Juvenile Rheumatoid Arthritis (cont.)
Medical Treatment for Juvenile Idiopathic Arthritis
The aim of treatment is to stop or slow down the progress of inflammation, thus relieving symptoms, improving function, and preventing joint damage and other complications. Specific objectives are to reduce joint swelling, stiffness, and pain; maintain full range of motion of all joints; and identify and treat complications early, when they can be stopped or reversed. The success of treatment is checked by regular physical examinations and interviews.
Medication is the foundation of treatment in JIA. The medications that work best in
JIA reduce inflammation, which in turn reduces symptoms. Aggressive, early treatment is the best way to stop or slow the disease over the long run as well as prevent permanent joint damage. Various classes of medications used in
JIA are described here.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Nonsteroidal anti-inflammatory drugs (NSAIDs) reduce inflammation, swelling, and pain. They work by blocking an enzyme called cyclo-oxygenase (COX), which promotes inflammation.
- These drugs are used to treat all types of JIA and are usually the first choice of treatment.
- An NSAID alone may be adequate in pauciarticular disease and mild cases of polyarticular disease.
- Children with more severe disease often require a second drug to be added to the NSAID. This is usually a drug from another class, since taking more than one NSAID does not help the disease and may cause severe side effects.
- It usually takes at least four weeks to determine whether treatment with a specific NSAID is going to work.
- Aspirin is no longer a first choice in
JIA because of its side effects. The side effects can be (but rarely are) serious, especially those in the digestive tract and liver.
- A newer generation of these drugs is called the COX-2 inhibitors. These drugs are much less likely than other NSAIDs to cause digestive side effects in adults. The COX-2 inhibitor, celecoxib (Celebrex), is commonly used.
- Predicting which children will respond to a particular NSAID is impossible.
Children who show no improvement after one to two months of treatment may benefit from changing to a different NSAID.
- Common side effects include nausea and vomiting, stomach pain, and anemia. Other side effects depend on the NSAID.
Disease-modifying antirheumatic drugs (DMARDs)
Disease-modifying antirheumatic drugs (DMARDs) are not a single class of drugs. Rather, they are a wide variety of different drugs that act in many different ways. Their main similarity is that they interfere in the immune processes that cause inflammation and
JIA. DMARDs can slow or stop the progression of JIA and thus
prevent joint damage and disability.
Examples of DMARDs include methotrexate (now considered the "gold standard" for those with JIA), sulfasalazine (Azulfidine), azathioprine (Imuran), cyclosporine (Sandimmune, Neoral) and several others. Side effects include immune suppression which may result in an increased risk of infection, lung toxicity, liver function abnormalities, abdominal pain and decrease in appetite.
- DMARDs may be given alone or in combination with other types of drugs. On the other hand, successful DMARD therapy may eliminate the need for other anti-inflammatory or analgesic medications.
- Many, but not all, work by stopping the autoimmune response; they are called "immunosuppressive drugs."
- These drugs do not work for everyone with JIA, but they give substantial relief to many.
- DMARDs may not reach their full effect for several months. It is important that the child keeps taking the medication for at least that long before you decide that it is not working. Until the full action of a DMARD
takes effect, your child's health care professional may prescribe anti-inflammatory or analgesic medications as "bridging therapy" to reduce pain and swelling.
- These drugs have many potential side effects (which vary by drug). Children taking some of these drugs require regular blood tests to check for side effects.
- The immunosuppressive drugs impair the immune system's ability to fight infections. Anyone taking one of these drugs must be very vigilant to watch for early signs of infection, such as fever, cough, or sore throat. Early treatment of infections can prevent more serious problems.
- These drugs have been shown to improve signs and symptoms (as well as quality of life) in most children with
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