Irreversible damage and health-related quality of life of patients with juvenile idiopathic arthritis in dynamics

Abstract

Background. Significant limitations of the body’s functional capabilities in children with rheumatic diseases are caused by the chronic, progressive nature of the course of the disease and concomitant, sometimes life-long, prescribed therapy. Thus, due to rheumatic diseases, every third patient with this pathology does not attend an educational institution and is forced to study at home, which limits the possibility of acquiring knowledge, which reduces the level of children education and the healthrelated quality of life. A decrease in the age of onset of rheumatic disease in children, an increase in its total duration, disability in childhood due to persistent functional disorders, a decrease in the indicators of chronic diseases and their socialization determine the need to develop and implement measures to prevent the formation of irreversible persistent disorders of organs and systems already in childhood, their early diagnostics, improvement of quality-of-life indicators. Purpose – to determine the dynamics of changes in irreversible damage in children with juvenile idiopathic arthritis and to assess their quality of life. Materials and Methods. 118 patients with jia were diagnosed, of which 47 were with polyarticular, 43 with oligoarticular, 28 with uveitis-associated variants. The presence of irreversible damage was studied from the side of the cardiovascular system, lungs, kidneys, as well as the lipid spectrum and blood coagulation system. Results. It was determined that in children with juvenile idiopathic arthritis, during the year of the disease, there is an increase in the size of the left atrium and a tendency to decrease the ejection fraction of the left ventricle, which may be the initial signs of the formation and progression, first of all, of diastolic dysfunction of the myocardium. The study of the functional state of the kidneys did not reveal any pathological differences. Against the background of the basic therapy of the main disease, positive changes occur: an increase in the level of glomerular filtration (р < 0.05), a tendency to decrease the level of creatinine in the blood serum (p < 0.1). During spirometry, 24 (21.1%) children with juvenile idiopathic arthritis were found to have a violation of the function of external respiration. Atherogenic changes in the lipid spectrum of the blood also persist, but against the background of long-term basic therapy, the atherogenicity of the spectrum is slightly reduced. Conclusion. In children with juvenile idiopathic arthritis, under dynamic observation, irreversible heart damage with signs of myocardial dysfunction, impaired external breathing function of the restrictive type, irreversible kidney damage with a decrease of glomerular filtration, and atherogenic changes in the lipid spectrum of the blood remain. The factors of their stabilization and progression are the long-term course of the disease with the preserved activity of the process, positivity on rheumatoid factor and antinuclear antibodies.