Joint pain in children is a common problem of a growing body. Arthralgia is diagnosed erroneously, sometimes despite the fact that the problem has been studied enough. The purpose of this article is a detailed description of different forms of benign and pathologic arthralgia in children. The article contains modern ideas about the causes of children’s arthralgia and description of the pain as one of the symptoms of various forms of joint disease. The features of clinical and instrumental diagnosis of joint pathology in children are clearly presented.

Juvenile arthritis is a severe inflammatory disease of pediatric musculoskeletal system that leads to the development of contractures, early disability and loss of joint function. An isolated elbow injury in children with juvenile arthritis (JA) is a rare condition that is diagnosed at a late stage and has a poor prognosis. Early diagnosis using a variety of imaging modalities is vital for maintaining elbow function and decreasing disability rate in children. Objective To specify diagnostic methods and clinical and laboratory tests that allow visualization of JA-specific signs in pediatric elbow. Material and methods The retrospective study included 15 children who received treatment for chronic arthritis of the elbow joint. Clinical and instrumental findings, dynamics in articular syndrome and efficacy of antirheumatic therapy were evaluated. Results and discussion The study allowed us to reveal specific features of elbow injury in children with JA. 1. The onset associated with an injury to the upper limb and ‘mute’ laboratory tests were observed in more than 80 % of the cases. 2. Clinical examination of patients with JA showed absence of morning stiffness and evident pain, dry synovitis and joint contracture in most of the cases. 3. Radiological evaluation exhibited early erosion of the subchondral bone at the articular surface of olecranon. 4. There was a slight monotherapeutic effect on elbow joint synovitis noted with NSAID use. 5. Diagnosis of pediatric chronic arthritis of the elbow joint suggests a complex approach to evaluation of clinical and instrumental findings and their dynamics taking into consideration age related specific anatomy of the elbow that can facilitate detection of the underlying cause of chronic arthritis.

Juvenile arthritis is a severe inflammatory disease of pediatric musculoskeletal system that leads to the development of contractures, early disability and loss of joint function.An isolated elbow injury in children with juvenile arthritis (JA) is a rare condition that is diagnosed at a late stage and has a poor prognosis.Early diagnosis using a variety of imaging modalities is vital for maintaining elbow function and decreasing disability rate in children.Objective To specify diagnostic methods and clinical and laboratory tests that allow visualization of JA-specific signs in pediatric elbow.Material and methods The retrospective study included 15 children who received treatment for chronic arthritis of the elbow joint.Clinical and instrumental findings, dynamics in articular syndrome and efficacy of antirheumatic therapy were evaluated.Results and discussion The study allowed us to reveal specific features of elbow injury in children with JA. 1.The onset associated with an injury to the upper limb and 'mute' laboratory tests were observed in more than 80 % of the cases.2. Clinical examination of patients with JA showed absence of morning stiffness and evident pain, dry synovitis and joint contracture in most of the cases.3. Radiological evaluation exhibited early erosion of the subchondral bone at the articular surface of olecranon.4.There was a slight monotherapeutic effect on elbow joint synovitis noted with NSAID use. 5. Diagnosis of pediatric chronic arthritis of the elbow joint suggests a complex approach to evaluation of clinical and instrumental findings and their dynamics taking into consideration age related specific anatomy of the elbow that can facilitate detection of the underlying cause of chronic arthritis.

НЕКОТОРЫЕ АСПЕКТЫ КЛИНИКО-ЛУЧЕВОЙ ДИАГНОСТИКИ ВОСПАЛИТЕЛЬНЫХ КОКСОПАТИЙ ДЕТСКОГО ВОЗРАСТАКожевников А.Н. 1,2, Поздеева Н

Juvenile arthritis continues to be a serious diagnostic problem of pediatric rheumatology despite the improvement of clinical, immunological and instrumental methods of examination. Clinical heterogeneity, nonspecificity of instrumental picture and limited application of some examination methods account for the diagnostic difficulties of articular pathology in young children. Chronic oligoarthritis in young children presents a particular challenge due to a frequent vague onset and minimally symptomatic course which can result in a late diagnosis and a high risk of early disability. This paper identifies the problem of diagnosis of childhood arthropathy in relation to its informative value and the practical and clinical significance of basic instrumental methods of chronic arthritis visualization. Special attention is paid to particular roentgenologic features and interpretation of MR images in diagnosis of juvenile olighoarthritis. This article aims at systematizing and expanding the views of pediatricians and rheumatologists on the importance of radiography methods in the diagnosis of joint pathology in children.

