediatrics.

Head Department Chuprov A.V.

Medical history

Full name patient: x

Clinical diagnosis: rheumatoid monoarthritis, subacute course, activity

I, without cardiac dysfunction

Concomitant diseases: hr. tonsillitis, decompensated form,

Follicular tonsillitis, stomatitis.

Curator: Korotkova E.V. course IV group 2 ped. f-t.

Assistant: Kedrova
K.S.

Novosibirsk - 1998

Passport information.
Patient's name: x
Date of birth: 10/18/1990.
Age: 7 years.
Gender: male.
Organized by: Studying at school, 1st grade.
Address: Zdvinsk
Referred by: regional clinic
Date of admission: 05/07/98
Directions: Rheumatoid arthritis, articular form.
Admissions: Rheumatoid arthritis, articular form, chronic disease. tonsillitis, compensation Form.
Ds clinical: rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction

Complaints

At the time of admission, the child complained of pain and swelling in the left knee joint, and headaches.
Anamnesis morbi.
He often suffered from respiratory diseases.
All winter I suffered from colds every month. The last time I had the flu was at the end of February, I went to school from 5.03.
On March 30, he consulted a doctor with complaints of swelling and pain, limited movement in the left knee joint (he was limping). The day before there was a joint injury (bruise). On April 6, he was hospitalized at the URB, as joint swelling and pain persisted. Anti-inflammatory therapy was prescribed there. Within 10 days there was some improvement, the boy was discharged home, and treatment was interrupted. Then pain in the joint reappeared, and bending was difficult. On May 07, he was admitted to the regional hospital for a routine examination.

Anamnesis vitae.

Born the second child from the second pregnancy. I went on maternity leave at 6 months. I followed the regime and ate normally. Childbirth, without complications. He immediately screamed, the scream was loud and strong. Birth weight 4250 g. The baby was put to the breast after 12 hours. Natural feeding until 1 year.
The umbilical cord remnant fell off on the 2nd day. Discharged on the 7th day. No diseases were noted during the neonatal period. He began to hold his head up at 2 months, at 4.5 months he began to stand with support, at 6.5 - crawling, at 7.5 - sitting independently, at 10 - standing independently, at 11 - walking. During the 1st year he was breastfed and suckled actively. From 2 months received apple juice (drop by drop). From 4 months received 5% semolina at 5 months. egg yolk (1/2), at 7 months. minced meat, meat broth at 12 months. - cutlet.
Complementary feeding was tolerated well, weaning time was 12 months. The child’s nutrition is currently adequate.

Vaccinated according to age, response to vaccinations is adequate. He tolerates medications well, there were no blood transfusions.

Allergic history is calm.

Epidemiological history: There was no contact with infectious diseases.

Family history:
The child's parents are healthy, no hereditary predisposition has been identified.

Admission status:

The condition is satisfactory, the position is active, behavior is adequate, consciousness is clear.

Condition of the skin: no pathological changes, increased sweating and skin moisture. Subcutaneous fatty tissue is moderately expressed.

Respiratory system: chest without pathological changes, auscultation - vesicular breathing, respiratory rate 18 per minute, no wheezing is heard. The boundaries of the lungs are within the age norm.

Cardiovascular system: The heart area is visually unchanged.
Heart rate – 80 per minute, blood pressure – 120/80 mmHg. Borders of the heart: left - along the midclavicular line, right - along the right sternum, upper - along the upper edge of the 3rd rib. On auscultation, a systolic murmur is heard at the apex. The first tone at the apex is weakened.
Digestive system: The abdomen is soft, palpation is painless. The liver protrudes 0.5 cm from under the lower edge of the costal arch.

Genitourinary system: the kidneys are not palpable, Pasternatsky’s sign is negative.

Osteoarticular system: when walking, the left leg is spared, the left knee joint is hot, swollen, increased in volume, flexion is limited, pain when moving. The muscular system is developed according to age.

Objective examination:

General information.

The condition is satisfactory, the position is active, consciousness is clear, behavior is adequate. Orients himself well in time and space.
Meningeal symptoms (Kernig, Brudzinski: upper, lower, pubic) are negative, there is no stiff neck.

SKIN: pale, without pathological elements, moderate hair growth, straight nails. The venous network of the lower limb is expanded.
Skin temperature is normal. Humidity is slightly increased. The skin is elastic.
Symptoms of pinch, tourniquet and hammer are negative. Dermographism is mixed.
Appears after 15 seconds, disappears after 2 minutes. Visible mucous membranes are pink and moist.

SUBCUTANEOUS FATTY FIBER: sufficiently expressed, evenly distributed.
Upon palpation, the thickness of the folds in symmetrical areas is the same: on the abdomen - 1.0 cm, on the chest 0.5 cm, under the shoulder blades 0.5 cm, on the posteromedial surface of the shoulder - 0.5 cm, on the posteromedial surface of the thigh - 1 cm, in the cheek area - 1.0. Palpation - compaction and swelling are absent.
Tissue turgor is good.

MUSCULOSCAL SYSTEM:

The muscular system is sufficiently developed, symmetrically, the muscle relief is pronounced. Muscle tone is moderate, strength is sufficient. The head is round, the face is symmetrical, the bite is without pathology, the teeth are closely spaced without gaps.

An examination of the skeletal system revealed no gross deformations. The chest is conical in shape, the shape, mobility and size of the joints are not changed. There are no curvatures of the spine or limbs. Posture is correct (waist triangles are symmetrical, shoulders are at the same level, the angles of the shoulder blades are at the same level, fingertips reach the hip at the same level).
The type of constitution is asthenic.

LYMPHATIC SYSTEM:

The submandibular lymph nodes are single, mobile, and have a dense elastic consistency. Dimensions 0.5x1 cm, painless. Cervical lymph nodes. Cervical lymph nodes are single, mobile, densely elastic consistency, size 0.3x0.5 cm, painless.
The axillary lymph nodes are single, mobile, and have a dense elastic consistency. Size 0.5X0.8, painless.

The remaining groups of lymph nodes (occipital, in the mastoid region, mental, tonsillar, posterior cervical, supra- and subclavian, thoracic, ulnar, popliteal) are not palpable.

Percussion size of the spleen is 5x6 cm. It was not possible to palpate the spleen.
RESPIRATORY SYSTEM:

The voice is clear, breathing through the nose is not difficult. Abdominal breathing type. NPV
20 per minute The depth of breathing is normal, the chest participates in the act of breathing normally, the movements are symmetrical. The ratio of pulse to respiration is 3:1.
The tonsils are not enlarged, protrude beyond the anterior arches, and are somewhat hyperemic. The chest is elastic and painless. Voice tremors are symmetrical on both sides, without any features.

Breathing is smooth and rhythmic. With comparative percussion over the entire surface of the pulmonary fields and in symmetrical areas of the lungs, a pulmonary sound is determined.

Topographic percussion of the lungs:

The lower border of the right lung - along the midclavicular line - 6th rib along the midaxillary line - 8th rib along the scapular line - 9th rib along the paravertebral line - at the level of the spinous process of the 11th thoracic vertebra

The lower border of the left lung - along the midclavicular line - along the midaxillary line - 8th rib along the scapular line
- 10th rib along the paravertebral line - at the level of the spinous process
11th thoracic vertebra

The height of the apex of the lungs posteriorly at the level of the spinous process
VII cervical vertebra. The width of the Krenig fields on the left and right is 4 cm. The mobility of the lower edge of both lungs along the scapular line is 6 cm. Symptoms of Arkavin,
Koranyas, Philosopher's cups - negative.

Auscultation reveals vesicular breathing. No wheezing or other pathological noises are heard. Breathing over the area of ​​the trachea and bifurcation is unchanged, clear, and no adverse respiratory sounds are heard. Bronchophony is carried out equally on both sides and is not changed.

CARDIOVASCULAR SYSTEM:

Upon examination, the area of ​​the heart was visually and palpably unchanged.
The apical impulse is determined in the 5th intercostal space along the left midclavicular line, limited (localized), of sufficient strength and height, rhythmic, non-resistant. The cardiac hump is absent. No systolic retractions are detected. No visible vascular pulsation is observed. Capillary pulse
Quincke is negative.

Palpation: The pulse is determined on the temporal, carotid, radial, femoral arteries, as well as on a. dorsalis pedis. The pulse on the radial artery is symmetrical, synchronous, frequency 70 beats per minute, rhythmic, tension and filling are sufficient, synchronous with the contraction of the heart.
The symptom of “cat purring” is negative.

Percussion:
Borders of relative cardiac dullness: left - along the midclavicular line, right - along the right edge of the sternum, upper - along the upper edge of the 3rd rib.
On auscultation, a systolic murmur is heard at the apex. The first tone at the apex and at the Botkin point is muffled.
Limits of absolute cardiac dullness:

Upper – third intercostal space.

Left - along the midclavicular line.

Right - along the left edge of the sternum.

The diameter of the heart is 9 cm.

The vascular bundle does not extend beyond the edges of the sternum.

Blood pressure 120/80 mm. RT., Art.

DIGESTIVE SYSTEM:

The oral cavity has a normal smell, the mucous membrane is hyperemic, the tongue is moist and pink, the tonsils are loose and hyperemic. There are no cracks or plaque.
The color of the visible mucous membranes is normal pink, there is no pigmentation or ulceration.
The gums are reddish, there is no bleeding or looseness.

The teeth are permanent, the number corresponds to age, no carious teeth were detected.

On examination: the shape of the abdomen is correct, there is no asymmetry.
Dilatation of the veins of the anterior abdominal wall, peristalsis, and divergence of the rectus abdominis muscles are not observed. No scars, pigmentation, or protrusions are observed. The abdominal wall participates in the act of breathing evenly.
Epigastric angle ~90o

Percussion of the abdomen reveals areas of tympany and dullness over the intestinal area. On superficial palpation the abdomen is soft and painless.

