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Corticosteroids for juvenile rheumatoid arthritis

Examples

Taken by mouth (pill form, oral)

Generic Name
prednisone
methylprednisolone

Injected

Generic Name
triamcinolone hexacetonide
methylprednisolone

Eyedrops

Generic Name
dexamethasone
fluorometholone
prednisolone

How It Works

Corticosteroids are similar to natural hormone substances produced by the body that help to reduce inflammation.

Why It Is Used

Corticosteroids are often used to treat juvenile rheumatoid arthritis. Corticosteroids that are taken by mouth or injected are most often used to control the initial stages of systemic juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA). Corticosteroids may also be used in children who have pauciarticular (oligoarthritis) or polyarticular disease with severe morning stiffness or night pain.

A short "burst" therapy (initially high doses of oral corticosteroids that are tapered off) may be useful when inflammation around the heart (pericarditis) or fever is present in children with systemic JRA.

Corticosteroids may also be used as "bridge" therapy when starting a stronger second-line medication, such as methotrexate, to control symptoms while the new medication takes effect. After a period of time, the corticosteroid is slowly withdrawn to see whether the other medication is effective.

Injections of corticosteroids may be used to treat specific joints when conservative therapy has controlled symptoms well except in those specific joints.

Corticosteroid eyedrops are used in children who develop inflammatory eye disease.

How Well It Works

Corticosteroids can provide rapid, dramatic improvement in some people with JRA.¹

Oral corticosteroids are often useful:
- For children with systemic JRA who have fever and inflammation of the protective sac around the heart (pericarditis).
- For controlling night pain or morning stiffness in JRA.
- For controlling a flare-up of symptoms in polyarticular JRA.
- While waiting for another drug such as methotrexate or etanercept to take effect. Methotrexate and etanercept are disease-modifying antirheumatic drugs (DMARDs).
Injected corticosteroids usually help when they are injected into the painful joints of children with limited arthritis, especially in children who have not responded to nonsteroidal anti-inflammatory drugs (NSAIDs) or who cannot tolerate NSAIDs.
Intravenous corticosteroids can help manage joint disease, but they are usually used only in children who have life-threatening complications such as pericarditis.
Corticosteroid eyedrops usually act quickly to control a flare-up of eye inflammation.

Side Effects

Side effects of high or long-term corticosteroid doses in children include:

Growth suppression.
Bone thinning (osteoporosis).
Easy bruising.
Moon-face appearance with fluid retention and weight gain (cushingoid appearance, related to Cushing's syndrome).
Mood swings.

Long-term use of corticosteroids causes significant side effects, including a weakened immune system and weakened muscles.

You can help reduce side effects, including growth problems, by giving your child this medication in the morning rather than at night. A low dose at bedtime is sometimes used to treat severe morning stiffness.¹

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

Long-term use of corticosteroids is not advisable due to the significant side effects. Low-dose corticosteroids have fewer side effects and may be appropriate for longer use in difficult cases.

In some cases the dose of corticosteroids that controls symptoms is too high for long-term use. The best dose may be a balance between a higher dose that controls symptoms well but causes significant side effects and a lower dose that doesn't control all symptoms completely but causes fewer side effects.

If your child is given corticosteroid treatment for 2 weeks or more, the medication should be gradually reduced (tapered), rather than abruptly stopped. Although tapering helps the body adjust to the change, some children have a temporary increase in pain when corticosteroid treatment is stopped.

Following a corticosteroid joint injection, your child should use the joint as little as possible for a day or two. A cast or splint may be put on the joint of a young child to protect the joint from excess movement.

Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.

Citations

Giannini EH, Brunner HI (2005). Treatment of juvenile rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1301–1318. Philadelphia: Lippincott Williams and Wilkins.

WebMD Medical Reference from Healthwise

Last Updated: June 30, 2006

This information is not intended to replace the advice of a doctor. Healthwise disclaims any liability for the decisions you make based on this information.

Take Charge of Your RA Treatment

Click to View Medication Guide

Important Safety Information you should know about HUMIRA® (adalimumab).

Serious infections have happened in patients receiving HUMIRA. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria that have spread throughout the body. Some patients have died from these infections.

Before starting HUMIRA:

Tell your doctor if you think you have an infection, are being treated for an infection, have signs of an infection (such as a fever, cough, or flu-like symptoms), have any open sores on your body, have warm, red, or painful skin, get a lot of infections or have infections that keep coming back, have or had hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have lived in an area where TB or histoplasmosis is common, or were born in, lived in or traveled where there is more risk for getting TB. Your doctor should test you for TB before starting HUMIRA. If your doctor prescribes any medicine for the treatment of TB, you should start taking it before starting HUMIRA and take the full course of TB medicine prescribed.

