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Treatments and drugs
By Mayo Clinic staffTreatment for juvenile rheumatoid arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.
Medications
For some children pain relievers may be the only medication needed. Others may need help from medications designed to limit the progression of the disease. Typical medications used include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), reduce pain and swelling. Because children can develop side effects such as bleeding and liver and stomach problems, be sure to use these medications under a doctor's supervision.
- Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling. They may be taken in combination with NSAIDs and are used to slow the progress of juvenile rheumatoid arthritis. Commonly used DMARDs for children include methotrexate (Rheumatrex) and sulfasalazine (Azulfidine). Side effects may include nausea and liver problems.
- Tumor necrosis factor (TNF) blockers. TNF blockers — such as etanercept (Enbrel) and infliximab (Remicade) — can help reduce pain, morning stiffness and swollen joints. But these types of drugs increase the risk of infections, particularly in the lungs — and even cancers, such as lymphoma.
- Corticosteroids. These prescription medications are for children with more severe juvenile rheumatoid arthritis. They're used to control symptoms until a DMARD takes effect or to prevent complications, such as inflammation of the sac around the heart (pericarditis). Corticosteroids, such as prednisone, may be administered by mouth or by injection. But they can interfere with normal growth and increase susceptibility to infection, and generally should be used for the shortest possible duration. Stopping long-term use of corticosteroids suddenly can be dangerous, so it's important to follow a doctor's instructions on usage.
Therapies
Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone. A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective equipment for your child. A therapist may also recommend that your child make use of special supports or splints to help protect joints and keep them in a good functional position.
Surgery
In very severe cases of juvenile rheumatoid arthritis, surgery may be needed to improve the position of a joint.
- Questions and answers about juvenile arthritis. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Juv_Arthritis/default.asp. Accessed Aug. 27, 2009.
- Miller ML, et al. Juvenile rheumatoid arthritis. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2007. http://www.mdconsult.com/das/book/body/157224368-3/881801128/1608/462.html#4-u1.0-B978-1-4160-2450-7..50156-0_3615. Accessed Aug. 31, 2009.
- Arthritis in children. American College of Rheumatology. http://www.rheumatology.org/public/factsheets/diseases_and_conditions/juvenilearthritis.asp. Accessed Sept. 1, 2009.
- Grom AA, et al. Immunopathogenesis of juvenile rheumatoid arthritis. http://www.uptodate.com/home/index.html. Accessed Aug. 31, 2009.
- Juvenile rheumatoid arthritis: How is it diagnosed? Arthritis Foundation. http://www.arthritis.org/disease-center.php?disease_id=38&df=diagnosed. Accessed Aug. 31, 2009.
- Lehman TJ. Management of polyarticular onset juvenile rheumatoid arthritis. http://www.uptodate.com/home/index.html. Accessed Sept. 1, 2009.
- Juvenile arthritis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=A00075. Accessed Sept. 1, 2009.
- Juvenile rheumatoid arthritis: Treatment options. Arthritis Foundation. http://www.arthritis.org/disease-center.php?disease_id=38&df=treatments. Accessed Sept. 1, 2009.
- JA Alliance. Arthritis Foundation. http://www.arthritis.org/ja-alliance-main.php. Accessed Sept. 1, 2009.
