SOVREMENNAYA PEDIATRIYA.2019.2(98):76-84; doi 10.15574/SP.2019.98.76

Berezhniy V. V., Bondarets Yu. I.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine

Objective: to investigate the state of the colon microbiota in patients with juvenile rheumatoid arthritis (JRA) against the background of treatment with basic, biological disease+modifying drugs and to evaluate the effectiveness of the combined synbiotic preparation (Rotabiotic) with the revealed violations.

Materials and methods. In total of 29 children aged 1.5 to 16 years old were diagnosed with juvenile rheumatoid arthritis. A general clinical, instrumental examination was performed in accordance with a unified clinical protocol of medical care for children suffering from juvenile rheumatoid arthritis (Ministry of Health Order No. 832 of October 22, 2012). In addition, all children underwent bacteriological examination of feces before and after the identified violations of the intestinal microbiota.

Results. When examining the gastrointestinal tract in patients with rheumatoid arthritis, there were complaints: intermittent abdominal pain in 23 (79.31%), loss of appetite — in 20 (68.97%), flatulence — in 12 (41.38%) , tendency to constipation — in 10 (34.48%) children. A violation of the microbiocenosis was found in 23 patients by reducing lactic and bifidobacteria of <10⁶ CFU, as well as increasing the number of conditionally pathogenic and pathogenic microoganisms: Candida fungi in 5 (21.74%), staphylococci (hemolytic, plasma-coagulating) in 5 (21.74%), Klebsiella pneumoniae in 3 (14.04%), Enterococcus faecium in 2 (8.70%), E. coli with altered enzymatic properties in 2 (8.70%) and Proteus mirabilis in 1 (4.35%) of the patient. I degree dysbiosis was diagnosed in 8 (34.78%), stage II — in 9 (39.13%), stage III — in 6 (26.09%) patients. After correction with a multicomponent synbiotic complex (rotabiotic), colon microflora normalization was observed in 16 (69.57%) children (p<0.001). Dysbiotic changes in I st were preserved in 7 children (30.43%), who were diagnosed with dysbiosis II–III at the beginning of the study.

Conclusions. In patients with juvenile rheumatoid arthritis, on the background of treatment with basic antirheumatic drugs, non-steroidal anti-inflammatory drugs and biological antirheumatic drugs, a violation of the microbiota of the large intestine with the development of dysbiosis of various degrees has been established, which complicates the course of the underlying disease and worsens the quality of life. The use of a multicomponent synbiotic drug (rotabiotics) in the complex treatment of patients with JRA is an effective means of correcting disorders of the colon microbiocenosis.

Key words: children, juvenile rheumatoid arthritis, colon microbiocenosis, dysbiosis, synbiotic drug.

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Article received: Nov 21, 2018. Accepted for publication: Feb 24, 2019.