The sigmoid, blind, ascending and descending sections of the colon are palpated painlessly and mobile. Deep palpation: painless, parts of the intestine could not be palpated

Palpation of the liver according to Strazhesko: the liver protrudes 0.5 cm beyond the edge of the right costal arch along the midclavicular line. The edge of the liver is sharp, painless, the surface is smooth. Dimensions according to Kurlov: along the midclavicular line on the right - 9, along the midline - 8, along the edge of the left costal arch - 7.
Palpation at the point of projection of the gallbladder is painless. Murphy's symptoms
Ortner, Mussi - negative. Palpation of the pancreas is painless in the Choffard area, Desjardins point and Mayo-Robson point.
Mesenteric lymph nodes are not palpable. When auscultating the abdomen, intestinal peristalsis is heard. The child's stool is regular, shaped, sausage-shaped, and brown in color. In the last three days, no bowel disturbances were detected.

URINARY SYSTEM:
On examination: there is no renal edema; The lumbar region is not changed.
There is no bulging or hyperemia of the skin.
Palpation:

Palpation of the bladder is painless.

Pain points of the ureters are not determined.

Pain when urinating and urinary incontinence are absent.
The frequency of urination is 6-7 times a day, painless, independent.
Daytime diuresis predominates. Pasternatsky's symptom is negative on both sides.

EDOCRINE SYSTEM:

There is no impairment of growth and body weight, the subcutaneous fat layer is moderately developed and evenly distributed.

The thyroid gland is not palpable.

There are no secondary sexual characteristics, according to age.

General conclusion based on objective examination data:

No lesions of the skin, subcutaneous fat, musculoskeletal system, lymphatic system and blood system, digestive system and endocrine system, or urinary system were detected.

From the cardiovascular system - systolic murmur at the apex and at Botkin's point. The first tone at the apex is weakened.

There are no special features from the respiratory system.

Considering the duration of the disease, the clear connection with trauma, and the absence of signs of inflammation, there is no convincing evidence for rheumatoid arthritis.

For differential diagnosis and clinical diagnosis, it is necessary to carry out the following additional research methods:

1. General blood and urine analysis;

2. Biochemical blood test (total protein, protein fractions, seromucoid, sialic acids, fibrinogen);

3. Feces on Yaglist

5. R-gr. knee joints

6. ECG and ultrasound of the heart

7. CEC and ASL-O

Additional research methods.

Laboratory methods:
Complete blood count (09/17/1997):

|Red blood cells|Hb |CP |Platelets|Reticulocytes|ESR |
|4x1012 G/l|125 |1 |180 /l |0.7% |15 mm/h|

|Leukocytes|Basoph.|Eosin.|Young |Paloch|Segmen|Lymph.|Monocytes|
| | | | |. |. | | |
|7.9 T/l |1 |5 |0 |5 |67 |19 |3 |

Conclusion.

Red blood: ESR increased

White blood: no change

General urine test (04/16/1998): total amount 150 ml, color - yellow
Specific gravity 1020.
|Chemical |Protein 0 |
|Research |Sugar negative |
| Microscopic | Renal epithelium - |
|Research |Squamous epithelium 0-1 in p/z |
| |Leukocytes 0-2 in p/z. |
| |Red blood cells - |
| |Salts + ; Bacteria - |

Conclusion: general urinalysis without any features

ReBiochemical blood test sample (04/16/1998):

(-lipoproteins – 3940; cholesterol – 4.6; triglycerides – 0.98; total protein – 78.2;

ALT-10
Seromucoid –0.01

Conclusion: All studied indicators are within age norms. No pathological abnormalities characteristic of any suspected disease were identified.

Immunological Blood test:

CEC - negative

ASL-O negative

Feces on i/g: --

Instrumental methods.

R-research

The left and right knee joints are unremarkable.

Ultrasound examination of the heart:

Conclusion: the heart cavities are not expanded, the walls are not thickened.
Slight marginal compaction of the right coronary and non-coronary leaflets.
Myocardial contractility is sufficient.

Impaired conduction through the atria, increased electrical activity of the left ventricle (stable over time). Sinus bradyarrhythmia 57-85 IM

Not convincing changes for congenital heart disease. Anomaly of pulmonary vein drainage.

General conclusion on complaints, anamnesis, objective examination and additional methods and differential diagnosis:
Rheumatoid arthritis should be differentiated from primary tuberculosis syndrome, rheumatism and deforming osteoarthritis. Rheumatoid arthritis, as well as primary tuberculosis, is characterized by the presence of functional systolic murmur at the apex, joint pain, and increased ESR. Rheumatoid arthritis differs from primary tuberculosis in the absence of anamnestic indications of the patient’s contacts with tuberculosis patients, and an increase in the titer of ASL-O and AST. Rheumatism is characterized by the presence of patients with rheumatism in the family, close contacts of the patient with patients with tonsillitis, palpitations at rest and after physical exercise. stress, the presence of skin manifestations (rheumatic nodules). Detection of increased titers of streptococcal antibodies in the blood, dysproteinemia, the appearance of C-reactive protein, an increase in seromucoid content. The diagnosis of osteoarthritis deformans can be based on an analysis of risk factors for this disease
(heredity, excess body weight), the presence of characteristic radiological changes.
Based on complaints of pain and swelling in the left knee joint, the status on admission (the left leg is spared when walking, the left knee joint is hot, swollen, enlarged, flexion is limited, pain when moving), a final clinical diagnosis can be assumed -
Rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction. Concomitant diseases: chronic tonsillitis, compensated form, stomatitis.

Treatment plan for the underlying and concomitant disease:
Mode IIa (semi-bed), table No. 5 (hypochloride). Vitamin therapy (multivitamins) is indicated.
Anti-inflammatory therapy with non-steroidal drugs (aspirin up to 1g), cardiotrophics (digoxin).

Treatment:
Rp: Dragee "Revit"

S. 1 tablet 2 times a day.

Rp: Acidi acetylsalicilici 0.5

D.t.d. N50 in tab

Signa: 1 tablet 2 times a day for 2 months at a decreasing dosage.

# # #
Rp: Sol. Digoxini 0.025%-0.5ml

D.t.d. N20 in amp.

S: 0.5 ml 2 times i.v.

Observation diary:
5. The condition is serious due to fever. Symptoms of intoxication.

The child is lethargic. t-39.2
Poorly reduced by antipyretics, the skin is clean and dry. In the pharynx: bright hyperemia of the tonsils, purulent follicles, there is a moderate increase in the submandibular and anterior cervical lymph nodes up to 1 cm. Pain in the throat when swallowing is a concern. In the lungs, breathing is vesicular, there are no wheezes. The boundaries of the heart are not changed. Soft systolic murmur at the apex, weakening of 1 tone at the apex, soft abdomen, slight pain on palpation in the duodenal zone. There was no chair. Urination is not difficult, painless. Taking into account the fever and changes in the nasopharynx, the child has clinical manifestations of follicular tonsillitis.
18.05 Condition without negative dynamics: the temperature remains at low-grade levels and drops to normal on its own. Symptoms of intoxication have decreased. The skin is pale, clean, dry. In the pharynx: bright hyperemia remains, swelling of the tonsils has decreased, purulent plugs on the tonsils remain. Breathing in the lungs is vesicular, heart sounds are loud, rhythmic, systolic murmur in L5-L4. The abdomen is soft, painless, physiological functions are normal.
19.05 Upon examination, the condition is of moderate severity, symptoms of intoxication, pale. In the pharynx: bright hyperemia, loose tonsils. Breathing in the lungs is vesicular, heart sounds are loud, rhythmic, systolic murmur in L5-L4.
The abdomen is soft, painless, physiological functions are normal. HELL
120/80 t-37.2
20.05 Upon examination, the condition is of moderate severity. Hyperthermia. Trouble in the throat when swallowing. The skin is pale, clean, dry. In the pharynx: bright hyperemia remains, the tonsils are loose. Breathing in the lungs is vesicular. Blood pressure 120/80, pulse 78. The abdomen is soft and painless.

Stage epicrisis:

The condition is of moderate severity. He was admitted to the department with manifestations of rheumatoid arthritis. Currently, the leading symptoms are symptoms of intoxication. Upon repeated echocardiography, there is no evidence of valve compaction, but a consultation with a cardiologist is planned to clarify the nature of the heart damage. The skin is pale, clean, the tongue is thickly coated with a greenish coating, the papillae are enlarged, there are purulent plugs in the tonsils, there is no fever. Auscultation: heart sounds are sonorous, rhythmic, the boundaries of the heart are not changed. The abdomen is soft and painless.
Recommended: Bed rest, diet No. 5. Therapy as planned. After 5-7 days, repeat the general blood test, immunologist. blood test (ASL-O), blood biochemistry (total protein, albumin, seromucoid, ALT, AST), fibrinogen,
GOS, CRP, repeat echocardiography. Consultation with an ENT doctor and dentist is recommended.
Literature:
1. The problem of rheumatoid arthritis Venblat M.E. Gravales E.M.
2. Pediatrician’s companion I.N. Usov.
3. Russian medical journal volume 6 No. 9. From the international Internet
(wide world web)

Curator's signature_____________________

Date of birth: 10/18/1990.

Organized by: Studying at school, 1st grade.

Referred to: regional clinic

Date of admission: 05/07/98

Directions: Rheumatoid arthritis, articular form.

Admissions: Rheumatoid arthritis, articular form, chronic disease. tonsillitis, compensation Form.

Dsclinical: rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction

At the time of admission, the child complained of pain and swelling in the left knee joint, and headaches.

He often suffered from respiratory diseases.

All winter I suffered from colds every month. The last time I had the flu was at the end of February, I went to school on March 5, and went to the doctor on March 30 with complaints of swelling and pain, limited movement in the left knee joint (I was limping). The day before there was a joint injury (bruise). On April 6, he was hospitalized at the URB, as joint swelling and pain persisted.

Born the second child from the second pregnancy. I went on maternity leave at 6 months. I followed the regime and ate normally. Childbirth, without complications. He immediately screamed, the scream was loud and strong. Birth weight 4250 g. The baby was put to the breast after 12 hours. Natural feeding until 1 year. The umbilical cord remnant fell off on the 2nd day. Discharged on the 7th day.

