Speakers - 2026

Title: Clinical, instrumental, and neurological aspects of complications of juvenile rheumatoid arthritis in children

Abstract

Clinically, neurological complications of JRA manifest as headaches, asthenic syndrome, cognitive and psychoemotional disturbances, autonomic dysfunction, sleep disorders, and peripheral neuropathies. These symptoms often correlate with disease activity, duration, systemic inflammatory burden, and chronic pain syndrome. In systemic and polyarticular forms, neurological manifestations tend to be more pronounced due to persistent immune-mediated inflammation and vascular involvement.

Study objective: to investigate the diagnostic indicators of neurological complications in individuals with YRA.

Materials and Methods. A study was conducted at Tashkent State Medical University the clinic's cardiolummatological department involving 45 children aged 4-18 years with a confirmed diagnosis of juvenile rheumatoid arthritis (YRA). Neurological impairments were identified in 38 (84%) of these children. The observed neurological manifestations included headaches (9 children, 24%), distal limb paresthesia and numbness (7 children, 18%), cramps/hyperkinesis (4 children, 11%), and vertigo (2 children, 5%). Behavioral and emotional changes were also present, with 5 children (13%) displaying reduced mood stability (including emotional lability and whimpering in younger children) and 3 (8%) experiencing social disorientation (difficulty with friendships and peer/teacher relationships). Furthermore, 5 children (13%) reported excessive sweating, and 3 (8%) suffered from night terrors.

Outcomes. YRA patients underwent ENMG (10 patients, 25%). Most (60%) showed ENMG changes, characterized by a 30% reduction in median and radial nerve tests and a 10% reduction in ulnar nerve tests. This was due to distal stimulation causing partial conduction block, not altered M-response amplitude. EEG was performed on 30 YRA patients (75%). Diffuse changes were prevalent (90%) in YRA treatment. Of 10 patients with epileptic seizures, only 12.5% (5 patients) had detectable spontaneous epileptic activity on EEG. One patient had focal changes alongside diffuse bioelectrical brain activity alterations. The rest exhibited only diffuse changes between seizures.

Conclusions. Neurological sequelae are present in 48.9% of individuals with juvenile rheumatoid arthritis. Within this group, headache (37.5%), sensory deficits (17.5%), and muscle spasms (15%) are the predominant clinical features. For systemic lupus erythematosus, a different pattern emerges, with cognitive dysfunction affecting over half of patients (51%), followed by headaches (40%), convulsions (33%), social integration difficulties (20%), and sensory perception alterations (6.7%).