Reactive arthritis in children

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

The term "reactive arthritis" was introduced into the literature in 1969 by Finnish scientists K. Akho and P. Avoneiom to refer to arthritis that developed after a previous iersiniosis infection. It was meant that in this case neither the living causative agent nor its antigens are found in the joint cavity.

In the following decades, in the joint tissues, antigens of microorganisms with which the development of arthritis: Yersinia, Salmonella, Chlamydia are associated. In a number of cases, microorganisms capable of reproduction, for example, on cell culture, are also isolated. In this regard, the term reactive arthritis can only be used with great caution. Nevertheless, it is common in rheumatological literature and in the classification of rheumatic diseases of all countries.

[1], [2]

The epidemiology of reactive arthritis suggests that the incidence rate has risen over the past decade. More than 75% of cases are associated with genetic factors, which emphasizes the role of heredity. In the prevalence there is some difference among children of different ages. In preschool children, the first place, as the cause, is intestinal infection, in children of early school age, the main cause is ARD, and in adolescent children - urogenital infection.

The frequency of reactive arthritis in the structure of rheumatic diseases of 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 children's rheumatological clinics in 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 the diagnostic capabilities and approaches to diagnosis of the criteria for the disease. In the United States, children with complete and incomplete Reiter syndrome and probable reactive arthritis will be included in the group of patients with reactive arthritis. In Britain, reactive arthritis includes only children with a complete simltomokompleksom Reiter's illness. Epidemiological surveys conducted in the late 1980s 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 frequent cause of development of reactive arthritis in children was iersinioznaya infection. In the last decade, in a pandemic of chlamydial infection in the world, reactive arthritis associated with chlamydia infection began to predominate in the structure of reactive arthritis.

The incidence of reactive arthritis also reflects the prevalence of H27 B27 in the population and the proportion of the infectious process caused by "zrtritogenic" microorganisms.

[3], [4], [5]

Among the most urgent problems of rheumatology are reactive arthropathies (arthritis) in childhood, which is due to both the increase in the incidence among children of different age groups and the complication of differential diagnosis with other rheumatic diseases that occur with joint syndrome.

Of course, the main reason for the development of such reactive arthritis in children are pathogenic microorganisms. Every year, the range of microorganisms responsible for the development of arthritis (more than 200 species) is becoming ever wider. The first place among them is occupied by such bacteria: yersinia, chlamydia, salmonella, shigella, hemolytic streptococcus. The causative factor of arthritis is also the viral agents - adenoviruses, Coxsackie A and B viruses, chicken pox, rubella, mumps. Depending on the type of pathogen and the transferred infection, it is common to separate reactive arthritis for reasons:

1. reactive arthritis of urogenital etiology;
2. reactive arthritis postterocolitic;
3. reactive arthritis after nasopharyngeal infection;
4. postvaccinal arthritis and after gastric bypass, which are very rare.

This etiological classification is needed not only to isolate children from the risk group, but in addition, the treatment is very dependent on the type of infection.

Reactive arthritis after urogenital infections are very common, especially in adolescents. Pathogens of urogenital arthritis: chlamydia trachomatis, chlamydia pneumonia, ureoplasma ureolyticum. The main triggers are Chlamydia, Gram-negative bacteria that persist intracellularly, which greatly complicates the diagnosis and treatment of such arthritis. Infection of children often occurs by the household way. Chlamydia are found intracellularly in the epithelium of the urethra, eye conjunctiva and cytoplasm of synovial cells. Less frequent pathogen urogenital ReA - ureaplasma ureolyticum. There is no clear seasonality of the disease, the main contingent of patients is pre-school and school-age boys. In the development of arthritis in children an important role is played by immunopathological reactions (leading factor in chronic forms), and a certain role is played by hereditary predisposition (its marker is HLA-B27), which is defined in 75-95% of patients. Thus, the most common cause of reactive arthritis is precisely the urogenital infection.

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

Infections of the nasopharynx, unfortunately, occupy an important place in the development of reactive arthritis. Inflammation of joints on the background of acute respiratory infections occurs 1-2-4 weeks after acute respiratory disease. Trigger factors - streptococcus group A and C - nonspecific infection of the upper respiratory tract. Post-streptococcal reactive arthritis should always be very carefully differentiated with rheumatoid arthritis, because it is not accompanied by defeat of the heart or other internal organs and is chronologically associated with focal infection.

