ВОПРОСЫ КЛАССИФИКАЦИИ, КЛИНИЧЕСКАЯ КАРТИНА И БАЗИСНАЯ ТЕРАПИЯ ЮВЕНИЛЬНОЙ СКЛЕРОДЕРМИИ

The development of a child's visual system begins in the first trimester of pregnancy, and refractogenesis continues after birth. Different age periods of development of the organ of vision have specific features and may be accompanied by risks affecting visual functions in the future. During the first year of a child's life, the morphological and functional development of the cranial nerves occurs, and the retina is formed. Newborns have hypermetropia; later, at 2 years, visual acuity increases to 0.3-0.5. After 3 years, the visual system experiences much stress associated with attending preschool and school. By the age of 7, emmetropia is normally formed. In school years, myopia (school myopia) is most often detected. Early diagnosis of refractive errors and timely correction in children prevents the following complications: strabismus, amblyopia, asthenopia, blepharitis, and conjunctivitis. An integrated approach to the follow-up and treatment of the child (the dosage of visual loads, eye gymnastics, adequate correction, and nutrition balance) will contribute to the normal development of the visual organ with the formation of high visual functions even with current high visual loads. It is recommended to take not individual vitamins but vitamin and mineral complexes, which can compensate for the deficiency of most vitamins by 20-30%. They should contain carotenoids (lutein, zeaxanthin), vitamins A, B group, C, E, and D, and potassium, zinc, and selenium. It is particularly relevant in children over 3 years of age due to the rapidly increasing intensity of visual load.

A retrospective study contains clinical and immunological characteristics of juvenile systemic scleroderma manifestations in 78 children according to data from a single rheumatology center. The average age of onset was 8.3 years, girls outnumbered boys, the form with diffuse skin involvement was more common, and among visceral involvement, the gastrointestinal tract and lungs were the most commonly affected; antinuclear factor was detected in 81% of children, anticentromere antibodies in 31%, and antitopoisomerase antibodies in 8.5%. The 5-year survival rate of patients in the main group was 100%, and the probability of survival at 74 months was 70%. Our data largely coincide with the studies of other authors. No obvious natural pathomorphosis of juvenile systemic scleroderma has been established in the 2000s compared to 1960–1980; therapeutic pathomorphosis of the disease is likely to occur. Key words: pathomorphosis, age of onset, visceral involvement, autoantibodies, survival

Vaccination of children with autoimmune rheumatic diseases is a significant problem since infectious diseases remain the main cause of complications of anti-rheumatic therapy and one of the leading causes of death in this category of patients. This review presents current information on the frequency of comorbid infections, the accumulated experience of vaccination in children with autoimmune rheumatic diseases. The recommendations of The European League Against Rheumatism (EULAR) for vaccination in paediatric patients with rheumatic diseases are presented in detail. The presence of rheumatic disease is not an exception for vaccination, it is recommended for all children following national guidelines. Non-live vaccines are effective and safe in paediatric patients with rheumatic diseases. Live vaccines are not recommended for patients receiving high doses of glucocorticoids, immunosuppressive and biologics therapy due to the risk of infectious complications. Vaccination against pneumococcal infection and seasonal influenzais are hihgly recommended. Key words: vaccination, children, autoimmune rheumatic diseases, guidelines, review