Juvenile Idiopathic Arthritis Treatment

NSAIDS, Corticosteroids, DMARDS, TNF and JAK Inhibitors, Nonoperative and Spine Surgical Care

Written by Stewart G. Eidelson, MD

Although there is currently no cure for Juvenile Idiopathic Arthritis (JIA), many medications and other treatment options are available to control inflammation and symptoms and enhance quality of life. Research continues to gain a deeper understanding of the different types of JIA and to develop newer, more effective treatments.
Medication, physical therapy, and surgery have their place in managing JIA, depending on the type of juvenile idiopathic arthritis your child has and which joints are involved. The goals of treatment strive to increase/maintain range of motion, reduce/control pain, prevent potential complications (and treat if a complication occurs), and help patients to be as physically active and functional as possible. Patients often receive a combination of medical and nonsurgical treatments. Depending on the type, severity and symptoms of JIA, surgery (spine surgery) may be necessary.

Non-steroidal Anti-Inflammatory Drugs (NSAIDs)
An NSAID is often the first line of treatment for juvenile idiopathic arthritis. NSAIDS block prostaglandins, which are chemicals involved in pain and inflammation. Common NSAIDS include aspirin, ibuprofen (Motrin), and naproxen (Naprosyn) or naproxen sodium (Aleve). Because aspirin has a potential to cause bleeding, liver problems, and Reye syndrome, it is not usually recommended for children with JIA. However, if the dosage is well managed, aspirin may be an effective treatment.

Corticosteroids (steroids)
Severe juvenile idiopathic rheumatic may warrant stronger medication to combat inflammation and prevent organ damage. Your child’s doctor may add a corticosteroid to the existing treatment regimen. Common corticosteroids include prednisone, cortisone, methylprednisolone (Medrol), and dexamethasone (Decadron).

Side effects from corticosteroid use may include decreased bone density and increased susceptibility to infections; it can also inhibit growth. The dose is gradually tapered and then stopped (stopping suddenly can be dangerous). It is important to follow the doctor’s instructions carefully. A corticosteroid can also be injected into the affected joint(s) to help provide symptom relief.

Disease-Modifying Antirheumatic Drugs (DMARDs)
If your child’s symptoms are not improved with NSAIDS, the doctor may prescribe a DMARD to slow the progression of juvenile idiopathic arthritis. However, a DMARD may take some time to be effective, so they are often are given along with an NSAID. Several types of DMARDs are available, but methotrexate is among the most commonly prescribed for treatment of JIA. It can cause liver damage, so regular blood tests and monitoring by the doctor are needed to prevent it and other adverse effects.

Biologic Response Modifiers (biologic agents)
If other medications do not provide relief, this newer class of drugs may help. Biologic agents act on areas of the immune system and on the signals and pathways that cause inflammation and joint damage. They are usually used in combination with methotrexate.

Anti-TNF (Tumor Necrosis Factor) drugs, or TNF Inhibitors
Anti-TNF drugs block the action of TNF; a protein that promotes inflammation. TNF inhibitors include adalimumab (Humira) and etanercept (Enbrel).

Non-TNF biologics
These drugs, which work on different components of the immune system, are given injection or infusion. Abatacept (Orencia) is an example.

JAK (Janus Kinase) Inhibitors
This new class of drugs target JAK pathways, which play a role in the body’s immune response. Tofacitinib citrate (Xeljanz) belongs to this drug class and is prescribed to adults with rheumatoid arthritis. Its safety and effectiveness in children is not known. Tofacitinib citrate is given by mouth, as a pill.

Non-surgical Treatment
Different nonsurgical treatments may help ease the symptoms of juvenile idiopathic arthritis and maintain mobility and function.

These therapies do not replace regular medical care. If your child’s doctor considers a therapy to be valuable and not harmful, it may be added to the treatment plan.

Surgery (Spine Surgery)
Surgery isn’t usually necessary for children with juvenile idiopathic arthritis. However, surgery may be recommended if your child has:

Each child’s needs vary according to the type of juvenile idiopathic arthritis, symptoms, and disease activity (eg, flares, remission, progression). There is no single solution for JIA. You, your child, and the doctor are all part of a team working together to arrive at the best treatment plan.

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Surgery for Juvenile Idiopathic Arthritis