No diseases were noted during the neonatal period. He began to hold his head up at 2 months, at 4.5 months he began to stand with support, at 6.5 - crawling, at 7.5 - sitting independently, at 10 - standing independently, at 11 - walking. During the 1st year he was breastfed and suckled actively. From 2 months received apple juice (drop by drop). From 4 months

Vaccinated according to age, response to vaccinations is adequate. He tolerates medications well, there were no blood transfusions.

Allergic history is calm.

Epidemiological history: There was no contact with infectious diseases.

The child's parents are healthy, no hereditary predisposition has been identified.

The condition is satisfactory, the position is active, behavior is adequate, consciousness is clear.

Condition of the skin: no pathological changes, increased sweating and skin moisture. Subcutaneous fatty tissue is moderately expressed.

Respiratory system: chest without pathological changes, auscultation - vesicular breathing, respiratory rate 18 per minute, no wheezing is heard. The boundaries of the lungs are within the age norm.

Cardiovascular system: The heart area is visually unchanged. Heart rate – 80 per minute, blood pressure – 120/80 mmHg. Borders of the heart: left - along the midclavicular line, right - along the right sternum, upper - along the upper edge of the 3rd rib. On auscultation, a systolic murmur is heard at the apex. The first tone at the apex is weakened.

Digestive system: The abdomen is soft, palpation is painless. The liver protrudes 0.5 cm from under the lower edge of the costal arch.

Genitourinary system: the kidneys are not palpable, Pasternatsky’s sign is negative.

Osteoarticular system: when walking, the left leg is spared, the left knee joint is hot, swollen, increased in volume, flexion is limited, pain when moving. The muscular system is developed according to age.

The condition is satisfactory, the position is active, consciousness is clear, behavior is adequate. Orients himself well in time and space. Meningeal symptoms (Kernig, Brudzinski: upper, lower, pubic) are negative, there is no stiff neck.

SKIN: pale, without pathological elements, moderate hair growth, straight nails. The venous network of the lower limb is expanded. Skin temperature is normal. Humidity is slightly increased. The skin is elastic. Symptoms of pinch, tourniquet and hammer are negative. Dermographism is mixed. Appears after 15 seconds, disappears after 2 minutes. Visible mucous membranes are pink and moist.

SUBCUTANEOUS FATTY FIBER: sufficiently expressed, evenly distributed. Upon palpation, the thickness of the folds in symmetrical areas is the same: on the abdomen - 1.0 cm, on the chest 0.5 cm, under the shoulder blades 0.5 cm, on the posteromedial surface of the shoulder - 0.5 cm, on the posteromedial surface of the thigh - 1 cm, in the cheek area - 1.0. Palpation - compaction and swelling are absent. Tissue turgor is good.

The muscular system is sufficiently developed, symmetrically, the muscle relief is pronounced. Muscle tone is moderate, strength is sufficient. The head is round, the face is symmetrical, the bite is without pathology, the teeth are closely spaced without gaps.

An examination of the skeletal system revealed no gross deformations. The chest is conical in shape, the shape, mobility and size of the joints are not changed. There are no curvatures of the spine or limbs. Posture is correct (waist triangles are symmetrical, shoulders are at the same level, the angles of the shoulder blades are at the same level, fingertips reach the hip at the same level). The type of constitution is asthenic.

The submandibular lymph nodes are single, mobile, and have a dense elastic consistency. Dimensions 0.5x1 cm, painless. Cervical lymph nodes. Cervical lymph nodes are single, mobile, densely elastic consistency, size 0.3x0.5 cm, painless. The axillary lymph nodes are single, mobile, and have a dense elastic consistency. Size 0.5X0.8, painless.

The remaining groups of lymph nodes (occipital, in the mastoid region, mental, tonsillar, posterior cervical, supra- and subclavian, thoracic, ulnar, popliteal) are not palpable.

Percussion size of the spleen is 5x6 cm. It was not possible to palpate the spleen.

The voice is clear, breathing through the nose is not difficult. Abdominal breathing type. NPV 20 per minute. The depth of breathing is normal, the chest participates in the act of breathing normally, the movements are symmetrical. The ratio of pulse to respiration is 3:1. The tonsils are not enlarged, protrude beyond the anterior arches, and are somewhat hyperemic. The chest is elastic and painless. Voice tremors are symmetrical on both sides, without any features.

Breathing is smooth and rhythmic. With comparative percussion over the entire surface of the pulmonary fields and in symmetrical areas of the lungs, a pulmonary sound is determined.

Have you been trying to heal your JOINTS for many years?

Symptoms

Reiter's syndrome is a common manifestation of reactive arthritis in children.

48. Reactive arthritis

Criteria for diagnosing reactive arthritis.

1) elimination of infectious foci that support the articular process;

2) regulation of immunological reactivity;

5) stimulating therapy (vitamins, nonspecific adaptogens, anabolic steroid drugs) strictly according to indications;

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Case history - Pediatrics (rheumatoid monoarthritis)

Reactive arthritis (RA) is a serious inflammatory joint disease that occurs as a result of an infection. It is considered secondary, because does not occur independently, but as a consequence of a bacterial or viral disease. Reactive arthritis is quite common and accounts for 40-50% of all rheumatic diseases in children.

Komarovsky E.O., a well-known pediatrician, considers reactive arthritis in children to be a difficult disease to diagnose due to the blurred clinical picture and the absence of signs of infection in the anamnesis. Also, reactive arthritis is easily confused with other types of joint inflammation. However, special vigilance is necessary with regard to this disease, since in addition to the musculoskeletal system, it can also affect other organs (heart, kidneys).

Case history Juvenile rheumatoid arthritis, systemic form, allergic septic variant at onset, seronegative according to the Russian Federation, activity 0-1, Rg stage 2-1, NF-1-0

Ministry of Health and Social Development of the Russian Federation

State educational institution of higher professional education

FIRST MOSCOW STATE MEDICAL UNIVERSITY named after I.M. Sechenov

Department of Childhood Diseases.

Completed by: 5th year student

Checked by: Ph.D., Associate Professor

1. Last name, first name, patronymic of the patient.

2. Age (year, month and birthday).01/24/1996 (14 years)

3. Date of admission to the clinic. 09/30/2010

4. Parents' occupation. Mother is a technician

5. Attends school

6. Address, telephone. -

1. Complaints upon admission to the clinic about limited mobility in the hip joints

2. Does not make complaints about the day of supervision

1. From the first pregnancy due to pyelonephritis. Delivery on time

2. At birth, weight 3600 g, height 54 cm. He screamed immediately. First breastfeeding on the first day.

3. Breastfeeding up to 3 months, then artificial

4. Indicators of the child’s physical and psychomotor development are appropriate for his age. Behavior in the family, in the team - contact.

5. Past diseases. Otitis at 8 months. Rare ARVI. Biliary dyskinesia in 2000. Angina in 2003 Chicken pox.

Allergic reactions to amikacin - rash and seizures.

6. Preventive vaccinations - BCG, DTP, against polio according to age without reactions. Mantoux reaction 10g. – papule 5 mm.

7. Family history.

8. Material and living conditions are satisfactory

He is admitted for follow-up examination and therapy correction.

Objective research data on the day of supervision.

Т° 36.6 1) table No. A1

Pulse 75 per minute 2) methotrexate 10 mg. 1r. on Tuesdays

3) folic acid 0.001 1r/d

4) calcium D3 1t 1r/d.

Blood pressure 120/70 mmHg.

The general condition of the child is satisfactory.

Eyes and ears – externally without visible pathology

Body weight 43.5 kg, body length 162.5 cm. Asthenic build.

According to the formula = 100 6 (n-4) = 100 6 (14-4) = 160 cm. The actual body length exceeds the calculated one by 1.5%

According to the formula = n x 5 - 20 = 14x5 - 20 = 50kg. The actual body weight is 13% less than the calculated one.

Physical development corresponds to age, disharmonious (deviation in body weight 13%).

Skin and subcutaneous fat.

The skin is pale and dry.

Hair, fingers and nails without pathology.

The muscles are developed satisfactorily, symmetrically, muscle tone is preserved, and are painless on palpation. No muscle tightness

The fontanelles are closed, the sutures are closed, the chest is cylindrical, the limbs are straight, the spine is a violation of posture.

The chest is cylindrical in shape, no deformations are noted. Epigastric angle 60°.

Paravertebral

In the lungs, breathing is vesicular, carried out evenly in all sections, there is no wheezing. Vesicular breathing.

There are no visible changes in the chest in the area of ​​the heart. Palpation in the heart area is painless.

Right: at the right edge of the sternum in the 4th intercostal space.

Left: 0.5 cm medially from the left midclavicular line, in the 5th intercostal space.

Upper: located at the level of the middle of the 3rd intercostal space.

The boundaries of this child’s heart correspond to the age norm.

Digestive system and abdominal organs.

Gums without pathological changes. The salivary glands (parotid, submandibular, sublingual) are not changed.

On auscultation, normal bowel sounds are heard. The stool is formed, normal consistency, regular.

The abdomen is symmetrical, there is limited protrusion in the area of ​​the right hypochondrium and there is no restriction in breathing in this area.

Liver dimensions according to Kurlov are within normal limits (9/8/7)

On palpation, the lower edge of the liver at the edge of the rib is not pointed, the surface is smooth, the consistency is elastic, painless.

The gallbladder is not palpable.

There is no hyperemia or swelling in the kidney area.

The kidneys are not palpable. There is no pain on palpation in the area of ​​the upper and lower ureteral points

Development of the genital organs according to the male type. Secondary sexual characteristics correspond to the age of the child.

Results of laboratory, instrumental and other special studies.

Based on complaints (joint pain, swelling, hyperemia, history of periodic attacks, duration of arthritis more than 3 months

(onset at the age of 1 year 7 months), symmetrical damage to small joints, as well as laboratory and instrumental diagnostic data (presence

effusion in the joint cavity, radiologically confirmed presence of osteoporosis, changes in joint spaces) a diagnosis can be made: juvenile

rheumatoid arthritis, articular form (polyarthritis), seronegative variant. Act. 1 tbsp. X-ray 1st. FC - 1.

