Juvenile Idiopathic Arthritis Treatment
Treatments are designed to reduce swelling, maintain full movement of the affected joints, relieve pain and prevent and treat complications so patients can participate in normal activites and enjoy a decent quality of life.
Treatments for juvenile idiopathic arthritis (JIA) are designed to reduce swelling, maintain full movement of the affected joints, relieve pain and prevent and treat complications. The condition is usually treated with a combination of medication, exercise and physical therapy.
Medication as a Treatment for JIA
About half of the children with JIA will outgrow the disease permanently without ever needing medication. But there are a variety of medications that can be used when necessary:
- Nonsteroidal anti-inflammatory drugs (NSAIDs).These medications include aspirin, ibuprofen, naproxen, and naproxen sodium. They are often the first type of medication used. NSAIDs block substances called prostaglandins that contribute to inflammation and pain. Some NSAIDs are available over-the-counter, while others, including COX-2 inhibitors, require a prescription. NSAIDs can have significant side effects, such as stomach irritation. They may also affect kidney function, Because of these risks, it is very important to take them exactly as directed. Risks of side effects increase the longer a person takes NSAIDs.
- Disease-modifying antirheumatic drugs (DMARDs).The doctor may prescribe a DMARD such as methotrexate if NSAIDs are not effective in improving a child’s symptoms. DMARDs slow the disease’s progression. Because it may take weeks or even months to provide relief, they are often taken with an NSAID. Note on methotrexate: Children who take it are given regular blood screening tests to make sure they do not develop liver damage or other rare but serious side effects including lung problems and low blood cell counts. Nausea is a troubling problem for many children on methotrexate but that can be treated with another medication. Methotrexate can also be delivered via injection if the oral version is problematic.
- Corticosteroids.These drugs may be given to children with severe JIA to treat symptoms such as inflammation of the sac around the heart, known as pericarditis. Corticosteroids such as prednisone can be given intravenously or by mouth. They can interfere with a child’s growth and cause other side effects including weakened bones, increased susceptibility to infections and a round face. Because of these side effects, the doctor will only use corticosteroids to control severe symptoms, gradually reduce the dose and then stop it completely over time with close monitoring. In some cases, a corticosteroid compound can be injected into an affected joint to bring quick relief, without side effects caused by oral or IV medication.
- Biologic agents.This class of drug is a newer treatment remedy and may be given to children with JIA who have received little relief from other drugs. These drugs block inflammatory proteins. Some can be given at home via an injection just under the skin. Others are intravenous (IV) infusions and need to be delivered on a schedule in a medical facility. Biologic agents for JIA include: etanercept (Enbrel), Infliximab (Remicade), adalibumab (Humira), anakinra (Kineret), abatacept (Orencia), rituximab (Rituxan), and tocilizumab (Actemra). The most common side effect of these drugs is a reaction at the injection site (redness, itchiness, pain and swelling). Rare side effects may include rash; flu-like symptoms; low blood counts; increased risk of infection; and increased risk of malignancies.
Other Types of Treatments
Non-medication options can also be useful in reducing pain, maintaining muscles tone and improving the child's ability to move. They include:
- Physical therapy. Children with JIA benefit from a regular exercise program. Exercise helps maintain muscle tone and the range of motion of the joints. A physical therapist or physiatrist (rehabilitation specialist) can design an appropriate exercise program. Swimming is often recommended for children with JIA, because it uses many joints and muscles without putting weight on the joints. Regular physical activity helps restore flexibility in sore joints and can help improve sleep, reduce anxiety and promote a child’s overall sense of well-being.
- Splints and other devices. The therapist may also recommend using splints and other devices to help maintain normal growth of the joints and bones.
- Restricted activity may be recommended. Most children with JIA can participate in physical activities and some sports when their symptoms are under control. If the child experiences a disease flare, the doctor may encourage limiting certain activities until the flare subsides.
- Complementary and alternative treatments can be effective and often used as an addition to the traditional medical approach. Keep in mind doctors have few guidelines on the safety and effectiveness of such treatments. These include dietary modifications (elimination diets), chiropractic care, relaxation techniques, homeopathy, massage, meditation, acupuncture, and naturopathy.
- Changing the diet. Some parents report their children benefit from eliminating refined sugar and nightshade vegetables (potatoes, tomatoes, peppers and eggplant) from their daily diet.
- Getting enough sleep can help children with JIA better manage their pain and anxiety. Good ways to improve sleep include avoiding late-day caffeine, large meals just before bedtime, as well as television, video games, social media and other mentally stimulating activities at bedtime that interfere with falling and staying asleep.