Children have fever and joint pain

Children always have joint pain when they have a fever, which is a typical symptom of reactive arthritis. Reactive arthritis is a type of arthritis and a disease that can have a great impact on the patient's physical and mental health. Therefore, when it occurs, it is necessary to seek medical treatment in time to avoid worsening of the condition. Here is an introduction to the treatment of reactive arthritis!

1. General treatment

Oral and genital mucosal ulcers often resolve spontaneously and do not require treatment. In acute arthritis, patients can rest in bed and avoid joint splinting to prevent fiber stiffness and muscle atrophy. When the acute inflammatory symptoms are relieved, joint function exercises should be started as soon as possible.

2. Nonsteroidal anti-inflammatory drugs (NSAIDs)

There are many types of drugs in this class, including diclofenac sodium, loxoprofen sodium, meloxicam, indomethacin and celecoxib, but their efficacy is roughly the same. The specific selection varies from person to person and can reduce joint swelling and pain and increase range of motion. It is the first choice for symptomatic treatment of patients in the early or late stages.

3. Antibiotics

Antibiotic treatment remains controversial. For acquired reactive arthritis, short-term use of antibiotics (ofloxacin or macrolide antibiotics) to treat concurrent urinary tract infections may reduce the risk of arthritis recurrence in patients with a history of reactive arthritis, but there is a lack of evidence whether it is beneficial for existing arthritis itself. In addition, long-term antibiotic treatment of chronic reactive arthritis is not recommended. For intestinal reactive arthritis, antibiotic treatment is often ineffective and is not recommended after reactive arthritis occurs.

4. Glucocorticoids

For individual patients whose symptoms cannot be relieved by non-steroidal anti-inflammatory drugs, glucocorticoids can be used for a short period of time, but oral treatment can neither prevent the progression of the disease nor cause adverse reactions due to long-term treatment. Topical corticosteroids and keratolytics are useful for keratoses with purulent exudate. Intra-articular corticosteroid injections can temporarily relieve swelling in the knee and other joints. Pain and tenderness caused by the plantar fascia or Achilles bursa can be treated with local injection of corticosteroids to allow early movement of the ankle joint to prevent Achilles tendon shortening and fiber ankylosis. Care must be taken to avoid injections directly into the Achilles tendon, which can cause tendon rupture.

5. Slow-acting antirheumatic drugs

When nonsteroidal anti-inflammatory drugs cannot control arthritis, joint symptoms persist for more than 3 months or there is evidence of joint destruction, slow-acting antirheumatic drugs can be added. The most widely used is sulfasalazine. For those with severe symptoms that do not improve, immunosuppressants such as methotrexate and azathioprine can be tried.

6. Biological agents

Tumor necrosis factor (TNF) inhibitors have been successfully used to treat other types of seronegative spondyloarthritis, such as ankylosing spondylitis and psoriatic arthritis. Currently, the tumor necrosis factor inhibitors available in China include etanercept, infliximab, and adalimumab. However, there is still a lack of randomized controlled studies to verify its effectiveness and safety in reactive arthritis. Some small open studies or case reports suggest that it may be effective.