Volume 05 Issue 10-2024
93
CURRENT RESEARCH JOURNAL OF PEDAGOGICS
(ISSN
–
2767-3278)
VOLUME
05
ISSUE
10
Pages:
93-98
OCLC
–
1242041055
Publisher:
Master Journals
ABSTRACT
The article deals with the clinic and classification of immunological aspects of juvenile rheumatoid arthritis in students
while teaching clinical sciences in medical education, acute rheumatic diseases, etiopathogenesis, classification,
clinical signs, diagnostic criteria, comparative diagnosis, treatment methods, prevention and dissemination.
Rheumatism, immunological aspects and its classification considered related to treatment methods, etiology and
pathogenesis of the disease, infectious factors. Causes of rheumatism, solution of therapeutic and methodical tasks
necessary in medical educational institutions, in classes, based on medico-didactic approach outlined.
KEYWORDS
Juvenile rheumatoid arthritis, the spread of rheumatism, treatment methods, clinical symptomatology, diagnostic
criteria, comparative diagnosis, medical and didactic approach.
INTRODUCTION
Teaching clinical sciences in medical education
methodically improve the quality of medical education,
paid attention to quality medical education, introduce
clinical innovative technologies to methodically
develop practical professional skills in real medical
environment, social training of medical professionals -
pay attention to the development of methodical
professional competencies in cultural, inclusive prism
and
scientific
research.
As
consequence
of
globalization and technological progress, innovative
strategies based on digital transformation of medical
education are widely implemented in the world. The
integration of the educational process supported,
improving individualized trajectories of need-based
Research Article
THE CLINICO-CLASSIFICATION OF IMMUNOLOGIC ASPECTS OF
JUVENILE RHEUMATOID DISEASES IN TEACHING STUDENTS
CLINICAL SCIENCES IN MEDICAL EDUCATION
Submission Date:
October 12, 2024,
Accepted Date:
October 17, 2024,
Published Date:
October 22, 2024
Crossref doi:
https://doi.org/10.37547/pedagogics-crjp-05-10-16
Normatov Jasur Javli ugli
Associate Professor of Tashkent International University of Chemistry, Uzbekistan
Journal
Website:
https://masterjournals.
com/index.php/crjp
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 05 Issue 10-2024
94
CURRENT RESEARCH JOURNAL OF PEDAGOGICS
(ISSN
–
2767-3278)
VOLUME
05
ISSUE
10
Pages:
93-98
OCLC
–
1242041055
Publisher:
Master Journals
medical education, providing infrastructural and
technological resources that serve to develop the
universal competencies, creative and critical thinking
skills necessary for the training and performance of
future pediatricians. This, in turn, allows for effective
work on the practical use of medical-methodological
opportunities for the implementation of collaborative
and learning models of clinical sciences.
Further improvement of educational services in
medical education, expansion of opportunities for
quality education, training of highly qualified personnel
in accordance with the needs of medical organizations,
introduction of dual education model based on
practice and medical education. To this regard, the
priority of higher medical education is to determine the
task of increasing the academic and innovative
potential of universities. Fundamental development of
the medical sphere in our country in 2020-2030,
introduction of international standards in the field of
medicine, improvement of the processes of personnel
training and professional development in the field of
medicine through the introduction of credit-modular
system, introduction of positive international
experience. Effective work carried out in the field of
medical education, science, practice and innovation.
METHODOLOGY
In 2018, Ashurova D.T., Tursunova O.A., Akhrarova
N.A., Mambetkarimov G.A. published the textbook
“Propedeutics of pediatric
diseases”, in 2012. Daminov
A., Khalmatova B.T., Boboeva “Children's diseases”, in
2014. Akhmedova D.I., Shamansurova E.A. G.G.
Makhkamova, N.G. Ishniyazova. The publication of the
doctor's textbook “Nutrition of infants and young
children” is important.
In 2010, foreign scientists published a textbook
Lezhnina I.V., Podlevskikh T.S., Tokarev A.N. “Clinical
and functional features of the newborn”, in 2011 the
textbook “Propedeutics of pediatric diseases” V.A.
Kelsev, in 2006 “Propedeutics of pediatric di
seases
with care” children” was created by the textbook T.V.
Kapitan ‘Propedeutics of pediatric diseases’ Mazurin
A.V., Voronsov I.M. in 2009. Important for medical
universities is the creation of the textbook
“Propedeutics of pediatric diseases” Geppe
N.A.,
Podchernyaeva N.S. in 2008.