Tell your doctor if you have any numbness or tingling, or have a disease that affects your nervous system such as multiple sclerosis or Guillain-Barré syndrome, have heart failure or other heart conditions, are scheduled for major surgery, are pregnant, become pregnant, plan to become pregnant or are breastfeeding. Tell your doctor if you are allergic to HUMIRA or any of its ingredients or are allergic to rubber or latex. The needle cover of the prefilled syringe and the pen contain dry natural rubber.

Also, tell your doctor if you have recently received or are scheduled for any vaccines. Except for live vaccines, patients may still receive vaccines while on HUMIRA. It is recommended that children with juvenile idiopathic arthritis be brought up to date with all immunizations prior to starting HUMIRA.

After starting HUMIRA:

Call your doctor right away if you get an infection, or any sign of an infection including a fever, feeling very tired, cough, flu-like symptoms, warm, red or painful skin or if you have any open sores on your body. HUMIRA can make you more likely to get infections or make any infection that you may have worse.

Possible side effects of HUMIRA:

Serious side effects, which sometimes lead to death, have happened in patients taking HUMIRA.

- Serious infections. These infections include TB (tuberculosis) and infections caused by viruses, fungi, or bacteria. Your doctor will examine you for TB and perform a test to see if you have TB. If your doctor feels that you are at risk for TB, you may be treated with medicine for TB before you begin treatment with HUMIRA and during treatment with HUMIRA. Even if your TB test is negative your doctor should carefully monitor you for TB infections while you are taking HUMIRA. Patients who had a negative TB skin test before receiving HUMIRA have developed active TB. Tell your doctor if you have any of the following symptoms while taking or after taking HUMIRA: cough, low-grade fever, weight loss, or loss of body fat and muscle.
- Certain types of cancer. There have been cases of certain kinds of cancer in patients taking HUMIRA or other TNF blockers. Patients with RA, especially more serious RA, may have a higher chance for getting a kind of cancer called lymphoma. Some patients receiving HUMIRA have developed types of cancer called non-melanoma skin cancer (basal cell cancer and squamous cell cancer of the skin), which are generally not life threatening if treated. Tell your doctor if you have a bump or open sore that doesn't heal.
- Allergic reactions. Signs of a serious allergic reaction include skin rash, a swollen face, or trouble breathing.
- Hepatitis B virus reactivation in patients that carry the virus in their blood. Tell your doctor if you have any of the following symptoms: feel unwell, poor appetite, fatigue, fever, rash or joint pain.
- Nervous system problems. Signs and symptoms include: numbness or tingling, problems with your vision, weakness in your arms or legs, and dizziness.
- Blood problems. Symptoms include a fever that does not go away, bruising or bleeding very easily, or looking very pale.
- New heart failure or worsening heart failure you already have. Symptoms include shortness of breath or swelling of your ankles or feet, or sudden weight gain.
- Immune reactions including a lupus-like syndrome. Symptoms include chest discomfort or pain that does not go away, shortness of breath, joint pain, or rash on your cheeks or arms that gets worse in the sun.

Call your doctor or get medical care right away if you develop any of the above symptoms. Your treatment with HUMIRA may be stopped.

Common side effects of HUMIRA are: injection site reactions (redness, rash, swelling, itching or bruising), upper respiratory infections (sinus infections), headaches, rash and nausea.

These are not all the side effects with HUMIRA. Ask your doctor or pharmacist for more information.

Information You Should Know About HUMIRA® (adalimumab).

HUMIRA is used to reduce the signs and symptoms of moderate to severe rheumatoidarthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of moderate to severe polyarticular juvenile idiopathic arthritis in children 4 years of age and older. HUMIRA can be used alone or with methotrexate or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of psoriatic arthritis in adults, may prevent further damage to your bones and joints, and may help your ability to perform daily activities. HUMIRA can be used alone or with certain other medicines. HUMIRA is used to reduce the signs and symptoms of ankylosing spondylitis in adults. HUMIRA is used to reduce the signs and symptoms of moderate to severe Crohn's disease in adults who have not responded well to conventional treatments. HUMIRA is also for these adults with moderate to severe Crohn's disease who have lost response or are unable to tolerate infliximab. HUMIRA is used to treat moderate to severe chronic (lasting a long time) plaque psoriasis in adults who are under the ongoing care of a physician, have the condition in many areas of their body and who may benefit from taking injections or pills (systemic therapy) or phototherapy (treatment using ultraviolet light alone or with pills).

HUMIRA is taken by injection.

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