Роль -3 полиненасыщенных жирных кислот в развитии ребенка

Study Objective: to present literature review of clinical parameters and course of psoriatic arthritis (PsA) in children, and results of PsA patients examination in University Clinical Children Hospital of I.M. Sechenov First Moscow State Medical University. Study Design: open prospective study. Materials and Methods. We analysed medical records of 83 children with PsA aged 3 to 17 years who were examined and managed in University Clinical Children Hospital of I.M. Sechenov First Moscow State Medical University in 1989 – 2019. Study Results. Confirmed PsA was diagnosed in 59 (71%) children, suspected PsA — in 24 (29%) children; 44 (53%) children got ill before they were 6.5 years old. In 24 (29%) patients, disease started with skin involvement; in 59 (71%) patients, articular syndrome was the first manifestation of disease. In the group of patients with confirmed psoriasis, the most common was plaque psoriasis: it was diagnosed in 45 (76.3%) out of 59 children; guttate psoriasis was found in 8 (13.5%) children, isolated nail plaque psoriasis — in 3 (5.1%) patients, and palm and foot psoriasis — in 3 (5.1%) children. Psoriasis of the scalp was diagnosed in 23 (39%) subjects. In 8 (13.5%) patients, skin syndrome was associated with mild infiltration and scant desquamation. 18 (21.7%) out of 83 children had skin involvement together with nail bed involvement. Psoriasic onychodystrophy was diagnosed in 19 (23%) children (onycholysis, “oil patches” on fingers and toes); 15 (18.1%) children had “thimble syndrome”. On disease onset, 68.7% of children had oligoarticular, sometimes asymmetric articular syndrome; 18.1% had symmetric rheumatoid-like disease, 13.2% — psoriasic spondylitis. After 5 years of follow-up, articular syndrome transformed: 41.2% of patients had symmetric rheumatoid-like disease, 24.1% — asymmetric oligoarthritis, 24.1% — spondylarthritis with peripheral joint involvement, and 10.8% — arthritis mutilans. Most commonly PsA affected knee, talocrural joints, small hand joints – 41%, 31.3%, 29%, respectively. Conclusion. Clinical manifestations of PsA varied a lot. Our patients did not have a second peak. Almost one third of children had skin changes prior to arthritis development. Onset of disease was associated with asymmetric oligoarthritis prevalence. Later, articular syndrome changed, and symmetric rheumatoid-like disease prevailed. Keywords: children, psoriatic arthritis, psoriasis, juvenile idiopathic arthritis, Vancouver diagnostic criteria.

Background: Takayasu’s arteritis (TA) is a systemic vasculitis that primarily affects the aorta and major arteries. Despite aggressive treatment with glucocorticoids (GCs) and non-biological disease-modifying antirheumatic drugs (nbDMARDs), about 30% of patients experience resistance to therapy or relapse. This study aimed to identify risk factors associated with refractory and relapse TA in pediatric patients. Methods: A retrospective, open-label, case–control study was conducted with 56 pediatric patients with TA diagnosed between February 2011 and October 2022. Fourteen patients were excluded due to insufficient data in their medical records, leaving 42 for further analysis. The patients were divided into two groups: Group 1 (18 patients) with no evidence of relapse and Group 2 (24 patients) with relapse despite first-line treatment at the end of the follow-up period. Clinical, laboratory, and instrumental data were collected and analyzed using R v4.2 and Python v3.10. Results: The median time to relapse was 18 [IQR: 13; -] months according to the Kaplan–Meier curve. Patients with ITAS.A with a diagnosis of TA ≥ 12 had a higher probability of relapse, according to the log-rank criterion (p = 0.006). Symptoms of critical ischemia, such as limb claudication, were more common in Group 2 at diagnosis (p = 0.047), and a trend toward a longer diagnostic delay was observed (p = 0.067). Conclusions: Pediatric patients with an initial ITAS.A score above 12 have a higher risk of relapse when treated with a combination of GCs and nbDMARDs as first-line treatment. Further research is needed to identify high-risk patients more accurately and optimize therapeutic strategies.

Rheumatoid uveitis is a serious problem in rheumatology and ophthalmology due to the peculiarities of the disease – an undistinguished beginning, chronic course and a high incidence of disabling complications. The article analyzes various data on the development and nature of uveitis in children with juvenile idiopathic arthritis. The authors describe the analysis of the results of various studies of this disease. They consider the features and results of treatment of children with rheumatoid uveitis using genetically engineered biological drugs.