Immunologic aspects. The pathologic process that
develops in patients with JRA has two stages. The
development and manifestation of the exudative
phase based on the disruption of microcirculation and
damage to the cells of the synovial membrane. It
contributes to an increase in the permeability of cell
membranes and increases the penetration of plasma
proteins and a number of cellular elements into the
joint. As consequence of this remodeling, chronic
inflammation (second stage) develops, manifested by
mononuclear infiltration in the structures of the
synovial membrane of joints and cartilage. The
inflammatory process characteristic of JRA lasts for
many years and has the character of autoimmune
inflammation. When studying the etiology of JRA, it
was indicated that polymorphism of 4 KLA haplotypes
lies behind the clinical diversity of forms, which is
probably associated with immune “defects” in the
div of a child with a predisposition to the disease
phenotype. All forms of JRA united by the fact that the
main target organ is the structures of the joint
apparatus, primarily the synovial membrane.
The main properties of autoantibodies are cross-
reactions
and
formation
of
antigen-antidiv
complexes in the bloodstream. Antigen-antidiv
reactions accompanied by activation of complement
system proteins, which manifested by a decrease in its
titer in the synovial membrane, an increase in vascular
permeability, release of hydrolytic enzymes, active
oxygen
radicals,
acid
metabolites
(supplier).
Volume 05 Issue 10-2024
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Publisher:
Master Journals
Prostaglandins). Immunoglobulins and rheumatoid
factor (RF) molecules gradually accumulate and
accumulate in the superficial layers of articular
cartilage, which promotes proliferation processes and
the formation of panes in the synovial membrane.
According to the systemic (articular-visceral) form,
clinical manifestations and morphology, classical JRA
referred to systemic vasculitis. It flows with the
phenomena of polyserositis and organ damage. In
patients with JRA, peculiarities detected practically at
all stages of the immune response of the organism.
They depend on the form and shape of the disease. In
general, the leading role of immunopathology
mechanisms in the pathogenesis of JRA considered
proven.
The particular interest is the presence of proteins of
the acute phase of inflammation, in particular SRB. It
considered an early manifestation of JRA and together
with high levels of IL-6 and a number of liposomal
enzymes considered be prognostic factor (marker) of
the progressive course and early development of the
disease. Systemic osteoporosis. A special role in the
diagnosis of JRA assigned to the determination of RF in
serum and synovial fluid of patients.
Changes in cellular immunity are often subtle and often
misdirected. It is often difficult to assess the nature of
cellular immune responses in children with JRA. It is not
always clear whether these changes related to the
activity of the process. In most children with JRA, the
total number of T-cells is low, but in patients with very
active JRA, the level of T-cells may be normal or even
elevated. Against this background, the subpopulation
of activated T-lymphocytes is significantly increased.
This especially manifested in systemic variants of the
disease.
Oligoarticular
variants
of
JRA
are
characterized by a decrease in the level of cytotoxic T
cells and an increase in the number of T-helper cells
(especially type 2), especially in children with articular-
visceral forms of the disease, of particular importance
in the development of JRA is the impairment of the
suppressor function of lymphocytes. Direct evidence
of the involvement of cytotoxic T-cells is the detection
of antibodies affecting these cells in the serum of
patients with high activity of JRA. During remission of
the disease, the functional state of lymphocytes
restored.
Thus, the changes in cellular immunity in patients with
JRA are heterogeneous, reflecting the polymorphism
of the pathogenesis of different forms of the disease.
Systemic forms of JRA characterized by impaired
immune-regulation, which is associated not with a
decrease in suppressive potential, but with activation
of type 2 T-helper function. Perhaps in these cases
there is a genetic determinacy of T-cell defect. It
manifested by their functional incapacity.
Studies in recent years have shown that in children,
especially in systemic forms of JRA, there is a
significant impairment of the migration functions of
effector cells, in particular polymorphonuclear
leukocytes and mononuclear cells. In patients with
JRA, their dysfunction manifested mainly by a decrease
in the activity of leukocyte chemotaxis (migration of
leukocytes to the site of inflammation) and
chemokinesis (migration stimulated by the C5-
component of complement). Primary (genetic) defect
and has a significant impact on the immune-
inflammatory process, immediately focusing on the
time course of the process.
DISCUSSION
Clinic and classification. The clinical picture of JRA
depends on many factors - the age of the child,
heredity, sex, initial state of the immune system, the
conditions of its external environment, the
peculiarities of the psychoemotional state of life, the
attitude to children. Disease of the patient and close
Volume 05 Issue 10-2024
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CURRENT RESEARCH JOURNAL OF PEDAGOGICS
(ISSN
–
2767-3278)
VOLUME
05
ISSUE
10
Pages:
93-98
OCLC
–
1242041055
Publisher:
Master Journals
relatives, timely diagnosis, adequacy of therapy. It
noted that in 80% of cases JRA is a severe chronic
disease with recurrent and progressive course, which
soon or later leads to disability.