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

[6], [7], [8]

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

1. children who have suffered a urogenital infection, especially chlamydial etiology;
2. children after intestinal infection;
3. children after ARI;
4. children after scarlet fever, sore throats;
5. often ill children;
6. children whose family has rheumatic heart disease or joint disease (genetic predisposition).

Such children need to carefully examine and tell their mother about possible changes in the joints, so that she would pay attention to it.

[9],

Symptoms of arthritis have their own peculiarities of development and course depending on the infection that has become the cause.

The first signs of reactive arthritis after urogenital infection develop acute. As a rule, 2-3 weeks after infection, the body temperature rises to subfebrile and febrile digits. Fever with a high body temperature (39-40 ° C) is relatively rare with acute onset of the disease. Against the backdrop of a temperature reaction, a clinic of urethritis, conjunctivitis, and later arthritis (a typical triad of lesions) develops. Such a sequence is not always observed, different combinations of symptoms, erosion of certain clinical manifestations are possible. The most constant is the defeat of the urogenital organs with the development of urethritis, vesiculitis, prostatitis, cystitis. In girls, urethritis is often combined with vulvovaginitis, in boys - with balanitis. There may be arriving dysuric disorders, pyuria. In 1-4 weeks after the urethritis, eye damage develops, as a rule, bilateral, most often there is catarrhal conjunctivitis lasting from several days to 1.5-2 weeks, sometimes up to 6-7 months. Possible development of acute anterior uveitis (in 5-6% of children), episcleritis, keratitis, resulting in reduced visual acuity.

The leading sign of the disease is joint damage, developing, as a rule, 1-1.5 months after urethritis. The asymmetric lesion is mainly in the joints of the lower extremities (knee, ankle, metatarsal, phalangeal, interphalangeal), gradually drawing them into the pathological process one after another, often from the bottom upwards - the "staircase symptom", from one side to the other - a "spiral symptom". In single patients, simultaneous inflammation of several joints is observed. As a rule, local signs of an inflammatory reaction are preceded by arthralgia for several days. A child may complain of joint pain even before the appearance of visible changes. There may be both mono- and polyarthritis. On average, 4-5 joints can be affected. Of the joints of the upper limbs - wrist, elbow, small joints of the hands, occasionally sternocleid, humeral, temporomandibular. Cases of the disease with inflammation of only the joints of the upper extremities are described.

When lesion of the interphalangeal joints of the foot develops dactylitis - "sosisk-like" deformation of the fingers as a result of the simultaneous filling of the joint and tendon-ligament apparatus; the toes are diffusely swollen, reddened. Characteristic pseudotograficheskoe lesion of the big toe, pronounced exudative reaction of inflammation (swelling, effusion into the joint cavity). In an acute period, the skin above the affected joints is of course hyperemic, often with a cyanotic shade. In addition, pain is expressed in active and passive movements, which is intensified at night and in the morning hours, which even the child himself can indicate. When the large joints are involved in the process, the atrophy of regional muscles develops rapidly, which completely disappears with successful therapy.

An important diagnostic sign of urogenital arthritis is the damage of ligaments and bags, the aponeurosis, fascia are also involved in the pathological process. There are enthesopathies of different localization - palpation tenderness in places of attachment of ligaments and tendons of muscles to bones (tibia, patella, external and internal bones, large and small trochanter, sciatic bumps).

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

Reactive arthritis of the hip joint in children is uncharacteristic and is rare. Sometimes in the clinical picture of the disease there is an isolated inflammation of one or two knee joints.

Other manifestations of reactive arthritis in children can 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 the clinical picture of the disease. On the mucous membrane of the oral cavity appears an enanthema with possible subsequent shelter by ulcers. Develops stomatitis, glossitis. Characterized keratodermia of the feet and palms. Rare is often observed in the form of erythema multiforme - pustular, urticarious, psoriasis-like, bubble elements are localized in different parts of the skin, focal or common. Perhaps the appearance of small red papules, sometimes erythematous spots, the development of paronychia, which is combined with onihogrifoza and subungual hyperkeratosis.

