MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
206
CHARACTERISTICS OF GENETIC PREDISPOSITION TO THE
DEVELOPMENT OF JUVENILE IDIOPATHIC ARTHRITIS IN
CHILDREN
Mallaev Sh.Sh., Samadov A.A., Nurmatova N.F., Sagdullayeva M.A..
Alfraganus university
Uzbekistan Tashkent 100109, Farobiy 2
Summary: The article presents clinical laboratory features and prognostic
criteria of juvenile rheumatoid arthritis. The clinical characteristics of the disease
and the results of laboratory analysis are important in choosing an effective treatment
method. Medicinal and surgical treatment of joints is recommended, depending on
the severity of the disease, the characteristics of the clinical flow and the results of
the functional laboratory analysis.
Keywords: juvenile rheumatoid arthritis, diagnostics, prognosis.
Relevance.
Juvenile rheumatoid arthritis (
JRA
) is a destructive inflammatory disease of
joints with unknown etiology, complex immunogenic pathogenesis, characterized by
symmetric chronic arthritis, systemic lesions of internal organs, which leads to the
disability of sick children. Improving the effectiveness of treatment for this disease is
therefore a highly topical issue in terms of both scientific and practical pediatrics.
There are many factors that trigger the disease. The most frequent are viral or mixed
bacterial-viral infection, joint injury, excessive or supercooling insolation,
prophylactic inoculations carried out against the background or immediately after the
acute respiratory infection of a viral or bacterial nature [3,11].
Corticosteroids attract the most attention among daily rhythms. It was for
these hormones that a simulation method was developed, as it was found that minimal
changes in adrenal corticosteroid function are observed when assigned corticosteroids
only in accordance with the natural daily rhythm of their secretion. The treatment of
corticosteroids takes into account the opposite direction of action in cortisol and
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
207
aldosterone. Therefore, the activity of mineralocorticoids (pro-inflammatory
hormones) can be suppressed by the introduction in the afternoon of an adequate dose
of glucocorticoids (anti-inflammatory hormones). Based on information on the daily
rhythm of inflammatory and anti-inflammatory hormones in the div, it can be
assumed that Nsaids have a more pronounced effect in the afternoons and evenings.
According to Y.E. Veltisheva and co-op. (1995) The one-time appointment of
ibuprofen to children with glomerulonephritis in the evening, one to two hours before
the acrophase of Transamidinase, increases their efficiency and significantly reduces
side effects. An analysis of the literature shows the aggressiveness and high
probability of disability of children with JRA. Traditional disease therapy is far from
being effective, necessitating the search for new and effective treatments for the
disease. The chronotherapy method makes it possible to increase the effectiveness of
the treatment while simultaneously reducing the doses of the drugs used, thereby
reducing their side effects and making the treatment cheaper.
Purpose of the study. Study clinical and laboratory manifestations of juvenile
rheumatoid arthritis and determine predictive outcome criteria.
Material and methods.
Eighty-four children between the ages of 3 and 16 (average age 11) with
rheumatoid arthritis were monitored, of whom 74 (per cent) were articular and 10 (per
cent) were systemic. Of the cases examined, 47 (56 per cent) were boys and 37 (44
per cent) were girls. The patients were divided into two groups depending on the
treatment provided: 54 patients constituted the main group that received
chronotherapy by nimesulide and 30 patients with traditional therapy Nsaids formed
a comparison group. The control group consisted of 20 practically healthy children.
As can be seen from the table, the vast majority of the patients we examined
had 3-month arthritis. And more, the morning shudder, the arthritis of the second
joint, which appeared after three months. and later, symmetrical small joint lesions,
effed into the joint cavity. The joint suffered pain, swelling, deformation and
restriction of movement, and increased skin temperature. More frequent were the
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
208
large and middle joints - knee, ankle, radius, ulna, hip. In 10 (11.9%) patients suffered
a lesion of the cervical spine.
Result and discussion
The polyarticular variant of the
JRA
was observed in 35 patients examined, of
which 6 were seropositive for the rheumatoid factor. In the seropositive subtype, the
start with symmetric polyarthritis was noted. The wrist and foot joints were usually
affected. Structural changes in the joints developed during the first six months of the
disease. By the end of the first year, diseases in the joints of the wrist formed ankylosis
in two patients. One patient developed destructive arthritis. According to literature, this
form of
JRA
is the early debut of adult rheumatoid arthritis.
The seronegative subtype had a sub-prime, with symmetric polyarthritis. The
arthritis flow was relatively benign.
Four patients suffered from kidney damage, three suffered from heart damage,
one suffered from lung damage and two suffered from a combination of internal
injuries. One preschool girl had Still syndrome, and one boy had Wissler-Fancony
syndrome. In systemic forms, articular syndrome also had its own distinctive features.