The main clinical manifestations of the disease are joint
involvement, specific eye involvement and general
rheumatoid syndrome characterized by fever, typical
rheumatoid rash, polyserositis and internal organ
involvement caused by systemic rheumatoid vasculitis.
Joint syndrome is virtually the earliest symptom of JRA.
Sometimes before arthritis occurs, the child bothered
by arthralgia, and then the picture of synovitis
develops, i.e. inflammatory process in the synovial
membrane. In this connection, it swells (swells),
becomes hyperemic, and secretes more fluid, the
composition of which differs significantly from normal
fluid. The fluid has low viscosity, may be light straw or
turbid yellow in color, cytosis is increased, leukocytes,
neutrophils may predominate, protein and lysosomal
enzymes are reduced. This allows early diagnosis and
adequate treatment.
Clinically, at the stage of acute synovitis, the child
bothered by pain and swelling in the joint, its mobility
is limited, and div temperature usually rises. As the
process continues, there is an overgrowth of microvilli
of the synovial membrane in the form of pannus
(accumulation of granulation tissue). It spreads to the
articular surface and penetrates the B-cartilage,
causing dystrophic and destructive changes in it, which
radiologically
manifested
by
cellularity
and
periarticular osteoporosis. Fibrosis of the capsule and
fibrous adhesions in the joint subsequently develop.
The epiphyses of bone eroded and destroyed. This
process usually increases, and further development of
fibrosis leads to changes in the configuration of the
joint, its mobility and limited because of ankylosis.
JRA characterized by the presence of rheumatoid
nodules. They localized mainly along tendons, joints in
elbow, knee and ankle joints. The nodules are usually
dense, mobile and painful on palpation. They disappear
when the acute process subsides. Involvement in the
process of internal organs in patients with SRA always
indicates a strong immune inflammation, i.e., the
general manifestations of rheumatoid systemic
vasculitis with high clinical and immunologic activity.
The cardiovascular system is often affected. The
clinical picture of myocarditis can usually develop with
a torpid course, but in rare cases leads to the
development of heart failure. Endocardium and
pericardium may be involved in the process, which
requires differential diagnosis of JRA with rheumatism.
The lungs are rarely involved in the process. Most
often, it manifested by pneumonitis and/or pulmonary
pleuritis, which further leads to the formation of
pleural adhesions.
Rheumatoid rashes, macular or maculopapular, not
accompanied by itching, brightness and distribution
related to div temperature and inconstant. It appears
and disappears within a short period, localized mainly
in the joints, groin, lateral surfaces of the div,
buttocks and extremities can be urticarial or even
hemorrhagic. Hyperesthesia of the skin, widespread
lymphadenopathy,
hepatosplenomegaly,
cardiac
involvement such as myopericarditis, lung involvement
in the form of pneumonitis or pleuropneumonitis,
sensation of shortness of breath and ineffective cough
are also characteristic. It is possible to develop serous
peritonitis in the abdomen in a blunt child. In the
systemic form of JRA often develops vasculitis. Palm
and/or plantar capillaritis, local angioedema, most
often on the hands, cyanotic coloration and marbling
of the skin and distal parts of the lower and upper
extremities. Often at the beginning of the disease,
children are bothered by transient arthralgias for a few
Volume 05 Issue 10-2024
97
CURRENT RESEARCH JOURNAL OF PEDAGOGICS
(ISSN
–
2767-3278)
VOLUME
05
ISSUE
10
Pages:
93-98
OCLC
–
1242041055
Publisher:
Master Journals
weeks (or days), then (more accurately) develop stable
synovitis of one or more joints. There may be a single
episode of clinical manifestation of this form without
joint syndrome, which, with adequate therapy, has a
completely reversible course and the child recovers.
RESULT
In addition to the most typical forms of JRA described
above, occurring in about 80% of patients, there are
less specific variants. In a large group of children of
different
ages,
only
mono-oligoarthritis
(not
associated with HLA-B27) is distinguished. Its course is
usually very favorable, after 3-5 years, 50% of children
recover or note very rare relapses without a clear
progression of the process, which requires a revision of
the diagnosis after years. Pathogenetic heterogeneity,
clinical polymorphism of JRA, as well as different
variants of the nature and outcome of the disease led
to the development of a new classification. Its first
version was proposed in 1972; E.I. Brewer, I.C. Bassou,
and I.T. Cassidy. Currently, the Eastern European
working classification JRA is still preferred in clinical
practice
(A.V.
Dolgopolova,
A.A.