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

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

Articular syndrome with yersiniosis develops in the phase of the immune response (secondary focal and allergic manifestations). The main symptoms of the disease are associated with intestinal damage, the development of acute enterocolitis. Children may have diarrhea with an admixture of blood and mucus. In some patients, there is a clinic of pseudoependicular syndrome caused by terminal ileitis, inflammation of the mesenteric lymph nodes or malaise of pain syndrome. Along with the intestinal syndrome, characteristic almost constant pain in the muscles, the appearance of polymyositis, arthralgia. Arthritis develops approximately in 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 the 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 foot, acromioclavicular and sternoclavicular joints in the pathological process. Possible damage to the wrist, elbow joints, small joints of hands. The most important sign of such a reactive arthritis is the presence of tenosynovitis and tendoperioditis. There are tendovaginitis, including Achilles tendon, bursitis. The development of arthritis is accompanied by an increase in body temperature to 38 ° -39 ° C, urticaria, maculopapular rash on the trunk, extremities, often in the area of large joints. In 18-20% of patients, erythema nodosum is diagnosed with localization in the region of the shins, which is characterized by a benign course with complete reverse development within 2-3 weeks.

In 5-25% of patients except the joints, the cardiovascular system is affected, carditis develops, more often myocarditis, myopericarditis.

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

[10], [11], [12]

The stages of development of reactive arthritis, as such, the inflammatory process, do not emit, since the process never changes the very structure of the joint, but only the periarticular tissues.

[13], [14], [15], [16]

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

[17], [18], [19]

Speaking about the diagnosis of reactive arthritis in a child, you need to know some diagnostic features of different forms of arthritis. If we are talking about reactive arthritis of urogenital etiology, then age is important - it's a teenager child. It is also important to pay attention to the anamnestic data and the existence of a chronological relationship between urogenital infection and the development of symptoms of arthritis and / or conjunctivitis. If an anamnesis in a preschool child has data on a recent intestinal infection, or if there simply could be stool changes, then this can also be considered a diagnostic factor in the development of reactive arthritis.

When examined, any reactive arthritis has an asymmetric character with a predominant lesion of the joints of the lower extremities (especially the joints of the toes) with enthesopathies and heel bursitis. The child can complain that his legs hurt and he can not walk, even if there are no classic changes in the joints themselves. If the joints are changed, their swelling, an increase in size, will be seen. When palpation may be pain along the tendon or muscle.

Analyzes that need to be carried out must be confirmed as precisely as possible by reactive arthritis. Therefore, it is important to make a blood test to exclude the active bacterial process. It is compulsory to perform rheumo tests for the purpose of differential diagnosis and in reactive arthritis they will be negative. If there is data for intestinal infection, then it is necessary to take into account the performed analyzes of the child's secretions. In the presence of urethritis, scraping of the epithelium of the genitourinary tract of the child must be performed. If it is possible to diagnose chlamydia (intracellular parasites are difficult to determine), then the diagnosis can not cause doubt.

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

Instrumental research is necessary to carry out the radiography of the affected joints and ultrasound. Ultrasound allows you to determine that with reactive arthritis there is inflammation of the joint, the amount of joint fluid is increased, there may be changes in surrounding tissues, but the cartilage of the joint itself is not changed. Radiographically, with a prolonged process, there may be cysts, but the structure of bone and periosteum itself is not broken.

Differential diagnosis of reactive arthritis is very important and should primarily be done with rheumatoid arthritis. Reactive and rheumatoid arthritis in children is accompanied by the same symptoms of an increase 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 itself, and with rheumatoid arthritis the cartilage itself is destroyed. Therefore, radiologically with rheumatoid arthritis, there are signs of bone-cartilage destruction. In the first months of the disease, only signs of effusion into the joint cavity, compaction of periarticular tissues, and periarticular osteoporosis are determined. With reactive arthritis, the structure of the bone and joint is not changed. Ultrasound with rheumatoid arthritis clearly shows synovitis as a diagnostic symptom of this disease, which is not present with reactive arthritis. A characteristic feature of rheumatoid arthritis is a violation of bone growth and the development of ossification nuclei due to the defeat of the epiphyseal zones. Progression of the process leads to the formation of contractures (often flexion) in individual joints, as a consequence of proliferative and destructive-sclerotic changes in the joint tissues. In contrast, with reactive arthritis, there are no changes and the symptoms pass without a trace on the background of treatment.

