| Sažetak | Dječja reumatologija jedna je od specifičnih grana medicine, zbog brojnih reumatskih bolesti za koje se i dan danas ne zna točan uzrok i način pojavljivanja. Brojna djeca boluju od određenih reumatskih bolesti poput juvenilnog idiopatskog artritisa, sistemskog eritemskog lupusa, juvenilnog dermatomiozitisa, septičnog artritisa. Jedna od bolesti koja zahtjeva veliku predanost bolesnika u liječenju iste je juvenilni ankilozantni spondilitis. Bolest se javlja obično u starije djece i to pretežito muške. Ankilozantni spondilitis spada u juvenilne spondiloartropatije odnosno u skupinu najčešćih reumatskih bolesti. Bolest najčešće zahvaća sakroilijakalne zglobove i kralježnicu. Smatra se upalnom reumatskom sistemskom bolesti, kod koje dolazi do osifikacije vezivnog tkiva. Etiologija same bolesti je nepoznata, ali se povezuje s genetičkim faktorima. Naime u 90% bolesnika koji boluju od ankilozantnog spondilitisa spominje se prisutnost antigena HLA-B27 pozitivnog. Takva povezanost čini jednu od najjačih veza između gena HLA i neke bolesti. Jedan od prvih znakova koji ukazuju na bolest je križobolja koja se pojavljuje u lumbalnoj kralježnici, te se širi preko glutealne regije sve do stražnje strane natkoljenice. Obično se bol javlja tijekom odmaranja ili dužeg sjedenja, tj. ako bolesnik zauzima određeni položaj tijela duže vrijeme. Tako je nakon spavanje potrebno odraditi razgibavanje ili istezanje tijela da se bolovi smanje ili potpuno uklone. Postavljanjem dijagnoze uzima se potpuna anamneza, klinička slika, provode se brojni testovi, mjerenja i procjene funkcije u sklopu fizikalnog pregleda. Radiološka metoda prva je koja se koristi za rano otkrivanje bolesti te se primjenjuje RTG i magnetska rezonancija. Medikamentozna terapija zahtjeva primjenu nesteroidnih protuupalnih lijekova, lijekova koji utječu na tijek bolesti, bioloških lijekova i kortikosteroida. Često se koriste injekcije u zglobove, ali i kirurško liječenje gdje se primjenjuje vertebrotomija, laminektomija, aloartroplastika, sinovijektomija, artrodeza segmenta C1- C4 i često dolazi do ugradnje endoproteze kuka. Fizikalna medicina zahtijeva niz postupaka i potpunu predanost bolesnika tijekom cijele rehabilitacije. Primjenjuje se elektroterapija, hidroterapija, magnetoterapija, terapija ultrazvukom i najvažnije kineziterapija. Terapija pokretom se primjenjuje od samog početka rehabilitacije odnosno od akutne faze, zauzima znatnu ulogu u liječenju te se je ne može isključiti. U sklopu terapije pokretom provode se vježbe disanja, jačanja, vježbe mobilnosti kralježnice i zglobova. Terapija se provodi individualno i uz prisutnost terapeuta. Medicinsko osoblje koje je zaduženo za rehabilitaciju pacijenta priprema ga na samostalan život i lako provođenje svakodnevnih funkcija i aktivnosti. Bolesnik kod kuće mora provoditi vježbe, zadovoljavati određene položaje tijela koji mu ne pogoršavaju bolest, odabrati budući posao s obzirom na tjelesne mogućnosti i tijek bolesti. Svakako se preporuča bavljenje sportom, a od sportova se preporuča jahanje, leđno plivanje, odbojka, košarka, trčanje, itd. |
| Sažetak (engleski) | Pediatric rheumatology is a specific branch of medical science because there are numerous rheumatic diseases for which the cause and reason for occurrence of disease are still unknown. Many children suffer from certain rheumatic diseases like juvenile idiopathic arthritis, systemic lupus erythematosus, juvenile dermatomyositis, septic arthritis. One of the diseases that demands a great dedication from the patient during the treatment is juvenile ankylosing spondylitis. This disease occurs among elder children and among mainly male children. Juvenile ankylosing spondylitis is a type of juvenile spondyloarthropathy, one of the most frequent rheumatic diseases. The disease affects mainly sacroiliac joints and spine. It is treated as an inflammatory rheumatic systemic disease, which leads to ossification of connective tissue. Etymology of the disease is unknown, but it is connected to genetic factor. There is the presence of antigens HLA-B27 positive present among 90 % of patients that suffer from Juvenile ankylosing spondylitis. This kind of connection is one of the strongest ones between an HLA gene and a disease. One of the first symptoms of the disease is a lumbago in lumbar spine that spreads across gluteal region to the back side of upper leg. The pain usually appears during resting or prolonged sitting, i.e. when a patient stays in a certain position for a longer period of time. It is recommended to do some exercise and to stretch after getting up in the morning, if you want to reduce or completely remove the pain. When setting diagnose you have to consider the whole anamnesis, the clinical history, there are many tests, measurements and function assessment that need to be done during the physical examination. Radiological method is the first one used in the early disease detection, along with X-ray and magnetic resonance. In medical treatment, we use non-steroidal anti-inflammatory drugs, medicines that affect the course of the disease, biological drugs and corticosteroids. Injections into joints are also often used, as well as surgical treatment with vertebrotomy, laminectomy, alloarthroplasty, synoviectomy, arthrodesis of the C1-C4 segment and hip endoprostheses is also sometimes implemented. Physical medicine demands a series of procedures and complete dedication of the patient to the process of rehabilitation. Electrotherapy, hydrotherapy, magnetotherapy, ultrasound therapy and the most important one, kinesitherapy are applied for the purpose of rehabilitation. Kinesitherapy is applied from the very beginning of the rehabilitation, from the acute phase, it plays a very important role in the rehabilitation process and it cannot be omitted. Breathing exercises, strength exercises, mobility of the spine and joints exercises are all part of kinesitherapy. The therapy is carried out individually and under the supervision of a therapist. Medical staff in charge of a patient’s therapy, prepares the patient for an independent life and easy carrying out daily activities. The patient has to continue with the recommended exercises at home, keep his/her body in the position that does not worsen the disease, chose his/her future job according to his/her possibilities and the course of the disease. Doing sports is definitely recommended, and recommended sports are: horse-riding, backstroke swimming, volleyball, basketball, running etc. |
