Drugs and Medications for Juvenile Rheumatoid Arthritis
Most children with JRA need medication and physical therapy to reach these goals.
This article will focus on the possible medications a child with JRA may have to take.
Non-steroidal 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.
If the doctor prefers not to use aspirin, other NSAIDs (non-steroidal anti-inflammatory drugs) are available. For example, 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 important side note: When taking medication, all 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 (see below).
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 follow-up.
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.
Please Note
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.
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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