Background. Congenital radioulnar synostosis (CRUS) is a rare musculoskeletal disease with a wide-ranging symptom complex. Attitudes toward surgical treatment of the disease is very diverse, ranging from complete negation to acceptance. When choosing a treatment method, high recurrence and complication rates should be taken into account.Aims. To analyze the clinical implications of CRUS and to identify optimal treatment options.Materials and methods. From 2008 to 2015, 54 patients (31 boys and 23 girls; aged 1–14 years) with CRUS were examined and treated. Presenting complaints and the possible factors leading to disease development were investigated; orthopedic examination, roentgenography, electromyography, and computed tomography were performed. The treatment approach was determined on the basis of the clinicoroentgenological presentation.Results. All cases of CRUS were sporadic. In 43.7% patients, risk factors resulting in disease development were detected. Unilateral lesions were observed in 30 patients, whereas bilateral lesions were observed in 24 patients. According to the Cleary and Omer classification, the first type is the rarest; it is distinguished by the absence of bony fusion and close to average forearm positioning. In such cases, operative treatment is not necessary. For the second and third types, pronounced pronation forearm realignment requiring corrective derotational osteotomy of the radial bone is the main factor. For the fourth type, the main functional disorder is the restriction of the forearm flexion; treatment for this type involves resection of the radius head. We attempted to divide the synostosis (to achieve active movements) in five patients; however, we were unsuccessful. In three patients, synostosis recurrence occurred; and in two patients, active movements were not obtained after surgery. In four patients, radial nerve neuropathy was detected in the postoperative period after conservative therapy. In two patients, ulnar fractures occurred as a result of a fall; in one of these patients, fragment apposition was required.Conclusions. Clinicoroentgenological manifestations of CRUS determine the treatment options. The most typical and important of these manifestations is the pronation positioning of the forearm. In such cases, it is reasonable to start operative CRUS treatment after 3 years. All variants of deformation are indicators for operation, and treatment options are determined by the degree of severity of the deformation. Attempts to form the forearm bone neoarthrosis in order to get rotational movements is not effective and can result in deformation recurrence.

Введение. Патология плечевого сустава, и в первую очередь его нестабильность, очень часто встречается у подростков. Материалы и методы. Нами были прооперированы 42 пациента в течение 3 лет с патологией плечевого сустава. Распределение по полу показало значительное преобладание патологии плечевого сустава у мальчиков (76,2 % наблюдений), что, вероятнее всего, связано с более агрессивными физическими нагрузками у лиц мужского пола. Большая часть больных получили травму плечевого сустава во время занятий спортом (27 человек, 64,3 %). Результаты и обсуждение. Артроскопия является высокоэффективным методом лечения патологии плечевого сустава. Длительная консервативная терапия без показаний и правильной диагностики может привести к быстрому прогрессированию дегенеративно-дистрофических изменений в плечевом суставе и, как следствие, к нарушению его функции.

Background.Shoulder joint injuries and shoulder instability often occur in adolescents.Materials and methods. During a 3-year period, we performed arthroscopic surgery on 42 patients with shoulder joint injuries.Results and discussion. The majority (76.2%) of the patients on whom we performed arthroscopic shoulder joint surgery were male. This is likely due to more aggressive physical activity among males. Most of the patients were injured during exercise (n = 27, 64.3%). Arthroscopy is a highly effective surgical method for the treatment of shoulder joint injuries. Prolonged non-operative treatment with no well-established indications and an incorrect diagnosis can lead to rapid progression of degenerative and dystrophic changes of the shoulder joint and may result in shoulder joint dysfunction.

The diagnosis and treatment of inflammatory joint diseases is the pressing problem of pediatric rheumatology and orthopedics. Juvenile arthritis is the most frequent chronic inflammatory disease of the musculoskeletal system in children and adolescents. Still juvenile arthritis is often misdiagnosed. The article provides current knowledge on juvenile arthritis, its clinical manifestations, as well as diagnostic and treatment strategies, and differential diagnosis.

Juvenile idiopathic arthritis (JIA) is a multifactor chronic inflammatory joints disease that is characterized by long progressive course leading to the development of contractures and loss of joint function. Prediction of the likely outcomes and course of JIA is key approach of treatment. Currently, there are only several laboratory and radiological predictors of unfavorable prognosis of JIA. Reduced sensitivity of cells to apoptosis is one the possible mechanisms maintaining synovial inflammation in JIA. Polymorphisms Arg72Pro 4exon, ins/del16bp 3intron, G/C 6intron can determine activity of the P53 protein - the key protein of intrinsic apoptosis pathway (P.Dumont et al 2003; A.Sallivan et al, A.Ghosh et al 2004).