Background . Despite the progress in diagnosis and treatment of chronic rheumatic diseases in children, the choice of anti-inflammatory drugs in case of the onset of oligoarticular juvenile idiopathic arthritis (JIA) still remains relevant. Till present, pediatric rheumatologists have not reached a consensus on this issue yet. The aim of this study was to search for predictors of early failure of local steroid therapy and assessment of its feasibility in patients with oligoarticular JIA. Materials and methods. In a retrospective study, 92 children aged 11 months – 9 years with chronic oligoarticular JIA without extra-articular manifestations were monitored. The features of the clinical, instrumental and laboratory diagnosis during the disease onset were studied, along with the dynamics of the articular syndrome and the effectiveness of intra-articular administration of corticosteroid drugs. Results and discussion. The data on 92 children with 164 active joints who received 218 local intra-articular injections of triamcinolone acetonide at the onset of the disease were analyzed. Intra-articular injections of triamcinolone acetonide at a dose of 20–40 mg were performed with an interval of 3, 6, and 12 months, depending on the intensity of the disease. In about one third of children with oligoarticular JIA, arthritis became inactive on average after two intra-articular injections of triamcinolone acetonide. The study did not reveal the predictors of early ineffective topical corticosteroid monotherapy in children. No clinical, instrumental, and laboratory signs were identified that would directly indicate the need for early therapy with methotrexate. Conclusion . Triamcinolone acetonide is an effective and safe drug for children with oligoarticular JIA. Despite the widespread use of biological, gene, and other innovative therapies, application of local corticosteroids as the firstline therapy in children with oligoarticular JIA should not be neglected.

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.

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.

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.

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.

We investigated the polymorphism of the gene p53 exon 4 Arg72Pro and intron 3 ins/del 16 b. p. in children with juvenile idiopathic arthritis in order to identify the influence of gene polymorphisms on the course and outcome of the disease. The children were divided into several groups according to the sex, type of articular lesion and the effectiveness of treatment. The main criteria of therapy effectiveness was defined as achieving "inactive" arthritis as well as a clinical (pharmacologic) remission. The correlation between p53 gene genotypes among girls with oligo-, polyarthritis of juvenile idiopathic arthritis was shown for the first time. The data obtained demonstrates the necessity for further studies of the correlation between genotype p53 and juvenile idiopathic arthritis.