Juvenile Rheumatoid Arthritis: Treatments
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.
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.
Material provided by the
National Institute of Arthritis and Musculoskeletal and
Skin Diseases
You
may visit their website at www.nih.com
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