Abstract
Purpose. To study the prevalence of the digestive system pathology in children with systemic connective tissue diseases.Characteristics of children and research methods. We carried out a clinical and instrumental examination of 108 children with systemic connective tissue diseases hospitalized in the rheumatology department of the 4th City Children’s Clinical Hospital in Minsk from 2008 to 2015. 60 patients suffered from juvenile idiopathic arthritis (mean age 12.3 [9.4; 15.6] years), 23 children suffered from juvenile scleroderma (mean age 11.8 [9.7; 14.9] years) and 25 children suffered from systemic lupus erythematosus (mean age 13.1 [12.2; 16.3] years). All patients received long-term immunosuppressive and anti-inflammatory therapy.Results. 75.9% patients had gastroenterological complaints, such as abdominal pains, nausea, heartburn. 69.4% of patients had endoscopic changes in the esophagus, stomach, and/or duodenum. According to the results of the morphological study, 43.5% of patients with systemic connective tissue diseases had mild inflammatory process, 29.6% of patients had average inflammatory process, and 3.7% of patients had severe inflammatory process. Among the children examined, 33 (55%) patients with juvenile idiopathic arthritis, 12 (48%) children with systemic lupus erythematosus and 11 (47.8%) patients with juvenile scleroderma were infected with Helicobacter pylori. Pathological changes of the hepatobiliary system and pancreas were diagnosed in 83.3% of children with systemic connective tissue diseases.Conclusion. The revealed changes indicate a probable connection between the pathology of the digestive organs in children with systemic connective tissue diseases and substantiate the gastroenterological examination of this category of patients.
Highlights
We carried out a clinical and instrumental examination of 108 children with systemic connective tissue diseases hospitalized in the rheumatology department of the 4th City Children’s Clinical Hospital in Minsk from 2008 to 2015. 60 patients suffered from juvenile idiopathic arthritis, 23 children suffered from juvenile scleroderma and 25 children suffered from systemic lupus erythematosus
33 (55%) patients with juvenile idiopathic arthritis, 12 (48%) children with systemic lupus erythematosus and 11 (47.8%) patients with juvenile scleroderma were infected with Helicobacter pylori
Pathological changes of the hepatobiliary system and pancreas were diagnosed in 83.3% of children with systemic connective tissue diseases
Summary
В исследование были включены 108 пациентов с системными заболеваниями соединительной ткани, госпитализированных в ревматологическое отделение 4-й городской детской клинической больницы г. В группе детей с ювенильным идиопатическим артритом в качестве базисной иммуносупрессивной терапии 56 (93,3%) пациентов получали метотрексат, 2 (3,3%) – циклофосфамид, 2 (3,3%)– сульфасалазин; с противовоспалительной целью глюкокортикоиды внутрь в средней дозе 0,5 [0,3; 0,6] мг/кг/сут получали 42 (70%) ребенка и нестероидные противовоспалительные препараты (НПВП) – все 60 детей. В группе детей с ювенильной склеродермией в качестве базисной иммуносупрессивной терапии 14 (60,8%) пациентов получали метотрексат, 2 (8,7%) – циклофосфамид и 8 (34,7%) – D-пеницилламин, глюкокортикоиды внутрь в средней дозе 0,2 [0,1; 0,5] мг/кг/сут получали 7 (30,4%) детей, НПВП 9 (39,1%). В группе системной красной волчанки все 25 детей получали системные глюкокортикоиды: в дебюте заболевания в виде пульс-терапии в средней дозе 12,5 [12,5; 15] мг/кг на 1 введение, затем внутрь в средней дозе 0,75 [0,6; 0,75] мг/кг/сут. Оценку значимости различия частот наблюдений осуществляли на основе многопольных таблиц с расчетом дисперсии по критерию χ2 с поправкой Йейтса
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