Concomitant diseases: Chronic chlamydial infection (according to medical history), chronic gastritis, duodenitis (according to endoscopy, the presence of

predisposing family history). Dysmetabolic nephropathy (oxaluria) due to anomalies in kidney development (according to medical history).

JRA should be differentiated from many diseases that occur with articular syndrome, in particular with rheumatism, osteomyelitis,

When distinguishing between JRA and rheumatism, the absence of cardiac changes and the persistence of the articular syndrome in JRA are essential.

With osteomyelitis and JRA with acute onset, there may be general symptoms - high fever, painful contracture in the affected limb,

intoxication, but with osteomyelitis, signs of soft tissue involvement appear in the coming days. Moreover, in this case the disease

It is not acute and lasts more than 10 years.

Trauma can be excluded based on the duration of the disease and the presence of polyartitis.

Tuberculosis can be excluded based on X-ray data and the results of tuberculin tests.

Ibuprofen 2 times a day after meals Has minimal toxic effect; recommended for use when the activity of the process is low,

predominantly in the articular form of JRA.

Polyoxidonium 3 mg IM 1 time per day every other day

Case history: “Juvenile rheumatoid arthritis (JRA), articular form, polyarthritis, seronegative variant, slowly progressive course”

1. The onset of the disease is damage to the joints, combined with damage to internal organs in the disease. No dysfunction is noted at this stage.

2. There is a persistent dysfunction of the affected joints, destruction of cartilage tissue. Damage to internal organs with disruption of their function.

3. Further progression of destruction of joints and their fusion.

There are several types of juvenile rheumatoid arthritis. The most uncomplicated option is when only one or two joints are affected. The disease begins with pain in the joints, which appears only when moving; their function is not impaired. If you feel them, there is usually no pain, it is only in cases where the disease begins very aggressively.

About half of newly diagnosed children are between two and four years old. And the more joints were affected at the onset of the disease, the more severe the disease. The very first sign that parents pay attention to is that the child moves worse in the morning, and by the middle of the day the movements are almost completely restored.

Most often, at the first stage of juvenile rheumatoid arthritis in children, one or more joints are affected, mainly large joints, mainly the knee. Then the ankles join. Internal organs are not often affected. Mainly the eyes in the form of iridocyclitis, and only in cases where the activity of the process is not great. But it is very difficult to detect, only with regular observation. Children complain of decreased vision, a feeling of sand stuck in the eyes.

More details

Juvenile rheumatoid arthritis was first described at the end of the last century by pediatricians Still and Shaffar, and was originally called Still-Chaffar disease. Juvenile rheumatoid arthritis is a chronic disease that develops only at an early age (before 16 years). The causes of the disease have not yet been clarified. It manifests itself with a wide range of symptoms, often involving internal organs, progresses quickly and often leads to disability of the patient.

According to ICD 10 (International Classification of Diseases), a group of rheumatic diseases characteristic only of childhood is called juvenile arthritis, but names such as juvenile idiopathic arthritis or juvenile chronic arthritis may also appear in the literature. In some patients, this form of arthritis may be accompanied not only by joint damage, but also by inflammatory processes in other organs. Professor Alekseeva, who studied this disease, described in her scientific work the possible causes of the appearance and development of the disease.

1. Systemic damage (Still's disease): fever, rash, damage to internal organs (myocardium, liver, kidneys).

2. Oligoarthritis (affects no more than 4 joints).

3. Polyarthritis (affects 5 or more joints, sometimes up to 20).

Arthritis can manifest itself in acute or subacute form. With the acute onset of the disease, the patient experiences multiple inflammations of the joints, which are accompanied by edema, swelling, deformities and severe pain. An increase in body temperature is typical, more often in the morning. A drop in temperature is accompanied by profuse sweating.

Deformation of limbs in sick children

More details

A. Clinical picture. Juvenile rheumatoid arthritis begins before the age of 16 years. It is characterized by the following features: 1) asymmetry of the lesion; 2) early involvement of large joints; 3) damage to one or more joints; 4) lack of connection between the presence of systemic manifestations and the severity of joint damage;

5) rare detection of rheumatoid factor. Depending on the clinical picture, three main forms of juvenile rheumatoid arthritis can be distinguished: 1) Still's syndrome (characterized by damage to internal organs); 2) oligoarthritis; 3) polyarthritis. The differences between these forms of the disease are presented in table. 15.8. A disease similar to Still's syndrome may first appear at a later age.

Pediatric rheumatoid arthritis - long-term treatment required

Pediatric rheumatoid arthritis is an autoimmune disease, most often of unknown origin. It is characterized by joint damage and a slow chronic course with constant progression of the disease.

• Causes of the disease
• Pathogenesis of the disease
• What are the manifestations of the disease
• Articular form of the disease
• Articular-visceral form of the disease
• Diagnosis of the disease
• Treatment approaches
• Disease prevention
• What then?

In children, this disease is called juvenile rheumatoid arthritis (JRA). Rheumatoid arthritis is quite common among diseases of the articular system; it most often affects adults (up to 1.5% of the total population). Children suffer from this disease less often - approximately 0.05%. This disease is usually diagnosed in preschool children; up to half of cases of rheumatoid arthritis are diagnosed before the age of 5 years. Before 1 year of age, it is almost impossible to identify symptoms; they are disguised as deviations in physical development and do not cause concern among parents and pediatricians.

Despite the fact that juvenile rheumatoid arthritis is rare, this disease is of great social importance, since due to joint damage, the normal development of the child is disrupted, which leads to disability, difficulties in his social adaptation and development.

The causes of arthritis in children have not yet been thoroughly studied. This disease is an autoimmune disease, that is, the body stops recognizing its own cells and begins to destroy tissues and organs. This leads to the occurrence of inflammatory reactions in tissues, as in allergic diseases, but here joint tissues act as an allergen.

Often the disease is provoked by an infection - streptococci, staphylococci, viruses and mycoplasmas can cause the onset of the disease. These microorganisms are found in the body of a child with JRA, or the disease itself begins after an upper respiratory tract infection, scarlet fever, tonsillitis or influenza.

But there are no factors proving the direct influence of these microorganisms on the occurrence of the disease. Currently, the cause of the disease is considered to be altered reactivity of the body and increased sensitivity to various environmental factors.

Rheumatoid arthritis in a child develops under the influence of a combination of several factors. The main target organ is the synovial membrane of the joints; it is the first to be affected by this disease.

Under the influence of the primary antigen (not yet precisely established, presumably bacteria or viruses), a change occurs in immunocompetent cells. The body subsequently regards them as foreign and begins to destroy them. Plasma cells produce antigens, an antigen-antibody complex is created, accompanied by the release of components of the inflammatory reaction. A large number of leukocytes are released into the cavity of the synovial membrane, which lead to the emergence of new antigens.

Immune complexes from the joint membrane enter the blood, spread throughout the body and cause damage to other organs and systems. Joints begin to deteriorate due to inflammatory reactions and damage by enzymes and immune complexes. This leads to disturbances in the functions and structure of cartilage and bone tissue.

With rheumatoid arthritis, damage to the heart, kidneys, liver, lungs, and small vessels is possible. Complications may occur in the form of myocarditis, pericarditis, pleurisy, amyloidosis, glomerulonephritis, liver dystrophy and necrosis.

The first signs of rheumatoid arthritis usually appear between the ages of 1 and 4 years. Less commonly, the disease begins in adolescence or is diagnosed in children under 1 year of age.

The main symptoms are signs of joint damage.

megan92 2 weeks ago

Tell me, how does anyone deal with joint pain? My knees hurt terribly ((I take painkillers, but I understand that I’m fighting the effect, not the cause... They don’t help at all!

Daria 2 weeks ago

I struggled with my painful joints for several years until I read this article by some Chinese doctor. And I forgot about “incurable” joints a long time ago. That's how things are

megan92 13 days ago

Daria 12 days ago

megan92, that’s what I wrote in my first comment) Well, I’ll duplicate it, it’s not difficult for me, catch it - link to professor's article.

Sonya 10 days ago

Isn't this a scam? Why do they sell on the Internet?

Yulek26 10 days ago

Sonya, what country do you live in?.. They sell it on the Internet because stores and pharmacies charge a brutal markup. In addition, payment is only after receipt, that is, they first looked, checked and only then paid. And now everything is sold on the Internet - from clothes to TVs, furniture and cars

Editor's response 10 days ago

Sonya, hello. This drug for the treatment of joints is indeed not sold through the pharmacy chain in order to avoid inflated prices. Currently you can only order from Official website. Be healthy!

Sonya 10 days ago

I apologize, I didn’t notice the information about cash on delivery at first. Okay then! Everything is fine - for sure, if payment is made upon receipt. Thanks a lot!!))

Margo 8 days ago

Has anyone tried traditional methods of treating joints? Grandma doesn’t trust pills, the poor thing has been suffering from pain for many years...

Andrey A week ago

No matter what folk remedies I tried, nothing helped, it only got worse...

Ekaterina A week ago

I tried drinking a decoction of bay leaves, it didn’t do any good, I just ruined my stomach!! I no longer believe in these folk methods - complete nonsense!!