For example, in one patient with an allergy-septic variant, the disease began with
persistent arthralgia in large (knee, hip) and medium (ankle, radius and ulna) joints
without any visible changes. The length of the period of arthralgia without clear signs
of arthritis was 1.5 months for the patient. Then came the exudative and productive
changes in joints with the rapid development of the usures and erosion. The most
comprehensive presentation was of articular syndrome under Still’s disease. One sick
girl developed generalized articular syndrome at the earliest stages, involving the joints
of the hand, foot, cervical spine, jaw-temporal, and larger joints. The initial exudative
phase was quickly replaced by two to three months of production, erosion, and
destruction of cartilage, which led to early ankylosis in the radial joints.
In the laboratory diagnostics of the JRA, we were based on a clinical blood
test, a determination of the rheumatoid factor. The level of activity of the
JRA
according to the laboratory criteria proposed by Nasonova V.A., (1997) was estimated
as follows: 0-OCE up to 12 mm/h, DRR not determined, I-OCE 13-20mm/h, DRR
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
209
slightly positive (+), II-OCE 21-39 mm/h, DRR positive (++), III-OCE 40 mm/h and
above, BDS is strongly positive (++, ++++).
We have conducted an X-ray examination of the instrumentation
methods, which makes it possible to determine the degree of joint damage and to
determine the stage of anatomical changes according to the Steinbrocker criteria. In
the first months of the disease, the main radiological indicator is epiphyseal
osteoporosis, a fine-cystic reconstruction of bone structure of epiphysis. Then you get
erosion. The frequency of occurrence of the
JRA
x-ray criteria according to the
Steinbrocker criteria is given in Table 3.3.2.
Table 4.
Frequency of
JRA
x-ray criteria
Stages
Signs
abs.
%
1
Epiphyseal osteoporosis
53
63.1
2
Joint cleft constriction, single
erosion
27
32.1
3
Destruction of cartilage and bone
3
3.6
4
Fibrous and bone ankylosis
1
1.2
As can be seen from the table, half of the patients we examined had the first
stage of anatomical changes for Steinbrocker, i.e. epiphyseal osteoporosis, and in 1/3
patients we found that the joint slit was constricted and that there was single erosion.
Destruction of cartilage and bone occurred in three patients with a disease lasting
more than three years. Ankylosis formed in a sick girl with Still syndrome.
The treatment of various forms of ADR, particularly severe and progressive,
is a complex task requiring the joint efforts of the doctor, the sick child, his parents
and the family as a whole. Effective therapy leads to the achievement of remission of
the disease and improvement of the patient’s quality of life. The emergence in recent
years of new biological agents (infilksimab, ethanercept, rituksimab, adalimumab,
etc.) that have a significant impact on the course of the disease, and the first
experience with some of them offers hope for improving the outcome of the disease.
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
210
In the presented algorithms, about 5% of the prediction error is planned. The
difference between the forecast and the reality is due to two reasons. First, all factors
are not taken into account at the time of projection; Second, the health of the child is
affected by factors that have subsequently joined, are not in force and therefore are
not taken into account at the time of projection. It is understandable that if a physician
can take these factors into account and foresee their occurrence from the first stage of
the examination, the accuracy of the forecast increases.
Conclusions.
1. On the basis of the complex of clinical-laboratory and instrumental and functional
methods of investigation, the clinical variant of the disease, the level of its activity
and the features of the current have been clarified. This is the basis for the
development
of
a
range
of
treatment
measures.
2. Applying a predictive approach to determining the threat of adverse outcome of the
ADP is a modern and effective way of preventing disease progression and choosing
the most appropriate therapeutic tactic option.
REFERENCE LIST.
1.
Beutler BA The role of tumor necrosis factor in health and disease. J Rheumatol
Suppl 1999;57:16 –21.
2.
McDevitt H., Munson S., Ettinger R., Wu A. Multiple roles for tumor necrosis
factor-alpha and lymphotoxin alpha/beta in immunity and autoimmunity. Arthr Res
2002;4(Suppl. 3 ):S 141–S152.
3.
Sfikakis PP, Kollias G. Tumor necrosis factor biology in experimental and
clinical arthritis. Curr Opin Rheumatol 2003;15(4):380–6.
4.
Dekker L., Armbrust W., Rademaker CM et al. Safety of anti- TNFalpha therapy
in children with juvenile idiopathic arthritis. Clin Exp Rheumatol 2004;22(2):252–8.
5.
Giannini EH, Ilowite NT, Lovell DJ et al. Long-term safety and effectiveness of
etanercept in children with selected categories of juvenile idiopathic arthritis. Arthr
Rheum 2009;60(9):2794–804.
6.
Horneff G., Schmeling H., Biedermann T. et al. The German etanercept registry
for treatment of juvenile idiopathic arthritis. Ann Rheum Dis 2004;63(12):1638–44.
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
211
7.
Horneff G., De Bock F., Foeldvari I. et al. Safety and efficacy of combination
of etanercept and methotrexate compared to treatment with etanercept only in patients
with juvenile idiopathic arthritis (JIA): preliminary data from the German JIA
Registry. Ann Rheum Dis 2009;68(4):519–25.
8.
