Reactive arthritis in children

Reactive arthritis in children is a non-purulent inflammation of the joint and periarticular bag in a child after an infectious disease, in which there is no infectious agent in the joint or its cavity. This disease is very serious in terms of clinical manifestations and possible complications, so it is necessary to pay attention to any changes in the child's joints in time for timely diagnosis.

The term "reactive arthritis" was introduced into the literature in 1969 by Finnish scientists K. Aho and P. Avonei to designate arthritis that developed after a Yersinia infection. It was implied that in this case neither the living causative agent nor its antigens were detected in the joint cavity.

In the following decades, antigens of microorganisms associated with the development of arthritis were identified in joint tissues: yersinia, salmonella, chlamydia. In some cases, microorganisms themselves are isolated, capable of reproduction, for example, in cell culture. In this regard, the term reactive arthritis can only be used with great caution. Nevertheless, it is widespread in rheumatological literature and in the classification of rheumatic diseases in all countries.

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The epidemiology of reactive arthritis shows that the incidence has increased over the past ten years. More than 75% of cases are associated with genetic factors, which emphasizes the role of heredity. There is some difference in prevalence among children of different ages. In preschool children, the main cause is intestinal infection, in early school-age children the main cause is acute respiratory infections, and in adolescents - urogenital infections.

The frequency of reactive arthritis in the structure of rheumatic diseases in different countries is 8.6-41.1%. In the structure of rheumatic diseases in children under 14 years of age, reactive arthritis is 57.5%, in adolescents - 41.8%.

Among patients of pediatric rheumatology clinics of the USA, England, Canada the frequency of reactive arthritis varies from 8.6 to 41.1%. The frequency of detection of reactive arthritis depends on diagnostic capabilities and approaches to diagnostic criteria of the disease. In the USA the group of patients with reactive arthritis includes children with complete and incomplete Reiter's syndrome and with probable reactive arthritis. In Britain only children with the complete symptom complex of Reiter's disease are classified as reactive arthritis. Epidemiological surveys conducted in the late 80s showed that reactive arthritis develops in 1% of cases in patients with urogenital infection; in 2% of cases - in patients with an infectious process caused by shigella and campylobacter; in 3.2% - salmonella; in 33% - yersinia. Until the end of the 20th century the most common cause of reactive arthritis in children was considered to be yersiniosis infection. In the last decade, in the context of the chlamydial infection pandemic in the world, reactive arthritis associated with chlamydial infection has become predominant in the structure of reactive arthritis.

The incidence of reactive arthritis also reflects the prevalence of HLA B27 in the population and the proportion of the infectious process caused by microorganisms.

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Among the most pressing problems of rheumatology are reactive arthropathies (arthritis) in childhood, which is caused by both the increase in morbidity among children of different age groups and the complication of differential diagnosis with other rheumatic diseases occurring with joint syndrome.

Of course, the main cause of the development of such reactive arthritis in children are pathogenic microorganisms. Every year the range of microorganisms responsible for the development of arthritis becomes wider (more than 200 species). The first place among them is occupied by such bacteria: yersinia, chlamydia, salmonella, shigella, hemolytic streptococcus. The causative factor of arthritis is also viral agents - adenoviruses, Coxsackie viruses A and B, chickenpox, rubella, epidemic mumps. Depending on the type of pathogen and the infection suffered, reactive arthritis is usually divided by causes:

1. reactive arthritis of urogenital etiology;
2. reactive arthritis postenterocolitic;
3. reactive arthritis after nasopharyngeal infection;
4. post-vaccination arthritis and after gastric bypass, which are very rare.

Such etiological classification is necessary not only to identify children from the risk group, but also treatment is highly dependent on the type of infection.

