DOI: https://doi.org/10.22141/2224-0551.13.1.2018.127061

Interrelations of impaired biochemical and immunological homeostasis in patients with juvenile rheumatoid arthritis taking into account the disease duration

N.S. Shevchenko, I.S. Lebec, D.A. Kashkalda, I.M. Nelina, J.M. Zajceva

Abstract


Background. Juvenile rheumatoid arthritis (JRA) is a life-long pathological condition. Therefore, the study of the mechanisms of its development, the metabolic systems functioning, the formation of dystrophic changes on the background of the inflammatory process is relevant. The purpose of the work was to study the features of metabolism of connective tissue structures depending on the state of immune homeostasis at the stages of evolution of the JRA in pediatric patients. Material and methods. The peculiarities of the structural composition of the connective tissue components, the content of trace elements, and immunological homeostasis in children with JRA were studied. Three hundred fifty-five clinical observations of JRA taking into account retro- and advanced stu­dies for 2012–2016 were analyzed. The clinical group consisted of 117 arthritis patients aged 2 to 18 years (average 6.0 ± 0.5 years). Results. Investigation of immune status determined the decreased T-common lymphocytes (p < 0.001), T-lymphocytes-helper (p < 0.001), T-suppressors/cytotoxic (p < 0.001) immuno-regulatory index (p < 0.05), reduction of bactericidal neutrophil activity (p < 0.001), increase in NST test and decrease in the index of stimulation of neutrophils (p < 0.001), elevated circulating immune complexes (p < 0.001). Analysis of proinflammatory cytokines content showed an increased IL-1 (p < 0.05) and IL-6 level. The study demonstrated the dependence of immunological parameters on disease duration and increased chondroitin-4- and -6-sulfates and blood keratin and dermatan sulfates. The largest deviations were noted at the early stages of the disease, which is undoubtedly related to the activity of the pathological process prior to the anti-inflammatory treatment initiation or at its early stages. The long-term periods of the disease are associated with decrease in the total glycosaminoglycanase, chondroitin-4- and chondroitin-6-sulfates, and the decreased excretion of uronic acid (pt < 0.05). The analysis of changes in the content of inorganic components, depending on the disease duration, revealed a slight decrease in phosphorus loss in the JRA period within 3–5 years. The analysis of deviations in immuno-biochemical correlations at different stages of the pathological process evolution revealed changes in the number and nature of the relationship between the parameters of connective tissue metabolism and immunological homeostasis. Conclusions. High activity of the disease is the main predictor of the dystrophic changes deve­lopment, which is confirmed by numerous correlation interactions of the parameters of connective tissue metabolism and immunological parameters. The most unfavorable periods are the first 1.5 years and 3–5 years from the disease onset. The revealed changes requires medical correction of the biochemical composition of the connective tissue structures in order to prevent the development of secondary dystrophic changes in the affected joints in children with JRA, and may also reflect the inadequate effect of treatment and maintaining of subclinical activity of inflammation.


Keywords


juvenile arthritis; children; connective tissue metabolism; immunological parameters

References


James RA, Wedderburn LR. Modern management of juvenile idiopathic arthritis. Prescriber. 2016;27(6):37-43. doi:10.1002/psb.1472.

Prakken B, Albani S, Martini A. Juvenile idiopathic arthritis. Lancet. 2011 Jun 18;377(9783):2138-49. doi: 10.1016/S0140-6736(11)60244-4.

Gowdie PJ, Tse SML. Juvenile Idiopathic Arthritis. Pediatr Clin North Am. 2012 Apr;59(2):301-27. doi: 10.1016/j.pcl.2012.03.014.

Berard R. Approach to the child with joint inflammation. Pediatr Clin North Am. 2012 Apr;59(2):245-62. doi: 10.1016/j.pcl.2012.03.003.

Aguiara F, Brito I. Structural damage to the hip in systemic juvenile idiopathic arthritis: A case of regression with Anakinra. Reumatol Clin. 2017 Mar - Apr;13(2):118-119. doi: 10.1016/j.reuma.2015.12.007.

Eisenstein EM, Berkun Y. Diagnosis and classification of juvenile idiopathic arthritis. J Autoimmun. 2014 Feb-Mar;48-49:31-3. doi: 10.1016/j.jaut.2014.01.009.

Lin YT, Wang CT, Gershwin ME, Chiang BL. The pathogenesis of oligoarticular/polyarticular vs systemic juvenile idiopathic arthritis. Autoimmun Rev. 2011 Jun;10(8):482-9. doi: 10.1016/j.autrev.2011.02.001.

Boyko YaY.Long-term consequences of juvenile idiopathic arthritis: results of observation of 70 patients. Ukrai'ns'kyj revmatologichnyj zhurnal. 2014;2:67-72. (in Ukrainian).

Pan'ko NA. Prognosis of juvenile arthritis evolution in the first year of the process. Sovremennaya pediatriya. 2013;6:134-137. (in Ukrainian).

Winsz-Szczotka K, Kuźnik-Trocha K, Komosińska-Vassev K, Jura-Półtorak A, Olczyk K. Laboratory Indicators of Aggrecan Turnover in Juvenile Idiopathic Arthritis. Dis Markers. 2016;2016:7157169. doi: 10.1155/2016/7157169.




Copyright (c) 2018 CHILD`S HEALTH

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта