Treatment regimen for juvenile chronic arthritis in children

Mono and oligoarthritic acute and subacute variants. In the therapy of these forms, tactics of minimal therapy are used. Treatment should begin with the use of acetylsalicylic acid (50-70 mg / kg body weight per day); with good tolerability of the drug and the absence of a pronounced anti-inflammatory effect, within 7–10 days, the dose will increase to 100–120 mg / kg. In parallel, they use enveloping agents (Ryss mixture, Almagel), taking into account the possible ulcerogenic effects of aspirin. In the specialized departments of Leningrad, all the anti-inflammatory drugs of children are washed down with milk. With a high activity of the pathological process and large exudative changes in the joints, which, as a rule, are accompanied by severe pain syndrome and painful contractures, the treatment can be started with the intravenous drip of sodium salicylate at the rate of 0,1—0.15 g / kg, bringing its concentration to 2–5% in a 5% glucose solution and a course of 10–15 infusions daily or every other day. Therapy is carried out on the background of moderate doses of aspirin orally (50–60 mg / kg), the purpose of which is better to be administered in the second half of the day.

In the absence of the effect of salicylates for 2–3 weeks or the occurrence of side effects, you should switch to other NSAIDs – metindol (indomethacin at a dose of 1-3 mg / kg per day, voltaren in the same position, brogren – 10-30 mg / kg per day 1 ). It is necessary to note once again that children with JUHA have individual sensitivity to the drugs listed above, and therefore, in each particular case, the selection of the drug is made individually.

Initially, all anti-inflammatory drugs are prescribed evenly throughout the day – 4 times. In some cases, focusing mainly on the severity of pain, the daily rhythm of medication can be changed. For example, in the presence of the greatest soreness or stiffness in the morning hours, it may be recommended to assign more of the daily dose in the evening and early morning hours.

In the presence of high activity, poorly amenable therapy, exudative changes of the joints and, especially, with pronounced general manifestations of the pathological process (fever, disruption of the general condition), means to improve the microcirculation (heparin in a dose of 100-150 units / kg for administration – the dose is considered adequate when lengthening the coagulation time according to Lee-White up to 10-12 minutes and is prescribed 3-4 times a day for subcutaneous administration), chimes 1–2 mg / kg per day, nicoshpang 2-3. mg / kg and others.

local_offerevent_note April 27, 2019

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