Juvenile Rheumatoid Arthritis: Treatments

National Institute of Arthritis and Musculoskeletal and Skin Diseases

What Causes Juvenile Rheumatoid Arthritis?

JRA is an autoimmune disorder, which means that the body mistakenly identifies some of its own cells and tissues as foreign. The immune system, which normally helps to fight off harmful, foreign substances such as bacteria or viruses, begins to attack healthy cells and tissues. The result is inflammation-marked by redness, heat, pain, and swelling. Doctors do not know why the immune system goes awry in children who develop JRA. Scientists suspect that it is a two-step process. First something in a child's genetic makeup gives them a tendency to develop JRA; and then an environmental factor, such as a virus, triggers the development of JRA.

Who Treats Juvenile Rheumatoid Arthritis? What Are the Treatments?

A pediatrician, family physician, or other primary care doctor frequently manages the treatment of a child with JRA, often with the help of other doctors. Depending on the patient's and parents' wishes and the severity of the disease, the team of doctors may include pediatric rheumatologists (doctors specializing in childhood arthritis), ophthalmologists (eye doctors), orthopaedic surgeons (bone specialists), and physiatrists (rehabilitation specialists), as well as physical and occupational therapists.

The main goals of treatment are to preserve a high level of physical and social functioning and maintain a good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling; maintain full movement in the affected joints; relieve pain; and identify, treat, and prevent complications. Most children with JRA need medication and physical therapy to reach these goals.

If the doctor prefers not to use aspirin, other NSAIDs are available. For example, in addition to those mentioned above, diclofenac and tolmetin are available with a doctor's prescription. Studies show that these medications are as effective as aspirin with fewer side effects. An upset stomach is the most common complaint. Any side effects should be reported to the doctor, who may change the type or amount of medication.

Corticosteroids

In children with very severe JRA, stronger medicines may be needed to stop serious symptoms such as inflammation of the sac around the heart (pericarditis). Corticosteroids like prednisone may be added to the treatment plan to control severe symptoms. This medication can be given either intravenously (directly into the vein) or by mouth. Corticosteroids can interfere with a child's normal growth and can cause other side effects, such as a round face, weakened bones, and increased susceptibility to infections. Once the medication controls severe symptoms, the doctor may reduce the dose gradually and eventually stop it completely. Because it can be dangerous to stop taking corticosteroids suddenly, it is important that the patient carefully follow the doctor's instructions about how to take or reduce the dose.

Disease-Modifying Anti-Rheumatic Drugs (DMARDs)

If NSAIDs do not relieve symptoms of JRA, the doctor is likely to prescribe this type of medication. DMARDs slow the progression of JRA, but because they take weeks or months to relieve symptoms, they often are taken with an NSAID. Various types of DMARDs are available. In the past, doctors prescribed hydroxychloroquine, oral and injectable gold, sulfasalazine, and d-penicillamine; however, doctors are now much more likely to use methotrexate for children with JRA.

Methotrexate

Researchers have learned that this type of DMARD is safe and effective for some children with rheumatoid arthritis whose symptoms are not relieved by other medications. Because only small doses of methotrexate are needed to relieve arthritis symptoms, potentially dangerous side effects rarely occur. The most serious complication is liver damage, but it can be avoided with regular blood screening tests and doctor followup. Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose and eliminate side effects.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen or naproxen sodium (Naprosyn, Aleve) are examples of NSAIDs. They often are the first type of medication used. Most doctors do not treat children with aspirin because of the possibility that it will cause bleeding problems, stomach upset, liver problems, or Reye's syndrome. But for some children, aspirin in the correct dose (measured by blood test) can control JRA symptoms effectively with few serious side effects.

Several Types Of Medication Are Available To Treat JRA:*

*Brand names included in this fact sheet are provided as examples only, and their inclusion does not mean that these products are endorsed by the National Institutes of Health or any other Government agency. Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

Exercise

In addition to medications, physical therapy is an important part of a child's treatment plan. Exercise can help to maintain muscle tone and preserve and recover the range of motion of the joints. A physical therapist can design an appropriate exercise program for a person with JRA. The physical therapist also may recommend using splints and other devices to keep joints growing evenly.

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