Reactive arthritis after urogenital infections is very common, especially in adolescents. Urogenital arthritis pathogens: chlamydia trachomatis, chlamydia pneumonia, ureoplasma ureolyticum. The main trigger factor is chlamydia, gram-negative bacteria that persist intracellularly, which greatly complicates the diagnosis and treatment of such arthritis. Children are most often infected through household contact. Chlamydia is found intracellularly in the epithelium of the urethra, conjunctiva of the eyes, and the cytoplasm of synovial cells. A less common pathogen of urogenital ReA is ureaplasma ureolyticum. There is no clear seasonality of the disease; the main contingent of patients is preschool and school-age boys. In the development of arthritis in children, an important role is played by immunopathological reactions (the leading factor in chronic forms), and a certain role is also played by hereditary predisposition (its marker is HLA-B27), which is determined in 75-95% of patients. Thus, the most common cause of reactive arthritis is urogenital infection.

Enterocolitis, as a source of infectious agent, can be called the second most common cause of reactive arthritis in children. The causative factor of intestinal reactive arthritis is a group of gram-negative microorganisms. Brucella, Klebsiella, Escherichia coli, together with Shigella, Salmonella, Yersinia, Campylobacter, participate in the pathogenesis of HLA-B27 associated rheumatic diseases. Reactive arthritis after enteral infection occurs with approximately the same frequency in boys and girls. The latent period lasts 10-14 days, up to 21 days with Shigella infection. Clinical manifestations are more similar to urogenital arthritis. More than 60% of postenterocolitic reactive arthritis are associated with Yersinia infection. Salmonella arthritis develops after an infection caused by Salmonella typhimurium or Salmonella enteritidis. Arthritis develops in 2-7.5% of patients with salmonellosis, mainly carriers of the HLA-B27 antigen (more than 80%), 1-2 weeks after the clinical manifestations of enterocolitis subside. Reactive arthritis after dysentery is less common, which has its own clinical features of the course. These are the most common pathogens of reactive arthritis in children after enterocolitis.

Nasopharyngeal infections, unfortunately, play an important role in the development of reactive arthritis. Joint inflammation against the background of acute respiratory infections occurs 1-2-4 weeks after an acute respiratory disease. Trigger factors are group A and C streptococcus - a non-specific infection of the upper respiratory tract. Post-streptococcal reactive arthritis should always be very carefully differentiated from rheumatoid arthritis, because it is not accompanied by damage to the heart or other internal organs and is chronologically associated with a focal infection.

Based on this, we can say that the main cause of reactive arthritis in children is a bacterial or viral infection. The pathogenesis of the development of the inflammatory process in the joint has the same mechanisms, regardless of the type of pathogen. When a microorganism enters the child's body, for example, acute chlamydial urethritis develops. The microorganism multiplies and inflammation of the urethra occurs with activation of the immune system. Many leukocytes react to the entry of chlamydia into the urethra and they destroy foreign agents. In this case, pus is formed, which is a manifestation of urethritis. But at the same time, chlamydia have sets of antigens that are similar to the structure of the human joint. When a huge number of leukocytes are formed, some of them perceive the joint tissues as an antigen, since they are similar in structure to chlamydia. Therefore, such leukocytes penetrate the joint and initiate an immune response. And there is no chlamydia in the joint cavity, but inflammation occurs there due to leukocytes. Pus does not form either, since leukocytes have nothing to "kill", but the synthesis of synovial fluid increases and an inflammatory reaction develops. Therefore, reactive arthritis is a non-purulent inflammation.

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Based on the etiological factors, it is necessary to identify children from the risk group who may be susceptible to developing reactive arthritis:

1. children who have had a urogenital infection, especially of chlamydial etiology;
2. children after intestinal infection;
3. children after acute respiratory infections;
4. children after scarlet fever, tonsillitis;
5. frequently ill children;
6. children in whose family there is rheumatic heart or joint disease (genetic predisposition).

Such children need to be carefully examined and the mother should be told about possible changes in the joints so that she pays attention to this.

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Symptoms of arthritis have their own characteristics of development and progression depending on the infection that caused it.