Yakovleva,
L.A.Isaeva). Clinical classification of JRA and clinical and
anatomical features of JRA
1. Rheumatoid arthritis, articular-visceral (systemic)
form (with lesions of the reticuloendothelial system,
heart, serous membranes, vessels, eyes, urine, nervous
and Broncho pulmonary systems):
a) In limited visceritis;
b) Still's syndrome;
c) Allergic septic syndrome.
2. Rheumatoid arthritis, predominantly in the articular
form (with or without eye involvement):
a) Polyarthritis;
b) oligoarthritis;
c) monoarthritis.
3. Combined with rheumatoid arthritis:
a) Rheumatism;
b) Immunologic features of diffuse connective tissue
diseases of JRA
RF-test positive (seropositive), RF-test negative
(seronegative).
Disease course: Fast growing, slow growing, without
significant progression. Activity level: high (III degree),
medium (II degree), low (I degree) remission.
Radiologic stage. Stage I: per articular osteoporosis,
effusion into the joint cavity, signs of compression of
per articular tissues. II. Stage, against the background
of the same changes, narrowing of the articular gap,
usurer of one bone III. Stage: widespread
osteoporosis, pronounced bone and cartilage
destruction, dislocations, subluxations, systemic bone
dysplasia. IV. Stage I-III changes and ankylosis.
Functional capabilities of the patient
1. Saved.
2. The condition of the locomotors apparatus is
impaired:
a) The possibility of self-care preserved:
b) Self-care ability is partially lost
c) The possibility of self-care is significantly lost.
3. Damaged, but the condition of the eyes or internal
organs.
Symptoms of the development of JRA. Involvement of
new participants in the process. Transition to a new
radiologic stage of arthritis. Progressive functional
disorders of the musculoskeletal system. Rapidly
progressive course characterized by the presence of
the above-described dynamics of the process in the
first year of the disease. If these symptoms are present
Volume 05 Issue 10-2024
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CURRENT RESEARCH JOURNAL OF PEDAGOGICS
(ISSN
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2767-3278)
VOLUME
05
ISSUE
10
Pages:
93-98
OCLC
–
1242041055
Publisher:
Master Journals
for 1.5-3 years from the onset of the disease, the course
called gradually progressive. If the patient has no
arthritis symptoms for 3 years, the course considered
slightly progressive.
CONCLUSION
In general, JRA is an autoimmune disease, classically
described as a pathologic condition that develops
when the regulation of physiologic immune processes
is disturbed, resulting in cellular and humoral immune
reactions against components of one's own tissues,
causes structural and functional abnormalities in target
organs. An important feature of JRA as an autoimmune
disease is the increased production of autoantibodies
directed against antigens present on self-labels, within
cells or in extracellular spaces of the human div.
Autoantibodies can react with a wide range of
molecules - components of the cytoplasm, nucleus, cell
membranes, serum proteins, hormones, enzymes,
HLA, nucleic acids, phospholipids, steroids, etc.
REFERENCES
1.
Mirziyoyev Sh.M. Critical analysis, strict order,
discipline and personal responsibility should be the
daily rules of every leader's activity, 2017, 104
pages, Creative House of the Agency of Press and
Information of Uzbekistan - Publishing House of
Uzbekistan.
2.
Mirziyoyev Sh.M. We will build our great future
together with our brave and noble people, 2017,
488 pages, Creative House of the Agency of Press
and Information of Uzbekistan - Publishing House
of Uzbekistan.
3.
Mirziyoyev S.M. Together we will build a free and
prosperous, democratic country Uzbekistan. 2016
56 pages, Creative House of the Press and
Information Agency of Uzbekistan - Uzbekistan
Publishing House.
4.
Ashurova D.T., Tursunova O.A., Akhrarova N.A.,
Mambetkarimov G.A. Propedeutics of pediatric
diseases. Stone PTI. Textbook.T: 2018.
5.
Clinical and functional features of newborns: a
textbook for students of medical universities /
comp: Lezhnina I. V., Podlevskikh T. S., Tokarev A.
N. - Kirov: Kirov State Medical Academy, 2010. - 82
с.
6.
Propaedeutics of pediatric diseases: a textbook for
students of pediatric faculties of medical
universities / V.A. Kelsev - Rostov n/D: Phoenix,
2011. -
573 с.
7.
Propaedeutics of pediatric diseases with childcare
/ T. V. Captain - 3rd edition, supplement. - M.:
MEDpress-Inform, 2006. -
704 с. 8.
8.
http://www.pediatr-russia.ru
9.
http://med-study.ru
10.
http://www.pediatrics-nmo.com
11.
http://medline.ru
12.
http://www.medicalstud.ru/med-ge