Maria 5 days ago

I recently watched a program on Channel One, it was also about this Federal program to combat joint diseases talked. It is also headed by some famous Chinese professor. They say that they have found a way to permanently cure joints and backs, and the state fully finances the treatment for each patient

Elena (rheumatologist) 6 days ago

»
Department of Faculty Pediatrics. Head Department Chuprov A.V. Medical history Full name patient: x Clinical diagnosis: rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction. Concomitant diseases: chronic. tonsillitis, decompensated form, follicular tonsillitis, stomatitis. Curator: Korotkova E.V. course IV group 2 ped. f-t. Assistant: Kedrova K.S. Novosibirsk - 1998. Passport information. Patient's full name: x Date of birth: 10/18/1990. Age: 7 years. Gender: male. Organized by: Studying at school, 1st grade. Address: Zdvinsk Referred to: regional clinic Date of admission: 05/07/98 Directions: Rheumatoid arthritis, articular form. Admissions: Rheumatoid arthritis, articular form, chronic disease. tonsillitis, compensation Form. Ds clinical: rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction Complaints At the time of admission, the child complained of pain and swelling in the left knee joint, headaches. Anamnesis morbi. He often suffered from respiratory diseases. All winter I suffered from colds every month. The last time I had the flu was at the end of February. I went to school on March 5, and on March 30 I went to the doctor with complaints of swelling and pain, limited movement in the left knee joint (I was limping). The day before there was a joint injury (bruise). On April 6, he was hospitalized at the URB, as joint swelling and pain persisted. Anti-inflammatory therapy was prescribed there. Within 10 days there was some improvement, the boy was discharged home, and treatment was interrupted. Then pain in the joint reappeared, and bending was difficult. On May 07, he was admitted to the regional hospital for a routine examination. Anamnesis vitae. Born the second child from the second pregnancy. I went on maternity leave at 6 months. I followed the regime and ate normally. Childbirth, without complications. He immediately screamed, the scream was loud and strong. Birth weight 4250 g. The baby was put to the breast after 12 hours. Natural feeding until 1 year. The umbilical cord remnant fell off on the 2nd day. Discharged on the 7th day. No diseases were noted during the neonatal period. He began to hold his head up at 2 months, at 4.5 months he began to stand with support, at 6.5 - crawling, at 7.5 - sitting independently, at 10 - standing independently, at 11 - walking. During the 1st year he was breastfed and suckled actively. From 2 months received apple juice (drop by drop). From 4 months received 5% semolina at 5 months. egg yolk (1/2), at 7 months. minced meat, meat broth at 12 months. - cutlet. Complementary feeding was tolerated well, weaning time was 12 months. The child’s nutrition is currently adequate. Vaccinated according to age, response to vaccinations is adequate. He tolerates medications well, there were no blood transfusions. Allergic history is calm. Epidemiological history: There was no contact with infectious diseases. Family history: The child’s parents are healthy, no hereditary predisposition has been identified. Status on admission: satisfactory condition, active position, adequate behavior, clear consciousness. Condition of the skin: no pathological changes, increased sweating and skin moisture. Subcutaneous fatty tissue is moderately expressed. Respiratory system: chest without pathological changes, auscultation - vesicular breathing, respiratory rate 18 per minute, no wheezing is heard. The boundaries of the lungs are within the age norm. Cardiovascular system: The heart area is visually unchanged. Heart rate – 80 per minute, blood pressure – 120/80 mmHg. Borders of the heart: left - along the midclavicular line, right - along the right sternum, upper - along the upper edge of the 3rd rib. On auscultation, a systolic murmur is heard at the apex. The first tone at the apex is weakened. Digestive system: The abdomen is soft, palpation is painless. The liver protrudes 0.5 cm from under the lower edge of the costal arch. Genitourinary system: the kidneys are not palpable, Pasternatsky’s sign is negative. Osteoarticular system: when walking, the left leg is spared, the left knee joint is hot, swollen, increased in volume, flexion is limited, pain when moving. The muscular system is developed according to age. Objective examination: General data. The condition is satisfactory, the position is active, consciousness is clear, behavior is adequate. Orients himself well in time and space. Meningeal symptoms (Kernig, Brudzinski: upper, lower, pubic) are negative, there is no stiff neck. SKIN: pale, without pathological elements, moderate hair growth, straight nails. The venous network of the lower limb is expanded. Skin temperature is normal. Humidity is slightly increased. The skin is elastic. Symptoms of pinch, tourniquet and hammer are negative. Dermographism is mixed. Appears after 15 seconds, disappears after 2 minutes. Visible mucous membranes are pink and moist. SUBCUTANEOUS FATTY FIBER: sufficiently expressed, evenly distributed. Upon palpation, the thickness of the folds in symmetrical areas is the same: on the abdomen - 1.0 cm, on the chest 0.5 cm, under the shoulder blades 0.5 cm, on the posteromedial surface of the shoulder - 0.5 cm, on the posteromedial surface of the thigh - 1 cm. , in the cheek area - 1.0. Palpation - compaction and swelling are absent. Tissue turgor is good. MUSCULOSCAL SYSTEM: The muscular system is sufficiently developed, symmetrical, the muscle relief is pronounced. Muscle tone is moderate, strength is sufficient. The head is round, the face is symmetrical, the bite is without pathology, the teeth are closely spaced without gaps. An examination of the skeletal system revealed no gross deformations. The chest is conical in shape, the shape, mobility and size of the joints are not changed. There are no curvatures of the spine or limbs. Posture is correct (waist triangles are symmetrical, shoulders are at the same level, the angles of the shoulder blades are at the same level, fingertips reach the hip at the same level). The type of constitution is asthenic. LYMPHATIC SYSTEM: The submandibular lymph nodes are single, mobile, and have a dense elastic consistency. Dimensions 0.5x1 cm, painless. Cervical lymph nodes. Cervical lymph nodes are single, mobile, densely elastic consistency, size 0.3x0.5 cm, painless. The axillary lymph nodes are single, mobile, and have a dense elastic consistency. Size 0.5X0.8, painless. The remaining groups of lymph nodes (occipital, in the mastoid region, mental, tonsillar, posterior cervical, supra- and subclavian, thoracic, ulnar, popliteal) are not palpable. Percussion size of the spleen is 5x6 cm. It was not possible to palpate the spleen. RESPIRATORY SYSTEM: The voice is clear, breathing through the nose is not difficult. Abdominal breathing type. NPV 20 per minute. The depth of breathing is normal, the chest participates in the act of breathing normally, the movements are symmetrical. The ratio of pulse to respiration is 3:1. The tonsils are not enlarged, protrude beyond the anterior arches, and are somewhat hyperemic. The chest is elastic and painless. Voice tremors are symmetrical on both sides, without any features. Breathing is smooth and rhythmic. With comparative percussion over the entire surface of the pulmonary fields and in symmetrical areas of the lungs, a pulmonary sound is determined. Topographic percussion of the lungs: Lower border of the right lung - along the midclavicular line - 6th rib along the middle axillary line - 8th rib along the scapular line - 9th rib along the paravertebral - at the level of the spinous process of the 11th thoracic vertebra Lower border of the left lung - along the midclavicular line - along the middle axillary line - 8th rib along the scapular line - 10th rib along the paravertebral line - at the level of the spinous process of the 11th thoracic vertebra. The height of the posterior apex of the lungs is at the level of the spinous process of the VII cervical vertebra. The width of the Krenig fields on the left and right is 4 cm. The mobility of the lower edge of both lungs along the scapular line is 6 cm. Symptoms of Arkavin, Koranya, and Philosopher's cups are negative. Auscultation reveals vesicular breathing. No wheezing or other pathological noises are heard. Breathing over the area of ​​the trachea and bifurcation is unchanged, clear, and no adverse respiratory sounds are heard. Bronchophony is carried out equally on both sides and is not changed. CARDIOVASCULAR SYSTEM: Upon examination, the area of ​​the heart is visually and palpably unchanged. The apical impulse is determined in the 5th intercostal space along the left midclavicular line, limited (localized), of sufficient strength and height, rhythmic, non-resistant. The cardiac hump is absent. No systolic retractions are detected. No visible vascular pulsation is observed. Quincke's capillary pulse is negative. Palpation: The pulse is determined on the temporal, carotid, radial, femoral arteries, as well as on a. dorsalis pedis. The pulse on the radial artery is symmetrical, synchronous, frequency 70 beats per minute, rhythmic, tension and filling are sufficient, synchronous with the contraction of the heart. The symptom of “cat purring” is negative. Percussion: Borders of relative cardiac dullness: left - along the midclavicular line, right - along the right edge of the sternum, upper - along the upper edge of the 3rd rib. On auscultation, a systolic murmur is heard at the apex. The first tone at the apex and at the Botkin point is muffled. Borders of absolute cardiac dullness: Upper – third intercostal space. Left - along the midclavicular line. Right - along the left edge of the sternum. The diameter of the heart is 9 cm. The vascular bundle does not extend beyond the edges of the sternum. Blood pressure 120/80 mm. RT., Art. DIGESTIVE SYSTEM: Oral cavity - the smell is normal, the mucous membrane is hyperemic, the tongue is moist, pink, the tonsils are loose, hyperemic. There are no cracks or plaque. The color of the visible mucous membranes is normal pink, there is no pigmentation or ulceration. The gums are reddish, there is no bleeding or looseness. The teeth are permanent, the number corresponds to age, no carious teeth were detected. On examination: the shape of the abdomen is correct, there is no asymmetry. Dilatation of the veins of the anterior abdominal wall, peristalsis, and divergence of the rectus abdominis muscles are not observed. No scars, pigmentation, or protrusions are observed. The abdominal wall participates in the act of breathing evenly. Epigastric angle ~90o Percussion of the abdomen - zones of tympania and dullness over the intestinal area are revealed. On superficial palpation the abdomen is soft and painless. The sigmoid, blind, ascending and descending sections of the colon are palpated painlessly and mobile. Deep palpation: painless, parts of the intestine could not be palpated. Palpation of the liver according to Strazhesko: the liver protrudes 0.5 cm beyond the edge of the right costal arch along the midclavicular line. The edge of the liver is sharp, painless, the surface is smooth. Dimensions according to Kurlov: along the midclavicular line on the right - 9, along the midline - 8, along the edge of the left costal arch - 7. Palpation at the point of projection of the gallbladder is painless. Murphy, Ortner, Mussi symptoms are negative. Palpation of the pancreas is painless in the Choffard area, Desjardins point and Mayo-Robson point. Mesenteric lymph nodes are not palpable. When auscultating the abdomen, intestinal peristalsis is heard. The child's stool is regular, shaped, sausage-shaped, and brown in color. In the last three days, no bowel disturbances were detected. URINARY SYSTEM: On examination: no renal edema; The lumbar region is not changed. There is no bulging or hyperemia of the skin. Palpation: The kidneys are not palpable. Palpation of the bladder is painless. Pain points of the ureters are not determined. Pain when urinating and urinary incontinence are absent. The frequency of urination is 6-7 times a day, painless, independent. Daytime diuresis predominates. Pasternatsky's symptom is negative on both sides. EDOCRINE SYSTEM: There is no impairment of growth and body weight, the subcutaneous fat layer is moderately developed and evenly distributed. The thyroid gland is not palpable. There are no secondary sexual characteristics, according to age. General conclusion based on the objective examination: Lesions of the skin, subcutaneous fat, musculoskeletal system, lymphatic system and blood system, digestive system and endocrine system, urinary system were not identified. From the cardiovascular system - systolic murmur at the apex and at Botkin's point. The first tone at the apex is weakened. There are no special features from the respiratory system. Considering the duration of the disease, the clear connection with trauma, and the absence of signs of inflammation, there is no convincing evidence for rheumatoid arthritis. For differential diagnosis and clinical diagnosis, it is necessary to carry out the following additional research methods: 1. General blood and urine analysis; 2. Biochemical blood test (total protein, protein fractions, seromucoid, sialic acids, fibrinogen); 3. Feces for worms 4. Echox 5. R-gr. knee joints 6. ECG and ultrasound of the heart 7. CEC and ASL-O Additional research methods. Laboratory methods: Complete blood count (09/17/1997): |Red blood cells|Hb |CP |Platelets|Reticulocytes|ESR | | | | | | | | |4x1012 G/l|125 |1 |180 /l |0.7% |15 mm/h| |Leukocytes|Basoph.|Eosin.|Young |Paloch|Segmen|Lymph.|Monocytes| | | | | |. |. | | | |7.9 T/l |1 |5 |0 |5 |67 |19 |3 | Conclusion. Red blood: ESR increased White blood: no changes General urine analysis (04/16/1998): total amount 150 ml, color yellow Specific gravity 1020. | Chemical | Protein 0 | |Research |Sugar negative | | Microscopic | Renal epithelium - | |Research |Squamous epithelium 0-1 in p/z | | |Leukocytes 0-2 in p/z. | | |Red blood cells - | | |Salts + ; Bacteria - | Conclusion: general urine test without any peculiarities. ReBiochemical blood test sample (04/16/1998): (-lipoproteins - 3940; cholesterol - 4.6; triglycerides - 0.98; total protein - 78.2; K+ - 4.5; Na+ - 145; ALT-10 Seromucoid –0.01 Conclusion: All studied parameters are within the age-related norms. No pathological abnormalities characteristic of any suspected disease were detected. Blood test: negative ASL-O negative Feces. d: -- Instrumental methods. R-examination of the left and right knee joints without any features. Ultrasound examination of the heart: Conclusion: the heart cavities are not expanded, the walls are not thickened. The contractility of the myocardium is sufficient. conduction through the atria, increased electrical activity of the left ventricle (stable in dynamics). Sinus bradyarrhythmia 57-85 im/m Echocardiography: Not convincing changes for congenital heart disease. Anomaly of pulmonary vein drainage. General conclusion on complaints, anamnesis, objective examination and additional methods and differential diagnosis: Rheumatoid arthritis should be differentiated from primary tuberculosis syndrome, rheumatism and deforming osteoarthritis. Rheumatoid arthritis, as well as primary tuberculosis, is characterized by the presence of functional systolic murmur at the apex, joint pain, and increased ESR. Rheumatoid arthritis differs from primary tuberculosis in the absence of anamnestic indications of the patient’s contacts with tuberculosis patients, and an increase in the titer of ASL-O and AST. Rheumatism is characterized by the presence of patients with rheumatism in the family, close contacts of the patient with patients with tonsillitis, palpitations at rest and after physical exercise. stress, the presence of skin manifestations (rheumatic nodules). Detection of increased titers of streptococcal antibodies in the blood, dysproteinemia, the appearance of C-reactive protein, an increase in seromucoid content. The diagnosis of osteoarthritis deformans can be based on an analysis of the risk factors for this disease (heredity, excess body weight), the presence of characteristic radiological changes. Based on complaints of pain and swelling in the left knee joint, the status upon admission (the left leg is spared when walking, the left knee joint is hot, swollen, enlarged in volume, flexion is limited, pain when moving), we can assume a final clinical diagnosis - Rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction. Concomitant diseases: chronic tonsillitis, compensated form, stomatitis. Treatment plan for the main and concomitant diseases: Mode IIa (semi-bed), table No. 5 (hypochloride). Vitamin therapy (multivitamins) is indicated. Anti-inflammatory therapy with non-steroidal drugs (aspirin up to 1g), cardiotrophics (digoxin). Treatment: Rp: Dragee “Revit” D.s. S. 1 tablet 2 times a day. # # # Rp: Acidi acetylsalicilici 0.5 D.t.d. N50 in tab Signa: 1 tablet 2 times a day for 2 months at a decreasing dosage. verte(# # # Rp: Sol. Digoxini 0.025%-0.5ml D.t.d. N20 in amp. S: 0.5 ml 2 times i.v. Observation diary: 5. Severe condition due to fever. Symptomatology of intoxication. The child is lethargic t-39.2 Poorly reduced by antipyretics, the skin is clean, dry. In the throat: bright hyperemia of the tonsils, purulent follicles, there is a moderate increase in the submandibular and anterior cervical lymph nodes up to 1 cm. Trouble in the throat when swallowing. In the lungs, vesicular breathing, wheezing. no. The borders of the heart are not changed. Soft systolic murmur at the apex, weakening of 1 tone at the apex, the abdomen is soft, slight pain on palpation in the duodenal area. Urination is not difficult, painless. the child has clinical manifestations of follicular tonsillitis. 18.05 Condition without negative dynamics: the temperature remains at low-grade levels and spontaneously decreases to normal. Symptoms of intoxication have decreased. The skin is pale, clean, dry. In the pharynx: bright hyperemia remains, swelling of the tonsils has decreased, purulent plugs on the tonsils remain. Breathing in the lungs is vesicular, heart sounds are loud, rhythmic, systolic murmur in L5-L4. The abdomen is soft, painless, physiological functions are normal. 19.05 Upon examination, the condition is of moderate severity, symptoms of intoxication, pale. In the pharynx: bright hyperemia, loose tonsils. Breathing in the lungs is vesicular, heart sounds are loud, rhythmic, systolic murmur in L5-L4. The abdomen is soft, painless, physiological functions are normal. Blood pressure 120/80 t-37.2 20.05 Upon examination, the condition was of moderate severity. Hyperthermia. Trouble in the throat when swallowing. The skin is pale, clean, dry. In the pharynx: bright hyperemia remains, the tonsils are loose. Breathing in the lungs is vesicular. Blood pressure 120/80, pulse 78. The abdomen is soft and painless. Stage epicrisis: Condition of moderate severity. He was admitted to the department with manifestations of rheumatoid arthritis. Currently, the leading symptoms are symptoms of intoxication. Upon repeated echocardiography, there is no evidence of valve compaction, but a consultation with a cardiologist is planned to clarify the nature of the heart damage. The skin is pale, clean, the tongue is thickly coated with a greenish coating, the papillae are enlarged, there are purulent plugs in the tonsils, there is no fever. Auscultation: heart sounds are sonorous, rhythmic, the boundaries of the heart are not changed. The abdomen is soft and painless. Recommended: Bed rest, diet No. 5. Therapy as planned. After 5-7 days, repeat the general blood test, immunologist. blood test (ASL-O), blood biochemistry (total protein, albumin, seromucoid, ALT, AST), fibrinogen, GOS, CRP, repeat echocardiography. Consultation with an ENT doctor and dentist is recommended. Literature: 1. The problem of rheumatoid arthritis Venblat M.E. Gravales E.M. 2. Pediatrician’s companion I.N. Usov. 3. Russian medical journal volume 6 No. 9. From the international Internet (wide world web) 05.20.1998 Curator’s signature_____________________ [email protected]