The first signs of reactive arthritis after urogenital infection develop acutely. As a rule, 2-3 weeks after infection, the body temperature rises to subfebrile and febrile numbers. Fever with a high body temperature (39-40 ° C) is relatively rare in the acute onset of the disease. Against the background of the temperature reaction, the clinical picture of urethritis, conjunctivitis, and later arthritis (a typical triad of lesions) develops. Such a sequence is not always observed, various combinations of symptoms are possible, some clinical manifestations are erased. The most constant is the lesion of the genitourinary organs with the development of urethritis, vesiculitis, prostatitis, cystitis. In girls, urethritis is often combined with vulvovaginitis, in boys - with balanitis. Transient dysuric disorders, pyuria may be observed. After 1-4 weeks, following urethritis, eye damage develops, usually bilateral, most often catarrhal conjunctivitis is observed lasting from several days to 1.5-2 weeks, sometimes up to 6-7 months. Acute anterior uveitis (in 5-6% of children), episcleritis, keratitis may develop, leading to decreased visual acuity.

The leading symptom of the disease is joint damage, which usually develops 1-1.5 months after urethritis. Characteristically, asymmetric damage mainly affects the joints of the lower extremities (knees, ankles, metatarsophalangeal, interphalangeal), gradually drawing them into the pathological process one after another, more often from the bottom up - the "staircase symptom", from one side to the other - the "spiral symptom". In isolated patients, simultaneous inflammation of several joints is observed. As a rule, local signs of an inflammatory reaction are preceded by arthralgia for several days. The child may complain of joint pain even before visible changes appear. Both mono- and polyarthritis may occur. On average, 4-5 joints may be affected. Of the joints of the upper extremities - wrist, elbow, small joints of the hands, occasionally sternoclavicular, shoulder, temporomandibular. Cases of the disease with inflammation of only the joints of the upper limbs have been described.

When the interphalangeal joints of the feet are affected, dactylitis develops - a "sausage-like" deformation of the toes as a result of simultaneous filling of the articular and tendon-ligament apparatus; the toes are diffusely swollen and reddened. Pseudo-gouty lesion of the big toe is characteristic, a pronounced exudative inflammatory reaction (swelling, effusion into the joint cavity). In the acute period, the skin over the affected joints is of course hyperemic, often with a cyanotic tint. In addition, there is pronounced pain during active and passive movements, which intensifies at night and in the morning, which can be indicated even by the child himself. When large joints are drawn into the process, atrophy of the regional muscles quickly develops, which completely disappears with successful therapy.

An important diagnostic sign of urogenital arthritis is damage to ligaments and bags; aponeuroses and fascia are also involved in the pathological process. Enthesopathies of various localizations occur - palpation pain in the places of attachment of ligaments and tendons of muscles to bones (tibia, patella, external and internal bones, greater and lesser trochanters, ischial tuberosities).

One of the first clinical manifestations of the disease may be pain in the heel, calcaneus due to inflammation of the plantar aponeurosis, Achilles tendon, and the development of calcaneal bursitis. In 50% of patients, one of the symptoms of arthritis is also pain in the back and buttocks, caused by sacroiliitis.

Reactive arthritis of the hip joint in children is uncommon and is rarely observed. Sometimes, isolated inflammation of one or two knee joints is observed in the clinical picture of the disease.

Other manifestations of reactive arthritis in children may be in the form of lesions of the skin and mucous membranes. It is observed in 20-30% of patients, in other children it dominates in the clinical picture of the disease. Enanthema appears on the mucous membrane of the oral cavity with possible subsequent ulceration. Stomatitis and glossitis develop. Keratoderma of the feet and palms is characteristic. Less often, a rash in the form of erythema multiforme is observed - pustular, urticarial, psoriasis-like, vesicular elements are localized in various areas of the skin, focal or widespread. It is possible that small red papules, sometimes erythematous spots, the development of paronychia, which is combined with onychogryphosis and subungual hyperkeratosis, may appear.

When exposed to Chl. pneumonia, the remaining patients develop erythema nodosum (nodular angiitis). At the early stage of the disease, there is an increase in lymph nodes, systemic and regional in the groin area. In 10-30% of patients, signs of heart damage are determined - myocarditis, myocardial dystrophy with rhythm or conduction disorders. In patients with peripheral arthritis, spondylitis and sacroiliitis, aortitis may develop, which leads to the formation of aortic valve insufficiency. With high activity of the process, polyneuritis, pneumonia, pleurisy, kidney damage - pyelonephritis, glomerulonephritis, prolonged subfebrile condition are observed.