Inflammatory bowel diseases, which include Crohn’s disease and ulcerative colitis, are systemic immunoinflammatory diseases. Among the extraintestinal manifestations of these diseases, musculoskeletal lesions with seronegative spondyloarthropathies are the most common.The aim of the study was to evaluate the frequency and nature of joint lesions in patients with inflammatory bowel diseases observed at the Sechenov Centre for Maternity and Childhood in the period from 2017 to 2024.Materials and Methods. The diagnoses of Crohn’s disease and ulcerative colitis were established in accordance with the clinical recommendations of the Union of Paediatricians of Russia. The classification criteria of the International Working Group on Ankylosing Spondylitis, 2011 and the Diagnostic Criteria for Juvenile Spondyloarthritis according to Garmisch–Partenkirchen, 1987 were used to verify the nature of joint damage. The prevalence of joint damage variants in the general group of children with inflammatory diseases of the intestine was analysed, as well as separately in groups with Crohn’s disease and ulcerative colitis.Results. Of 175 children with inflammatory bowel disease, 77 (44%) had extraintestinal manifestations in the form of joint syndrome: 52 (68%) of them with Crohn’s disease and 25 (32%) with ulcerative colitis. Isolated arthralgias were noted in 7 of 77 children (9.1%). Of the 77 children, peripheral arthropathy in the form of oligoarthritis of large joints was noted in 64 (83.1%) patients, including 40 (62.5%) with Crohn’s disease and 24 (37.5%) with ulcerative colitis. Spondyloarthritis occurred in 6 (7.8%) children, in 5 children with Crohn’s disease and in 1 child with ulcerative colitis. Joint syndrome preceded intestinal manifestations of the disease in 40 (52%) of 77 patients with spondyloarthropathy.Conclusions. The analysis of the prevalence of spondyloarthropathies in inflammatory bowel diseases in children showed its high frequency — 44%, significantly more often in Crohn’s disease. Among the patients with arthropathy associated with inflammatory bowel disease, the joint syndrome preceded the intestinal syndrome in 52% of cases. Peripheral oligoarthritis prevailed in 83.1% of our patients. Spondyloarthritis was detected in 7.8% of children, the vast majority of them with Crohn’s disease.

Background. Inflammatory bowel diseases, which include Crohn's disease and ulcerative colitis, are immune-mediated inflammatory diseases with a complex pathogenesis. In addition to the involvement of the intestinal wall in the pathological process, systemic extraintestinal manifestations are observed in Crohn's disease and ulcerative colitis, and there is also often an association with psoriasis and psoriatic arthritis. Objective. Purpose of the study was to analyze the nature of the articular syndrome in children with inflammatory bowel diseases associated with juvenile psoriatic arthritis. Materials and methods. A retrospective analysis of the nature of the articular syndrome was carried out in a group of children with inflammatory bowel diseases associated with juvenile psoriatic arthritis (20 patients, mean age 12.7 years (95% CI [11.01; 14.29]). The diagnosis of juvenile psoriatic arthritis was established according to the Vancouver diagnostic criteria (1989). The diagnosis of Crohn's disease was established in accordance with Clinical recommendations for Crohn's disease for pediatric patients, 2025. The diagnosis of ulcerative colitis was established in accordance with Clinical guidelines for ulcerative colitis for pediatric patients, 2025. Statistical processing was performed using parametric methods and exact formulas for percentages. Results. 17/20 (85%) of our patients were diagnosed with Crohn's disease, inflammatory form, 3/20 patients (15%) – ulcerative colitis. The diagnosis of definite juvenile psoriatic arthritis, according to the Vancouver diagnostic criteria, was made in 11/20 patients (55%), probable – in 9/20 (45%). Boys predominated in the group – 14/20 (70%). The mean disease duration was 5.0 years (95% CI [3.21, 6.79] years). 13/20 (65%) patients had relatives 1 and 2 degrees of relatives suffered from psoriasis. All children with definite psoriatic arthritis (11/20 children) had plaque (vulgar) psoriasis. In 15/20 (75%) patients, the onset of articular syndrome was asymmetrical oligoarthritis. At the height of the disease, the oligoarticular variant was observed in 10/20 (50%) children, rheumatoid-like (polyarticular) in 3/20 (15%), spondyloarthritis with damage to peripheral joints in 7/20 (35%). The most commonly affected joints were the knee (15/20 (75%)), ankle (5/20 (25%)), and hip (8/20 (40%)) joints. Conclusions. The articular syndrome in inflammatory bowel diseases associated with juvenile psoriatic arthritis is characterized by a frequent onset of the disease with joint damage (in 40%), asymmetric oligoarthritis at the onset and at the height of the disease, while isolated juvenile psoriatic arthritis is characterized by a pattern of development of the articular syndrome from oligo- to polyarthritis. The association of inflammatory bowel diseases and juvenile psoriatic arthritis is characterized by a high percentage of spondyloarthritis with damage to peripheral joints (35%). The most common joints involved are the knee and hip joints (75% and 40%), with a high incidence of enthesitis (55%), while in isolated juvenile psoriatic arthritis the knee and ankle joints are most often affected. The course of inflammatory bowel diseases against the background of psoriatic arthritis requires an individual approach to patient management and selection of therapy aimed at the common links in the pathogenesis of these conditions.