Start of supervision: 02.21.2003. End of supervision: 26.02. 2003. Curator: x

Passport part

Age 47 years

Gender: Male

Nationality: Russian

Education: secondary

Profession: miller

Date of admission: 02/18/03

Home address: x history disease diagnosis anamnesis

The diagnosis with which he was sent to the clinic: Rheumatoid arthritis, polyarthritis, seropositive, slowly progressive course, stage II activity.

Preliminary diagnosis: Rheumatoid arthritis: polyarthritis, seropositive, slowly progressive course, stage II activity, radiological stage II, functional impairment I.

Clinical diagnosis: Rheumatoid arthritis: polyarthritis, seropositive, slowly progressive course, stage II activity, radiological stage II, functional impairment I.

Complaints: At the time of supervision: complaints of mild pain in the metacarpophalangeal, wrist, knee and shoulder joints, painful limitation of mobility and a slight increase in skin temperature over these joints. There is a crunch in these joints when moving; their swelling; morning stiffness until lunchtime; general weakness. Upon admission: aching pain in the metacarpophalangeal, wrist, knee and shoulder joints, which occurs not only during movement, but also at rest; severe painful limitation of mobility and increased skin temperature over these joints. There is a crunch in these joints when moving; their swelling; morning stiffness until lunchtime; general weakness; loss of appetite, dizziness.