Quartier P., Taupin P., Bourdeaut F. et al. Efficacy of etanercept for the
treatment of juvenile idiopathic arthritis according to the onset type. Arthr Rheum
2003;48(4):1093–101.
9.
Eberhard BA, Ilowite NT Response of systemic onset juvenile rheumatoid
arthritis to etanercept: is the glass half full or half empty? J Rheumatol
2005;32(5):763–5.
10.
Mallaev Sh.Sh, Alimov A.V. Comparative effectiveness of traditional therapy
and chronotherapy in the treatment of juvenile rheumatoid arthritis. // New day in
medicine - 2020. - T. 1. No. 1 - P. 258-262.
11.
Mallaev Sh.Sh, Alimov A.V. Clinical course of juvenile rheumatoid arthritis
and its treatment optimization // journal "Pediatrics" No. 2 Tashkent 2020. P. 200-
203.
12.
Mallaev Sh . Sh ., Alimov A . IN . Clinical course of juvenile rheumatoid arthritis
and its treatment optimization // Tibbiyotda yangi kun . – 2020. - №4 (32). – P. 68-
71. (14.00.00. - No. 22) .
13.
Mallaev Sh.Sh. , Alimov AV Clinic - laboratory manifestation of juvenile
rheumatoid arthritis // European vestnik pediatrii . – 2020. - No. 3 – P. 56-60.
14.
Mallaev Sh.Sh. Modern features of the course of clinical variants of juvenile
rheumatoid arthritis // Interuniversity Scientific Congress
"Higher School: Scientific
Research" Moscow, 2020. - P. 64-65.
15.
Mallaev Sh.Sh. Justification of the chronopharmacological approach to the
treatment of diffuse connective tissue diseases in children // Interuniversity Scientific
Congress
"Higher School: Scientific Research" Moscow, 2020. - P. 66-67.
16.
Mallaev Sh.Sh., Alimov A.V. Functional state of the adrenal glands in children
with juvenile rheumatoid arthritis // Collection of articles based on the materials of
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
212
the XXXI international scientific and practical conference No. 1 (28) Moscow 2020.
- P. 76-80.
17.
Mallaev Sh.Sh., Alimov A.V. New approaches to the treatment of juvenile
rheumatoid arthritis // Collection of articles based on the materials of the XXXI
international scientific and practical conference No. 2 (62) Moscow 2020. - P. 18-22
.
18.
Muxtorov MG, Yunusova RT Bolalarda C ovid-19 dan keyings davrda
biriktiruvchi to'qimaning tizimli kasalliklarining laborator va clinic xususiyatlari //
Journal of Academic Research of New Uzbekistan. – 2024. – T. 1. – No. 6. – pp. 33-
35.
19.
Muxtorov M. et al. Biriktiruvchi to' qimaning tizimli kasalliklari bor bolalarda
Covid-19 ning uchrash chastotasi //Theoretical aspects in the formation of
pedagogical sciences. – 2024. – T. 3. – No. 10. – S. 149-151.
20.
Fayziev, N. N., Mallaev , Sh. Sh., Sultanova, N. S., & Bobomuratov , T. A.
Changes in the hemostasis system in children with pneumonia and optimization of
their treatment. Academic Research in Educational Sciences Volume 4 | Special Issue
1 | 2023 ISSN: 2181-1385
21.
Bobomuratov T. A., Fayziev N. N., Mallaev Sh. Sh. Coronavirus infections in
children, clinical features, diagnostics, treatment in children. Bulletin Tashkent
medical academy № 5 2022. P. 21-23
22.
Mallaev Sh. Sh., Fayziev N. N., et al. Features of the clinical course of
coronavirus infection in children (literature review) // JOURNAL OF HEPATO-
GASTROENTEROLOGICAL RESEARCH. - 2022. - No. SI-2.
23.
Sultanova , NS, Avezova , GS, Mallaev , SS, & Fayziyev , NN
//COMPREHENSIVE CHARACTERISTICS OF THE STATE OF HEALTH OF
CHILDREN IN DIFFERENT AGE PERIODS, DEPENDING ON THE TYPES OF
FEEDING AND CARE //British Medical Journal. – 2023. – T. 3. – No. 2.
24.
N.N. Fayziev , Sh.Sh. Mallaev , N.S. Sultanova, T.A. Bobomuratov // Changes
in the system hemostasis in children with pneumonia and optimization their treatment
//Academic research in educational sciences, 2023 No. 1 P 180-187
MODERN EDUCATION AND DEVELOPMENT
Выпуск журнала №-23
Часть–3_ Апрель –2025
213
25.
Mallaev Sh Sh , NS Sultanova , GS Avezova , NN Faiziev . //Molecular-Genetic
Mechanisms of the Development of Juvenile Idiopathic Arthritis in Children./ / Texas
Journal of Medical Science. – 2023 31-34
26.
TA Bobomuratov , NN Fayziev GENETIC FEATURES OF THE
HEMOSTASIS SYSTEM IN CHILDREN WITH PNEUMONIA Bulletin of the
Tashkent Medical Academy No. 9 2023. P. 29-30 .