Reactive arthritis in children after an intestinal infection develops more often if its cause was Yersinia. Pathogenetically, an acute phase of Yersinia infection is distinguished, which includes an enteral phase (penetration of the pathogen, development of gastritis, enteritis, toxic dyspepsia) and a phase of regional-focal and general reactions (development of enterocolitis, mesenteric lymphadenitis, terminal ileitis).

Joint syndrome in yersiniosis develops in the immune response phase (secondary focal and allergic manifestations). The main symptoms of the disease are associated with intestinal damage, development of acute enterocolitis. Children may have diarrhea with blood and mucus. Some patients have a clinical picture of pseudo-appendicular syndrome caused by terminal ileitis, inflammation of the mesenteric lymph nodes or vague pain syndrome. Along with the intestinal syndrome, there are characteristic almost constant muscle pain, the appearance of polymyositis, arthralgia. Arthritis develops approximately 1-3 weeks after enterocolitis or abdominal syndrome and has a peculiar clinical picture. The most characteristic is the acute onset and further course of joint syndrome with a relatively short duration of monoarthritis or asymmetric oligoarthritis mainly of the joints of the lower extremities, with possible involvement of the big toe, acromioclavicular and sternoclavicular joints in the pathological process. The wrist, elbow joints, and small joints of the hands may be affected. The most important sign of such reactive arthritis is the presence of tenosynovitis and tendoperiostitis. Tendovaginitis, including Achilles tendon, and bursitis are observed. The development of arthritis is accompanied by an increase in body temperature to 38 ° - 39 ° C, urticarial, maculopapular rash on the trunk, limbs, often in the area of large joints. In 18-20% of patients, nodular erythema is diagnosed with localization in the shins, which is characterized by a benign course with complete regression within 2-3 weeks.

In 5-25% of patients, in addition to the joints, the cardiovascular system is affected, carditis develops, most often myocarditis, myopericarditis.

Reactive arthritis in children against the background of ARVI can also develop some time after tonsillitis or simple pharyngitis. Then there are pains in the joints and their changes, which are similar to the symptoms described above. Reactive arthritis of the knee joint in children often develops against the background of a nasopharyngeal infection, which is characterized by damage to first one knee, and then the other.

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The stages of development of reactive arthritis, as an inflammatory process, are not distinguished, since the process never changes the structure of the joint itself, but only the periarticular tissues.

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The consequences of reactive arthritis do not develop if the child began therapy on time. Then all the symptoms disappear without a trace and the function of the limb is fully restored. Complications may occur with treatment that is started late. Then the tendons or synovial membranes may become inflamed, which requires longer treatment and is accompanied by severe pain syndrome, and for a child this is very difficult. Therefore, it is necessary to monitor children from the risk group to avoid complications.

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When talking about the diagnosis of reactive arthritis in a child, it is necessary to know some diagnostic features of different forms of arthritis. If we are talking about reactive arthritis of urogenital etiology, then age is important - this is a teenager. It is also important to pay attention to the anamnestic data and the presence of a chronological connection between the genitourinary infection and the development of arthritis symptoms and / or conjunctivitis. If the anamnesis of a preschool-age child has data on a recent intestinal infection, or there could simply be changes in stool, then this can also be considered a diagnostically significant factor in the development of reactive arthritis.

Upon examination, any reactive arthritis is asymmetrical with predominant damage to the joints of the lower extremities (especially the joints of the toes) with enthesopathies and calcaneal bursitis. The child may complain that his legs hurt and he cannot walk, even if there are no classic changes in the joints themselves. If the joints are changed, then their swelling and increase in size will be visible. Upon palpation, there may be pain along the tendon or muscle.

The tests that need to be done should confirm reactive arthritis as accurately as possible. Therefore, it is important to do a blood test to exclude an active bacterial process. Rheumatic tests are mandatory for differential diagnostics and in case of reactive arthritis they will be negative. If there is evidence of an intestinal infection, then it is necessary to take into account the tests of the child's discharge. In the presence of urethritis, a scraping of the epithelium of the child's urogenital tract is mandatory. If it is possible to diagnose chlamydia (intracellular parasites are difficult to determine), then the diagnosis may not be in doubt.