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

[20], [21], [22], [23], [24], [25]

The treatment of reactive arthritis certainly depends on the cause. It is very important to kill the microorganism that causes such high immunization with the involvement of the joint. Only after such etiotropic treatment can use pathogenetic drugs and alternative means for better recovery of joint function.

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

Indication for the prescription of etiotropic antibacterial therapy is the active phase of the disease, persistent chlamydial infection. With latent forms of chlamydia, the use of antibiotics is not advisable. For drugs that are used in pediatric practice and have antichlamydia activity, include macrolides, for older children - tetracyclines, fluoroquinolones.

1. Azithromycin  is an antibacterial agent from the macrolide group. Among the known drugs has the maximum activity against chlamydia, is able to accumulate in the cell, in inflammation foci, does not lose qualities 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 the age and may be in the form of a suspension or tablets. It is prescribed for children older than 3 years and the dosage is 10 mg / kg / day on the first day, from 2 to 7-10 days - 5 mg / kg / day 1 time per day. A mandatory condition is eating two hours after a meal or an hour before it. The course of treatment is 5-7-10 days. Side effects of azithromycin - paresthesia, violations of skin sensitivity, numbness of the hands and feet, tremor, violation of the outflow of bile, as well as dispatches. Precautions - do not use for cholestasis or cholelithiasis.
2. Ciprofloxacin is an antibacterial agent from the group of fluoroquinolones, which can be used to treat reactive arthritis in children over the age of twelve years, or as needed for children of lesser age for life. This antibiotic is active against most intracellular parasites, including ureaplasma and chlamydia infections. The drug penetrates inside the cell and blocks the work of the microbial wall, thus neutralizing the bacterium itself. The dosage of the drug is 500 milligrams per day in two divided doses. The course of treatment at least one week, with the severity of the clinic and up to two weeks. Side effects - pain in the stomach, dizziness, pressure decrease. Precautions - do not take in case of Wilson-Konovalov's illness.

Short courses of antibiotic therapy with reactive arthritis are inexpedient, which is 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 to hold 2 or more courses of treatment for 7-10 days each. The duration of antibiotic therapy is individual. When developing persistent forms of infection, combinatorial administration of macrolides and immunomodulating agents is recommended.

The most widespread for the treatment of chronic persistent chlamydia was the preparation of interferon.

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. Dosage of the drug - 125 mg (1 ml) in / m children older than 4 years according to the scheme: 1, 2, 4, 6, 8, 11, 14, 17, 20, 23 day. Side effects are possible: thrombocytopenia, itching at the injection site, redness, and also allergies. Precautions - not recommended for children up to four years.

Non-steroidal anti-inflammatory therapy has anti-inflammatory, analgesic, antipyretic effect, affecting various pathogenetic links of the inflammatory process with reactive arthritis. Non-steroidal 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 swelling of the joint, its soreness, and lowers the 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 admission after meals, in / m - 75 mg, once a day. Side effects - dyspeptic disorders, dizziness, hepatitis, erosive-ulcerative lesions of the stomach, 12 duodenal ulcer, allergic rash (rarely), "aspirin asthma." Given the strong effect on the gastrointestinal tract, it is desirable 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, because effective in this case will be aminoglycosides and chloramphenicol.

1. Amikacin is an antibiotic of the aminoglycoside group, which is effective against yersinia, klebsiels, 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 with the influence on the stomach - develops colitis or dysbiosis, which manifests by bloating, a violation of the stool, so when using therapy in children, it is necessary to use probiotics. Precautions - do not use with kidney damage.

Vitamins must be used, given long-term treatment with antibiotics and non-steroid medication.

Physiotherapeutic treatment is used in the form of local forms: iontophoresis with hydrocortisone on the affected joints in exudative-proliferative changes; electrophoresis of drugs with dimethylsulfoxide (dimexide). Course - 10-12 procedures; applications with 50% dimexide solution, Diklak-gel, Dolgit-gel, Indovazin, rheumagel. With the stability of the exudative component of inflammation, local injection therapy of SCS is possible.