History of the present illness: (Anamnes morbi) Considers himself sick since 1999, when for the first time there was a sharp pain in the left wrist and metacarpophalangeal joints of both hands, short-term stiffness in these joints, and general malaise. The occurrence of pain is associated with working conditions - constant hypothermia and dampness. He was hospitalized at the Central District Hospital of Asekeyevsky District, where he was diagnosed with rheumatoid arthritis. After 2 weeks of treatment (diclofenac, cannot indicate the dosage), the pain subsided. After being discharged from the clinic, I began to notice that the joints began to react to changes in the weather, and pain occurred in spring and autumn. In the spring of 2000, swelling and pain appeared in the shoulder and knee joints. The regional clinic sent him to the Regional Clinical Hospital, where he was prescribed prednisolone tablet. within one month, physiotherapeutic treatment. Joint pain disappeared and mobility increased. Spring 2001 was sent for spa treatment to a sanatorium in Pyatigorsk. 02/18/03 readmitted to the rheumatology department of the Regional Clinical Hospital due to an exacerbation of the disease: aching pain in the metacarpophalangeal, wrist, knee and shoulder joints, which occurs not only during movement, but also at rest; severe painful limitation of mobility and increased skin temperature over these joints. There is a crunch in these joints when moving; their swelling; morning stiffness until lunchtime; general weakness; loss of appetite, dizziness.

Life history: (Anamnes vitae) Born in ***, the third child in the family, grew and developed according to his age. He did not lag behind his peers in physical and mental development. I went to school at the age of 7, studied satisfactorily, and was involved in physical education in the main group. After graduating from school, he was drafted into the army and the navy. Married, has one child (daughter). Denies childhood diseases (measles, rubella, scarlet fever, diphtheria). Notes a hereditary predisposition to joint diseases: the mother had joint pain. There is a reaction to the administration of nicotinic acid - skin rash, ulcers on the mucous membranes. Denies tuberculosis, hepatitis, malaria, and sexually transmitted diseases. There were no blood transfusions. I have not traveled outside the region for the last 6 months. Bad habits: does not smoke, drinks alcohol in limited quantities. Living conditions are satisfactory, meals are regular.

Present condition (Status preasens) The patient's condition is satisfactory, consciousness is clear, the position in bed is active, the patient is available for contact. The physique is normosthenic. The patient's appearance corresponds to age and gender. Height 164 cm, weight 64 kg. The skin is dry, clean, the color of the skin is pale, the elasticity of the skin is preserved, the visible mucous membranes are pink and moist. Limitation of movement in the wrist, metacarpophalangeal, shoulder, knee joints. Synovitis of the wrist, metacarpophalangeal joints of both hands: swelling, increased skin temperature over the joint area, pain on palpation. There are no rashes, scratches, petechiae, or scars. Male pattern hair growth. Hair splits. The nail plates are of the correct shape, the nails are brittle, the nail plates do not peel off. Subcutaneous fatty tissue is moderately expressed and evenly distributed. There is no edema or acrocyanosis. Examination by organ systems:

Respiratory system: The nose is not deformed, breathing through the nose is free. The chest is cylindrical in shape, the collarbones are at the same level, the ribs run obliquely downwards, the intercostal spaces do not bulge or sink. Both halves of the chest evenly participate in the act of breathing and produce vocal tremors. Respiratory rate 16 per minute. Percussion above the pulmonary fields is a clear pulmonary sound. There are no local sound changes. Topographic percussion data: standing height of the apexes of the lungs - in front - 3 cm on both sides, in the back - at the level of the spinous process of the 7th cervical vertebra. The width of the Kernig margins is 5 cm on both sides. Mobility of the lower edge of the lungs along the midclavicular line is 5 cm on both sides. Breathing is vesicular, there is no wheezing or pleural friction noise. The lower borders of the lungs. Right Landmarks Left 6th intercostal space parasternal line 6th intercostal space midclavicular line 7th intercostal space anterior axillary line 7th intercostal space 8th intercostal space midaxillary line 8th -\-\-\-\\- \-\\\-\ 9th intercostal space posterior axillary line 9th -\-\-\-\-\-\-\-\ 10th intercostal space scapular line 10th -\-\-\- \-\\-\-\- 11th intercostal space paravertebral line 11th -\-\-\-\\-\-\-\

Cardiovascular system: The heart area is not changed. There is no pathological pulsation of blood vessels. There is no cyanosis, peripheral edema, or shortness of breath. The pulse is rhythmic, blood pressure in the right arm is 110/70 mm. Hg Art., on the left 110/70 mm. Hg Art. The pulsation of the vessels of the lower extremities is symmetrical and good. Apical impulse in the 5th intercostal space on the left, medially from l. medioclavicularis sinistra by 1 cm, width 1.5 cm, moderate strength and height. Borders of relative cardiac dullness: RIGHT LEFT 2nd intercostal space - along the edge of the sternum 2nd intercostal space - edge of the sternum 3rd intercostal space - 1 cm outward from the right edge of the sternum 3rd intercostal space - 1 cm from the edge of the sternum to the left 4th intercostal space - 1.5 cm outward from the right edge of the sternum 4th intercostal space -1.5 cm from the edge of the right sternum to the left 5th intercostal space -2 cm from the edge of the sternum to the left Borders of absolute cardiac dullness Right - 4th intercostal space 1 cm from the sternum to the left. Left - 5th intercostal space 2.5 cm from the sternum on the left. Upper - along the upper edge of the 4th rib along the parasternal line.

Digestive system. Pink lips. The oral mucosa is clean, moist, pink. The tongue is moist, slightly coated with a white coating at the root. The abdomen is of normal shape and size, evenly participates in the act of breathing, is soft, painless, and accessible to deep palpation. There is no ascites or visceroptosis. The sigmoid colon is palpated in the form of a dense cylinder, 2 cm wide, painless. The cecum is palpated in the form of a soft cylinder, 3 cm wide, painless. The transverse colon is palpated 2 cm below the navel in the form of a soft cylinder, 3 cm wide, painless. The edge of the liver is smooth, elastic in consistency, painless. The dimensions of the liver according to Kurlov are 10 x 8 x 7 cm. Palpation of the points of the gallbladder is painless. The stool, according to the patient, is filled once a day.

Urinary system: The kidneys are not palpable. The points of the kidneys and urinary tract are painless. There is no pain when tapping the lumbar region. Urine is light yellow in color and transparent. Urination is free, painless, 5-6 times a day. Daily diuresis is about 1200 ml. Doesn't urinate at night.

Hematopoietic system: There are no hemorrhages or hemorrhagic rashes on the skin. The mucous membranes are pale pink. Lymph nodes are not enlarged. The spleen is not palpable; percussion is determined from the IX to the XI rib along l. axillaris media sinistra. Tapping the flat bones is painless. Dimensions of the spleen according to Kurlov: diameter 4 cm, length 6 cm.

Endocrine system: Height 164 cm, weight 64 kg. Hairline corresponds to gender. General development is appropriate for age. The face is round, pale. Subcutaneous tissue is moderately developed and evenly distributed. Upon examination, the contours of the neck are smooth. The thyroid gland is not enlarged. There is no tremor of the hands, tongue, or eyelids.

Musculoskeletal system: Limitation of movement in the wrist, metacarpophalangeal, shoulder, knee joints. There is a crunch in these joints when moving; morning stiffness until lunchtime. Synovitis of the wrist, metacarpophalangeal joints of both hands: swelling, increased skin temperature over the joint area, pain on palpation.

Central nervous system: The patient is sociable and emotionally labile. Speech is clear, attention is maintained. Pain sensitivity is not reduced. There are no paresis or paralysis. Intelligence is average. Insomnia due to severe joint pain. The patient treats the disease adequately and easily comes into contact. Pulse 62 per minute. Muscle strength is age appropriate. Sweating during physical activity. There are no pathological symptoms. disease diagnosis history rheumatoid arthritis

Laboratory and instrumental studies: KLA: indicators February 18, 2003 February 28, 2003 normal red blood cells 4.46*10 /l 4.66*10 /l 4.0 - 5.0*10 /l hemoglobin 131g/l 119g/l 130 - 160g/l color index 0.88 0.85 0.85 - 1.05 leukocytes 5.3*10 /l 6.0*10 /l 4.0-7.0 /l Rod nuclear. 3% 3% 2 - 4% Nuclear segment. 86% 85% 40 - 70% Monocytes 4% 5% 2 - 8% Eosinophils 0.50% 0.5% 0-1% Platelets 400*10 /l 219*10 /l 180 - 320*10 /l ESR 32mm /h 30mm/h 1 -15mm/h

Conclusion: accelerated ESR. OAM: indicators February 18, 2003 norm color light yellow light yellow density 1014 1004 - 1024 epithelial cells 0-1 in the field 0-3 in the field leukocytes 0-1 in the field to 4 in the field erythrocytes absent 0-1 in p/z reaction weakly acidic neutr-slightly acidic protein absent up to 0.033%

Conclusion: within normal limits. Biochemical blood test: 04/16/02. total protein 79 g/l normal: 65 g/l albumin 47% normal: 50-70% globulins 35% normal: 20-30% fibrinogen 15,000 mg/l normal: 10,000 mg/l urea 4.56 normal: total bilirubin 13 .9 norm: AlAT 0.05 norm: up to 0.42 AsAt 0.020

Conclusion: dysproteinemia: hypoalbuminemia, hyperglobulinemia; increased fibrinogen content. Immunological study: 02.18.03. rheumatoid factor - weakly positive (+) C reactive protein - weakly positive (+) X-ray examination: 02.21.03. The provided photographs of both hands in a direct projection show diffuse osteoporosis, brush-like lucencies in the heads of the middle fingers of the metacarpal bones, small bones of the wrist, narrowed joint spaces in the wrist joints, more on the left. The contours of the articular surfaces are unclear. Conclusion: stage II rheumatoid arthritis.