Sometimes, if it is difficult to determine reactive or rheumatoid arthritis, a puncture of the affected joint with cytological examination is performed. The presence of predominantly neutrophils in the synovial fluid with a moderate total number of cells without bacteria will indicate reactive arthritis. In addition, the presence of cytophagocytic macrophages, chlamydial antigens and a high level of total complement.

Instrumental examination necessarily includes radiography of the affected joints and ultrasound examination. Ultrasound allows us to determine that with reactive arthritis there is inflammation of the joint, the amount of synovial fluid is increased, there may be changes in the surrounding tissues, but the cartilage of the joint itself is not changed. Radiologically, with a long process, there may be cysts, but the structure of the bone and periosteum itself is not damaged.

Differential diagnostics of reactive arthritis is very important and should be carried out primarily with rheumatoid arthritis. Reactive and rheumatoid arthritis in children are accompanied by the same symptoms of enlargement and inflammation of the joint. The only distinctive feature in pathogenesis is that with reactive arthritis there are no changes in the articular surface and cartilage, while with rheumatoid arthritis the cartilage itself is destroyed. Therefore, radiologically with rheumatoid arthritis there are signs of bone-cartilaginous destruction. In the first months of the disease, only signs of effusion in the joint cavity, compaction of periarticular tissues, periarticular osteoporosis are determined. With reactive arthritis, the structure of the bone and joint are not changed. On ultrasound with rheumatoid arthritis, synovitis is clearly visible as a diagnostic symptom of this disease, which is not the case with reactive arthritis. A characteristic feature of rheumatoid arthritis is the disruption of bone growth and the development of ossification nuclei due to damage to the epiphyseal zones. The progression of the process leads to the formation of contractures (usually flexion) in individual joints, as a consequence of proliferative and destructive-sclerotic changes in the joint tissues. In contrast, with reactive arthritis no changes remain and the symptoms disappear without a trace during treatment.

Also, reactive arthritis should be differentiated from joint hypermobility syndrome. This disease, which is also accompanied by periodic swelling and pain in the joints, can give a similar clinical manifestation with reactive arthritis. The main differential sign of such a syndrome is precisely increased mobility and hyperextension of the joints more than ten degrees from the norm, which is easy to determine already during a simple examination of the child.

Thus, the diagnosis of reactive arthritis in children is aimed not only at identifying the cause, but also at carefully differentiating various pathologies, which is very important in treatment.

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Treatment of reactive arthritis certainly depends on the cause. After all, it is very important to kill the microorganism that causes such high immunization with joint involvement. Only after such etiotropic treatment can pathogenetic drugs and folk remedies be used for better restoration of joint function.

Therapy of urogenital reactive arthritis in children is complex. It includes: drug therapy (etiotropic, pathogenetic, anti-inflammatory, immunomodulatory drugs), physiotherapy; correction of intestinal dysbiosis (proteolytic enzymes, probiotics).

The indication for the appointment of etiotropic antibacterial therapy is the active phase of the disease, persistent chlamydial infection. In latent forms of chlamydia, the use of antibiotics is inappropriate. The drugs that are used in pediatric practice and have antichlamydial activity include macrolides, for older children - tetracyclines, fluoroquinolones.

1. Azithromycin is an antibacterial agent from the macrolide group. Among the known drugs, it has the highest activity against chlamydia, is able to accumulate in the cell, in the foci of inflammation, does not lose its properties under the influence of lysosomes, that is, it acts on intracellular microorganisms, thus interrupting the persistence of the pathogen. Azithromycin has a long half-life. The method of administration depends on age and can be in the form of a suspension or tablets. It is prescribed to children over 3 years old and the dosage is 10 mg / kg / day on the first day, from the 2nd to the 7-10th day - 5 mg / kg / day 1 time per day. A mandatory condition is to use two hours after a meal or an hour before it. The course of treatment is 5-7-10 days. Side effects of azithromycin are paresthesia, impaired skin sensitivity, numbness of the arms and legs, tremor, impaired bile outflow, as well as dyspepsia. Precautions: Do not use in case of cholestasis or gallstones.
2. Ciprofloxacin is an antibacterial agent from the fluoroquinolone group that can be used to treat reactive arthritis in children over twelve years of age, or as needed for younger children for vital indications. This antibiotic is active against most intracellular parasites, including ureaplasma and chlamydia infections. The drug penetrates the cell and blocks the work of the microbial wall, thus neutralizing the bacteria themselves. The dosage of the drug is 500 milligrams per day in two doses. The course of treatment is at least one week, and up to two weeks if the clinical symptoms are severe. Side effects include stomach pain, dizziness, and decreased blood pressure. Precautions: do not take with Wilson-Konovalov disease.