Alternative treatment of reactive arthritis

Alternative methods of treatment can be used only against the background of active antibiotic therapy with the permission of the doctor. It is usually the use of different compresses on the affected joints for a more rapid recovery function.

1. Shark fat is considered to be the most effective treatment for joint diseases in children with a pronounced allergic component. This fat can be bought in a pharmacy and for treatment you just need to lubricate the affected joints in the morning and evening.
2. Horseradish and black radish are known for their warming and anti-inflammatory properties. To prepare a compress you need to take the fruits of radishes and horseradish in equal quantities, grind them with a blender or a meat grinder and mix into a gruel. Further, such a solution should be placed on the joint and primed on top with a food film, covered with cotton and fixed with a bandage easily. This compress is best done at night.
3. At home, you can compress from hormones. They act locally without being absorbed into the systemic circulation and relieve the symptoms, so that the child can sleep without awakening. To do this, take one ampoule of hydrocortisone and mix it with dimexide in a ratio of 1: 1. Such a solution must be impregnated with gauze and put on the area of the affected joint for a while.

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

1. Comfrey is a plant that is widely used for the treatment of joints due to a pronounced anti-inflammatory agent. Use compresses for the affected joints from the grass comfrey. To do this, take a hundred grams of grass comfrey, 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, stir everything and get a uniform consistency. After the mass has cooled, an ointment will be obtained, which must be rubbed into the joints twice a day.
2. Pine branches need to boil over a slow fire for half an hour, then add the hips and insist an hour. Before drinking, you need to add a spoonful of honey so that the child can drink such tea. You should take at least a tablespoon four times a day.
3. The burdock leaves and mother-and-stepmothers need to be cut and squeezed out juice. Such juice should be applied fresh in the area of the joints, which relieves pronounced edema.

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

1. Potassium iodate is an inorganic homeopathic preparation. Used to treat reactive arthritis, which are caused by an intestinal infection. The effectiveness of the drug has been proven by many studies. The way of using the drug depends on the form. Dosage in case of taking drops - one drop per year of life of the child, and when taking capsules - two capsules three times a day. Side effects are hyperemia of the skin of the hands and feet, as well as sensations of heat. Precautions - do not use in combination with sorbents.
2. Silicea and Urtica Urens - combining these preparations in appropriate dilutions allows to achieve effective treatment of articular syndrome, especially with pronounced edema and soreness. The drug is used in the pharmacological form of homeopathic drops and dosed four drops twice a day for half an hour before meals at the same time. The course of treatment is three months. Side effects can be in the form of the appearance of rashes behind the ears.
3. Pulsatilla is a homeopathic remedy of natural origin. This agent is used to treat reactive arthritis, which is accompanied by high fever and skin manifestations. The drug is dosed by half a teaspoon twice a day. Side effects are not common, but there may be stool disruption, dyspeptic phenomena and allergic reactions. Precautions - it is impossible to use the drug with active angina or in an acute period of intestinal infection.
4. Calcium carbonate is a homeopathic remedy based on inorganic material. Used for the treatment of reactive arthritis in children of slim build, which often get sick. The drug reduces allergic organism and increases local immunity of the pharyngeal lymphoid ring. Method of application - under the tongue, dosage - ten drops of solution three times a day. Adverse events occur rarely, allergic manifestations are possible.

Operative treatment of reactive arthritis in children is not used, because with effective and correct conservative therapy, there are no changes and contractures of the joint and surrounding tissues. 

[26], [27], [28]

Prophylaxis of reactive arthritis in children is the timely treatment of acute respiratory, intestinal infections. After all, if there is no adequate treatment, then the virus or bacterium is 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.

Primary prophylaxis of reactive arthritis does not exist.

[29], [30], [31]

The prognosis of reactive arthritis in children is favorable, although the treatment is prolonged. If the complex therapy was correct, then 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, moms should be alert if the child complains of leg pain after some kind of disease, because the change in the joint may not always be the first sign of reactive arthritis. In any case, the complaints of the child should not be ignored, then the diagnosis and treatment will be timely.