EYE DAMAGE AS A COMORBID CONDITION IN JUVENILE IDIOPATHIC ARTHRITIS
Summary. It is well known that damage to the organ of vision in juvenile idiopathic arthritis (JIA) is a complex condition due to unresolved issues of diagnosis, treatment and control, severe progressive course, the reliable development of long-term complications and the risk of blindness. The aim of the study was to determine the features of manifestations of JIA in children, which is accompanied by eye damage. Object of study: the results of dynamic examination of 121 children aged 7–18 years, with JIA, a polyarthritis (82 people, 67.77%) and oligoarthritis (18 people, 14.88%) and uveitis-associated arthritis (21 patients, 17.36% of the total group of children with JIA), who underwent, according to the protocol, a comprehensive examination and treatment. The children had clinical and sonographic signs of arthritis. The duration of the disease was more than a year. Research methods: the analysis includes the results of a clinical examination of patients, the degree of activity of the disease (indicators of the activity of the inflammatory process, the presence of immunological markers of the autoimmune process) determining, Х-ray and ultrasound examinations of the joints, an ophthalmologist’s examination once every 3 months, incl. in a specialized ophthalmological department in the presence of uveitis. All patients underwent a study of the functional state of the cardiovascular system, kidneys, lungs, lipid spectrum and blood coagulation system. Main results: it was found that the uveitis-associated variant of JIA is characterized by a disease onset at an earlier age (average age 2.89 years), female predominance (71.42%), oligoarthritis of the disease (52.4%) with a primary lesion knee joints (90.5%), the presence of activity of the pathological process according to the JADAS27 scale (average 12.5 points). Uveitis in JIA is characterized by an asymptomatic course of pathological changes in the organ of vision, which is a prerequisite for late diagnosis and improper treatment. In children with uveitis-associated arthritis, the formation of comorbid conditions is noted, changes in the cardiovascular system (80.9%), functional state of the kidneys (33.3%) and the function of external respiration of the lungs (60.0%), as well as dyslipoproteinemia (61.5%) and blood hypercoagulation (27.3%). Conclusions: eye damage at JIA cannot be considered only as an extra articular manifestation. Uveitis-associated variant of JIA has significant differences in the development of clinical manifestation. Uveitis in children with JIA is characterized by an asymptomatic course of pathological changes in the eyes, which is the cause of late diagnosis and improper treatment. The presence of uveitis in JIA should be considered as an unfavorable factor in the formation of comorbid conditions on the part of internal organs as well as dyslipoproteinemia and hypercoagulation.
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