Drugs and Medications for Juvenile Rheumatoid Arthritis

For juvenile rheumatoid arthritis (JRA), 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.

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.

Also, if a particular brand name is not mentioned, this does not mean or imply that the product is unsatisfactory.

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