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LECTURE No. 9. Differential diagnosis of diffuse diseases of connective tissue in children. Clinic, diagnosis, treatment



Classification of rheumatic diseases.

1. Rheumatism.

2. Juvenile rheumatoid arthritis.

3. Ankylosing spondylitis.

4. Other spondyloarthropathies.

5. Systemic lupus erythematosus.

6. Vasculitis:

1) hemorrhagic vasculitis (Shacklein-Genocha);

2) periarteritis nodosa (polyarteritis in young children, Kawasaki disease, Wegener's disease);

3) Takayasu arteritis.

7. Dermatomyositis.

8. Scleroderma.

9. Difficultly classified rheumatic syndromes.

10. Various diseases associated with rheumatic symptoms and signs in children:

1) benign rheumatoid nodules;

2) erythema nodosum;

3) Lyme disease;

4) sarcoidosis;

5) Steven-Johnson syndrome;

6) Goodpasture syndrome;

7) symptoms of fibrositis and fibromyalgia;

8) Behcet's syndrome;

9) Sjogren's syndrome.

11. Non-rheumatic diseases similar in clinic to rheumatic.

Diffuse connective tissue diseases (DBST, collagenoses) is an immunopathological lesion of connective tissue with systemic damage to blood vessels and various organs, a progressive course.

Three leading factors can be distinguished in the etiology of DBST.

The 1st factor is a genetic predisposition, which is confirmed by epidemiological studies, the disease of close relatives, twins and the detection of markers of individual diseases by the HLA system.

The second factor is the trigger mechanism, which are viruses containing RNA and slowly reacting (retroviruses), and a chronic persistent infection that is transmitted transplantally.

3rd factor - resolving: stressful situation, hyperinsolation, hypothermia.

For all DBST, the degree of disease activity is determined; nature of the current; the presence of visceral lesions: the patient's functional ability according to the state of the organs and systems involved in the process; the nature of the complications.
In the DBST prodrome there are a number of common signs that combine various nosological forms: unmotivated weakness, lack of exercise, decreased appetite and body weight; fever resistant to antibiotics, non-steroidal anti-inflammatory drugs and reacting to the treatment of HA; damage to the skin and mucous membranes; joint syndrome; lymphadenopathy; enlarged liver and spleen; persistent mono- or polyviscerite. In laboratory diagnostics, for most DBST (except SSD), typical are: high acute phase parameters (ESR, sialic acids, CRP, etc.); some more specific (LE cells, HLA, etc.).

In the DBST group, 4 “large collagenoses” are distinguished.

1. Systemic lupus erythematosus (SLE).

2. Systemic scleroderma (SJS).

3. Progressive sclerosis.

4. Dermatomyositis (DM).

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LECTURE No. 9. Differential diagnosis of diffuse diseases of connective tissue in children. Clinic, diagnosis, treatment

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