Short courses of antibiotic therapy for reactive arthritis are inappropriate, due to the peculiarities of cyclic reproduction of chlamydia. The duration of treatment with macrolides, tetracycline drugs, fluoroquinolones should be 1.5-2 months. The most effective is 2 or more courses of treatment for 7-10 days each. The duration of antibiotic therapy is individual. In the development of persistent forms of infection, a combination of macrolides and immunomodulatory agents is recommended.

Interferon preparations are most widely used for the treatment of chronic persistent chlamydia.

1. Cycloferon is a drug that contains recombinant human interferon, which increases the activity of antibiotics in the complex therapy of reactive arthritis, and also has an immunomodulatory effect. The dosage of the drug is 125 mg (1 ml) intramuscularly for children over 4 years old according to the scheme: 1, 2, 4, 6, 8, 11, 14, 17, 20, 23 days. Side effects are possible: thrombocytopenia, itching at the injection site, redness, and allergies. Precautions - not recommended for use in children under four years of age.

Nonsteroidal anti-inflammatory therapy has anti-inflammatory, analgesic, antipyretic effect, affecting various pathogenetic links of the inflammatory process in reactive arthritis. Nonsteroidal anti-inflammatory therapy is prescribed for a long period until complete regression of the joint syndrome, normalization of laboratory activity indicators.

1. Diclofenac sodium is a non-steroidal anti-inflammatory drug that relieves joint swelling, pain, and lowers temperature. The drug reduces the number of inflammatory cells in the joint itself. Thus, the use of this drug eliminates symptoms and accelerates recovery. Dosage - 2-3 mg / kg / day in 2-4 doses after meals, intramuscularly - 75 mg, 1 time per day. Side effects - dyspeptic disorders, dizziness, hepatitis, erosive and ulcerative lesions of the stomach, duodenum, allergic rash (rare), "aspirin asthma". Given the strong effect on the gastrointestinal tract, it is advisable to take the drug under the cover of proton pump inhibitors.

If reactive arthritis develops against the background of an intestinal infection, then the approach to antibiotic therapy is slightly different, since aminoglycosides and chloramphenicols will be effective in this case.

1. Amikacin is an antibiotic of the aminoglycoside group, which is effective against Yersinia, Klebsiella, and some other intestinal bacteria. In the treatment of reactive arthritis in children, a dosage of 3-4 mg / kg / day in 2-3 doses is used. The course of therapy is 7-10 days. Side effects are possible when affecting the stomach - colitis or dysbacteriosis develops, which is manifested by bloating, stool disorders, therefore, when treating children, it is imperative to use probiotics. Precautions - do not use in case of kidney damage.

Vitamins must be taken, taking into account long-term treatment with antibiotics and non-steroidal drugs.

Physiotherapeutic treatment is used in the form of local forms: iontophoresis with hydrocortisone on the area of affected joints with exudative-proliferative changes; electrophoresis of drugs with dimethyl sulfoxide (dimexide). The course is 10-12 procedures; applications with a 50% solution of dimexide, Diclac gel, Dolgit gel, Indovazin, revmagel. If the exudative component of inflammation is persistent, local injection therapy with GCS is possible.

Folk treatment of reactive arthritis

Traditional methods of treatment can be used only against the background of active antibacterial therapy with the permission of the doctor. This is usually the use of various compresses on the affected joints for faster restoration of function.

