Treatments and drugsBy Mayo Clinic staff
Treatment 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.
For some children, pain relievers may be the only medication needed. Other children may need help from medications designed to limit the progression of the disease. Typical medications used for juvenile rheumatoid arthritis include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve), reduce pain and swelling. Stronger NSAIDs are available by prescription. Side effects include stomach upset and liver problems.
- 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 (Trexall) and sulfasalazine (Azulfidine). Side effects may include nausea and liver problems.
- Tumor necrosis factor (TNF) blockers. TNF blockers — such as etanercept (Enbrel) and adalimumab (Humira) — can help reduce pain, morning stiffness and swollen joints. But these types of drugs increase the risk of infections. There may also be a mild increase in the chance of getting some cancers, such as lymphoma.
- Immune suppressants. Because juvenile rheumatoid arthritis is caused by an overactive immune system, medications that suppress the immune system can help. Examples include abatacept (Orencia), rituximab (Rituxin), anakinra (Kineret) and tocilizumab (Actemra). Immune suppressants increase the risk of infections and, rarely, some types of cancer.
- Corticosteroids. Medications such as prednisone may be used to control symptoms until a DMARD takes effect or to prevent complications, such as inflammation of the sac around the heart (pericarditis). Corticosteroids may be administered by mouth or by injection directly into a joint. But these drugs can interfere with normal growth and increase susceptibility to infection, so they generally should be used for the shortest possible duration.
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 joint supports or splints to help protect joints and keep them in a good functional position.
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. 24, 2011.
- Wu EY, et al. Juvenile idiopathic arthritis. In: Kliegman RM, et al. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2011. http://www.mdconsult.com/das/book/body/208746819-6/0/1608/0.html. Accessed Aug. 24, 2011.
- Arthritis in children. American College of Rheumatology. http://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/juvenilearthritis.asp. Accessed Aug. 24, 2011.
- Juvenile arthritis. American Academy of Orthopaedic Surgeons. http://orthoinfo.aaos.org/topic.cfm?topic=a00075. Accessed Aug. 25, 2011.
- Mason TG (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 26, 2011.
- Lehman TJ. Polyarticular onset juvenile idiopathic arthritis: Management. http://www.uptodate.com/home/index.html. Accessed Aug. 25, 2011.
- What is life with juvenile arthritis like? Arthritis Foundation. http://www.arthritis.org/life-with-juvenile-arthritis.php. Accessed Aug. 25, 2011.
- Juvenile Arthritis Alliance. Arthritis Foundation. http://www.arthritis.org/juvenile-arthritis-alliance.php. Accessed Aug. 25, 2011.