Abstract
Juvenile idiopathic arthritis (JIA) is a heterogeneous group that includes all forms of childhood chronic arthritis (joint inflammation lasting more than 6 weeks) of unknown cause in children under 16 years of age. JIA is the most common rheumatic disease in childhood (with an annual incidence from 1.6 to 23.0 new cases per 100,000 adolescents) and is characterized by an often hidden onset and a chronic relapsing course after diagnosis. Tuberculosis plays a special role among opportunistic infectious diseases in JIA, because rheumatic diseases are associated with an increase in the overall risk of developing tuberculosis. Children's phthisiologists often deal with the differential diagnosis difficulty of tubercular lesions of the joints with JIA, and first of all, with oligoarthritis. Clinical symptoms in JIA can be very diverse, and some characteristics of arthritis, not necessarily significant in JIA diagnosis, may have multiple etiologies that need to be carefully differentiated. It was detected during review that JIA is of urgent importance in children’s phthisiatric practice due to various reasons: oligoarthritis in JIA has similar clinical manifestations as in tuberculosis arthritis, which significantly complicates differential diagnosis and delays timely treatment of a correctly diagnosed disease; there is a high frequency of diagnosis of latent tuberculosis infection (LTBI) in JIA, which requires the appointment of preventive treatment to reduce the risk of LTBI progression to an active form of tuberculosis; patients with JIA receiving tumor necrosis factor blockers and/or methotrexate have a higher risk of tuberculosis activation, which is a serious problem in the treatment plan, and require constant monitoring for the possible development of tuberculosis. Therefore, in all pediatric patients with JIA, mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, taking into account the high frequency of false-negative result of the tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI, and with a positive result of preventive antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.Therefore, all pediatric patients with JIA should undergo mandatory diagnostic screening (combination of tuberculin skin test methods with QuantiFERON®-TB Gold In-Tube, considering the high frequency of false-negative result of tuberculin skin test due to immunosuppression caused by JIA) for timely detection of LTBI. When there is a positive result of the screening tests, it is necessary to carry out prophylactic antimycobacterial treatment, which will prevent the development of an active form of tuberculosis.
Published Version
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