1. Shark fat is considered the most effective remedy for treating joint diseases in children with a pronounced allergic component. This fat can be bought at a pharmacy and for treatment you just need to lubricate the affected joints with it in the morning and evening.
2. Horseradish and black radish are known for their warming and anti-inflammatory properties. To prepare a compress, take equal amounts of radish and horseradish, grind them with a blender or a meat grinder and mix into a paste. Then put this solution on the joint and wrap it with cling film on top, cover with cotton wool and secure with a bandage. It is better to do this compress at night.
3. At home, you can make a compress from hormone solutions. They act locally without being absorbed into the systemic bloodstream and relieve symptoms, so the child can sleep without waking up. To do this, take one ampoule of hydrocortisone and mix it with dimexide in a 1:1 ratio. Soak gauze in this solution and place it on the affected joint for a while.

Herbal treatment can be used systemically, then the main effect is the anti-inflammatory and desensitizing action. Local herbal compresses can also be used.

1. Comfrey is a plant that is widely used to treat joints due to its pronounced anti-inflammatory effect. Compresses for affected joints from comfrey herb are used. To do this, take one hundred grams of comfrey herb, add half a glass of vegetable oil and gently bring to a boil. Then add ten drops of vitamin E and half a glass of beeswax, mix everything and get a uniform consistency. After the mass has cooled, you will get an ointment that needs to be rubbed into the joints twice a day.
2. Pine branches should be boiled on low heat for half an hour, then add rose hips and leave for an hour. Before drinking, add a spoonful of honey so that the child can drink such tea. It is necessary to take at least a tablespoon four times a day.
3. Burdock and coltsfoot leaves need to be cut and the juice squeezed out. This juice should be applied fresh to the joint area, which relieves severe swelling.

Homeopathy in the treatment of reactive arthritis can be used most intensively already in the period of remission, since the drugs can be taken for a long time with the restoration of joint function.

1. Potassium iodatum is an inorganic homeopathic preparation. It is used to treat reactive arthritis caused by intestinal infection. The effectiveness of the preparation has been proven by many studies. The method of using the preparation depends on the form. The dosage in case of taking drops is one drop per year of the child's life, and in case of taking capsules - two capsules three times a day. Side effects - hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use in combination with sorbents.
2. Silicea and Urtica Urens - a combination of these drugs in appropriate dilutions allows for effective treatment of joint syndrome, especially with severe swelling and pain. The drug is used in the pharmacological form of homeopathic drops and is dosed four drops twice a day half an hour before meals at the same time. The course of treatment is three months. Side effects may include rashes behind the ears.
3. Pulsatilla is a homeopathic remedy of natural origin. This remedy is used to treat reactive arthritis, which is accompanied by high temperature and skin manifestations. The drug is dosed at half a teaspoon twice a day. Side effects are rare, but there may be stool disturbance, dyspeptic phenomena and allergic reactions. Precautions - the drug cannot be used in case of active angina or in the acute period of intestinal infection.
4. Calcarea carbonica is a homeopathic remedy based on inorganic material. It is used to treat reactive arthritis in children of thin build who often get sick. The drug reduces the body's allergization and increases local immunity of the lymphoid ring of the pharynx. Method of application - under the tongue, dosage - ten drops of solution three times a day. Side effects are rare, allergic reactions are possible.

Surgical treatment of reactive arthritis in children is not used, since with effective and correct conservative therapy, no changes or contractures of the joint and surrounding tissues remain.

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Prevention of reactive arthritis in children consists of timely treatment of acute respiratory and intestinal infections. After all, if there is no adequate treatment, then the virus or bacteria remains in the body for a long time, which allows the inflammatory process to develop in the joints. Therefore, to avoid complications, it is important that the treatment is long enough.

There is no primary prevention of reactive arthritis.

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The prognosis for reactive arthritis in children is favorable, although the treatment is long. If the complex therapy was correct, there are no changes in the joint or bones and muscles.

Reactive arthritis in children can develop against the background of any infection several weeks after it. Therefore, mothers should be wary if the child complains of pain in the legs after some illness, because the first sign of reactive arthritis may not always be a change in the joint. In any case, you should not ignore the child's complaints, then diagnosis and treatment will be timely.