Clinical diagnosis and rationale

Diagnosis: Rheumatoid arthritis, polyarthritis, seropositive, slowly progressive course, stage II activity, radiological stage II, functional impairment I.

justification: morning stiffness before lunch in the wrist, metacarpophalangeal, shoulder, knee joints; arthritis of more than three joints; arthritis of the hand joints; symmetrical arthritis - the areas of the wrist, metacarpophalangeal, shoulder, knee joints have swelling of the periarticular soft tissues; presence of rheumatoid factor in blood serum; X-ray changes: photographs of both hands in a direct projection show diffuse osteoporosis, brush-like lucencies in the heads of the middle fingers of the metacarpal bones, small bones of the wrist, narrowed joint spaces in the wrist joints, more on the left, the contours of the articular surfaces are unclear.
Seropositive, because rheumatoid factor is detected in the blood serum
A slowly progressive course is indicated by the history of the disease and X-ray examination: during the course of the disease (3 years), no significant deformation of the damaged joints was detected; 2 new joints were involved in the process (shoulder, knee).
For the II degree of activity (medium), the following signs: pain in the joints not only during movements, but also at rest, stiffness continues until noon, severe painful limitation of mobility in the joints, moderate stable exudative phenomena. Hyperthermia of the skin over the affected joints is moderate. ESR - increased to 32 mm/h (normal = 15 mm/h), dysproteinemia: blood albumin - 47% when normal = 50-70%, the number of globulins - increased to 35% (normal = 20-30%). Rheumatoid factor - words. positive (+); C - reactive protein - sl. positive (+).
X-ray stage II is determined according to the X-ray examination data: On the provided photographs of both hands in a direct projection, diffuse osteoporosis is noted, brush-shaped lucencies in the heads of the middle fingers of the metacarpal bones, small bones of the wrist, narrowed joint spaces in the wrist joints, more on the left. The contours of the articular surfaces are unclear.
Functional disorders I - slight limitation of movements in the joints, feeling of stiffness in the morning; professional suitability is preserved, but somewhat limited.

Treatment:
Rp.: Tab. Ampicillini 0.25 N. 20 D.S.: Take 2 tablets 4 times a day (regardless of meals) 7 days
Rp.: Tab. Ibuprofeni 0.2 N.30 D.S.: Take 1 tablet 3 times a day after meals for 2 weeks
Rp.: Tab. Prednisoloni 0.005 N.20 D.S.: Take 1 tablet 2 times a day for 10 days.
Rp.: Chole conservata medicata 100ml D.S.: For compresses on the knee joints. Use for 6 days

Organized by: Studying at school, 1st grade.

Referred to: regional clinic

Date of admission: 05/07/98

Directions: Rheumatoid arthritis, articular form.

Admissions: Rheumatoid arthritis, articular form, chronic disease. tonsillitis, compensation Form.

Dsclinical: rheumatoid monoarthritis, subacute course, activity I, without cardiac dysfunction

At the time of admission, the child complained of pain and swelling in the left knee joint, and headaches.

He often suffered from respiratory diseases.

Vaccinated according to age, response to vaccinations is adequate. He tolerates medications well, there were no blood transfusions.

Allergic history is calm.

Epidemiological history: There was no contact with infectious diseases.

The child's parents are healthy, no hereditary predisposition has been identified.

Admission status:

The condition is satisfactory, the position is active, behavior is adequate, consciousness is clear.

Digestive system: The abdomen is soft, palpation is painless. The liver protrudes 0.5 cm from under the lower edge of the costal arch.

Genitourinary system: the kidneys are not palpable, Pasternatsky’s sign is negative.

Percussion size of the spleen is 5x6 cm. It was not possible to palpate the spleen.

Reactive arthritis pediatric case history

On how to treat reactive arthritis in children, Komarovsky E.O.

Have you been trying to heal your JOINTS for many years?

Types of reactive arthritis in children

Based on the type of pathogen, reactive arthritis in children can be divided into:

Symptoms

Symptoms of reactive arthritis in children are based on the following signs:

1. General clinical signs:

2. Joint changes:

Reiter's syndrome is a common manifestation of reactive arthritis in children.

It begins 2-3 weeks after an infectious disease and is accompanied by signs:

Video: Symptoms of reactive arthritis

Diagnostics

There are certain criteria, the presence of which can make a diagnosis of reactive arthritis:

Therapeutic measures

Treatment tactics for reactive arthritis include several stages:

These include:

Prevention

These include:

Pediatric rheumatoid arthritis - long-term treatment required

Causes of the disease

Pathogenesis of the disease

What are the manifestations of the disease

The main symptoms are signs of joint damage.

The initial phase of the disease is exudative

Proliferative phase

Articular form of the disease

Articular-visceral form of the disease

Still's syndrome

This form of the disease is rapidly progressive, with frequent relapses and a poor prognosis.

Allergoseptic form

Individual visceral forms

The course of JRA in children can be rapidly progressive or slowly progressive.

Diagnosis of the disease

According to clinical signs:

Laboratory tests include x-rays and fluid tests:

Treatment approaches

Basic medications:

Disease prevention

The prognosis of the disease depends on the form and course of the disease.

Medical history
Juvenile rheumatoid arthritis, systemic form, allergic variant at onset, seronegative according to the Russian Federation, activity 0-1, Rg stage 2-1, NF-1-0

Ministry of Health and Social Development of the Russian Federation

State educational institution of higher professional education

FIRST MOSCOW STATE MEDICAL UNIVERSITY named after I.M. Sechenov

Department of Childhood Diseases.

Completed by: 5th year student

Checked by: Ph.D., Associate Professor

1. Last name, first name, patronymic of the patient.

2. Age (year, month and birthday).01/24/1996 (14 years)

3. Date of admission to the clinic. 09/30/2010

4. Parents' occupation. Mother is a technician

5. Attends school

6. Address, telephone. —

7. Clinical diagnosis:

1. Complaints upon admission to the clinic about limited mobility in the hip joints

2. Does not make complaints about the day of supervision

1. From the first pregnancy due to pyelonephritis. Delivery on time

2. At birth, weight 3600 g, height 54 cm. He screamed immediately. First breastfeeding on the first day.

3. Breastfeeding up to 3 months, then artificial

4. Indicators of the child’s physical and psychomotor development are appropriate for his age. Behavior in the family, in the team - contact.

5. Past diseases. Otitis at 8 months. Rare ARVI. Biliary dyskinesia in 2000. Angina in 2003 Chicken pox.

Allergic reactions to amikacin - rash and seizures.

6. Preventive vaccinations - BCG, DPT, against polio according to age without reactions. Mantoux reaction 10g. – papule 5 mm.

7. Family history.

8. Material and living conditions are satisfactory

He is admitted for follow-up examination and therapy correction.

Objective research data on the day of supervision.

Date 10/7/10 Sickness day 8th Appointments:

Т° 36.6 1) table No. A1

Pulse 75 per minute 2) methotrexate 10 mg. 1r. on Tuesdays

3) folic acid 0.001 1r/d

4) calcium D3 1t 1r/d.

Blood pressure 120/70 mmHg.

General condition child is satisfactory.

Eyes and ears – externally without visible pathology

Body weight 43.5 kg, body length 162.5 cm. Asthenic build.

According to the formula = 100 + 6 (n-4) = 100 + 6 (14-4) = 160cm. The actual body length exceeds the calculated one by 1.5%

According to the formula = n x 5 - 20 = 14x5 - 20 = 50kg. The actual body weight is 13% less than the calculated one.

Physical development corresponds to age, disharmonious (deviation in body weight 13%).

Skin and subcutaneous fat.

The skin is pale and dry.

Hair, fingers and nails without pathology.

The muscles are developed satisfactorily, symmetrically, muscle tone is preserved, and are painless on palpation. No muscle tightness

The fontanelles are closed, the sutures are closed, the chest is cylindrical, the limbs are straight, the spine is a violation of posture.

The chest is cylindrical in shape, no deformations are noted. Epigastric angle 60°.

Paravertebral

In the lungs, breathing is vesicular, carried out evenly in all sections, there is no wheezing. Vesicular breathing.

There are no visible changes in the chest in the area of ​​the heart. Palpation in the heart area is painless.

Limits of relative dullness of the heart:

Right: at the right edge of the sternum in the 4th intercostal space.

Left: 0.5 cm medially from the left midclavicular line, in the 5th intercostal space.

Upper: located at the level of the middle of the 3rd intercostal space.

The boundaries of this child’s heart correspond to the age norm.

Digestive system and abdominal organs.

Gums without pathological changes. The salivary glands (parotid, submandibular, sublingual) are not changed.

On auscultation, normal bowel sounds are heard. The stool is formed, normal consistency, regular.

Liver and gallbladder:

The abdomen is symmetrical, there is limited protrusion in the area of ​​the right hypochondrium and there is no restriction in breathing in this area.

Liver dimensions according to Kurlov are within normal limits (9/8/7)

On palpation, the lower edge of the liver at the edge of the rib is not pointed, the surface is smooth, the consistency is elastic, painless.

The gallbladder is not palpable.

There is no hyperemia or swelling in the kidney area.

The kidneys are not palpable. There is no pain on palpation in the area of ​​the upper and lower ureteral points

Development of the genital organs according to the male type. Secondary sexual characteristics correspond to the age of the child.

Results of laboratory, instrumental and other special studies.

Case history of pediatric reactive arthritis

48. Reactive arthritis

Reactive arthritis in children

Symptoms of reactive arthritis in children

Treatment of reactive arthritis in children

Sick children in adolescence may be prescribed tetracycline and fluoroquinolone drugs.

In very severe cases, with a high level of inflammation, methotrexate and sulfasalazine are used.

Possible consequences

Parents should remember that timely treatment of reactive arthritis produces effective results.

If there is a problem

If the application does not launch on your phone, use this form.

Hereditary metabolic diseases are a monogenic pathology in which gene mutation leads to

Reactive arthritis

Criteria for diagnosing reactive arthritis.

1) elimination of infectious foci that support the articular process;

2) regulation of immunological reactivity;

5) stimulating therapy (vitamins, nonspecific adaptogens, anabolic steroid drugs) strictly according to indications;

Characteristics of the patient's complaints upon admission to the hospital (swelling and pain in the knee joint when walking). Clinical examination of the patient, analysis of symptoms, formulation and substantiation of the diagnosis. Recommended treatment for reactive arthritis.

Submitting your good work to the knowledge base is easy. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://allbest.ru

MINISTRY OF EDUCATION, SCIENCE AND SPORTS OF UKRAINE

Kharkov National University named after. V.N. Karazin

REACTIVE ARTHRITIS IN CHILDREN

1. Patient complaints upon admission

reactive arthritis knee joint

2. Objective research

3. Preliminary diagnosis