Rheumatoid Arthritis Health Center

Most children with juvenile idiopathic arthritis (JIA) need to take medicine to reduce inflammation and control pain and to help prevent increasing damage to the joints. When inflammation and pain are controlled, a child is more willing and able to do joint exercises to improve joint strength and prevent loss of movement.

Many different medicines are used to treat JIA. No single medicine works for every child. It may take some time to find the right medicine or combination of medicines that best controls your child's symptoms. Treatment is tailored to each child by his or her doctor and parents while considering effectiveness, side effects, cost, and the type and severity of the disease.

Medication Choices

Although treatment varies depending on the needs of the individual child, certain medications are often tried first (first-line medications), while others are often saved to try later if they are needed (second-line medications).

First-line medication. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first medicines tried to control JIA inflammation and symptoms. Naproxen is the most frequently used NSAID treatment for JIA. Doctors choose naproxen based on its low incidence of side effects compared to its effectiveness.⁶Ibuprofen is an effective alternative. But in general, less than one-third of children will have significant relief from NSAIDs.³

Corticosteroids may also be used as a first-line medication, especially as injections, for children who have just a few joints affected or who have enthesitis. Oral or intravenous (IV) corticosteroids are often used for widespread joint pain or systemic problems such as fever or pericarditis. Corticosteroids work faster than some other drugs, so they may also be used until other medicines start working.

Second-line medication. If symptoms are not well-controlled with NSAIDs or corticosteroids, stronger medicines such as methotrexate are often used successfully.⁷ Methotrexate, sulfasalazine, and other second-line medicines are sometimes referred to as disease-modifying antirheumatic drugs (DMARDs). Some experts prefer to call them slow-acting antirheumatic drugs (SAARDs).

Some children with JIA gain significant benefit from early methotrexate treatment. Although there is no definitive way of knowing which children are the best candidates for early methotrexate treatment, this practice is becoming more common in an effort to prevent joint and eye damage. Early treatment with methotrexate is often used for polyarticular JIA.³

Biologic therapy is a newer option to treat JIA that does not respond to other treatments. Biologics such as etanercept have had some success in relieving symptoms and decreasing the number of flare-ups.

Medications used to treat JIA

First-line

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids

Second-line

Corticosteroids

Methotrexate

Biologics such as abatacept (Orencia), adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), and tocilizumab (Actemra)

Other second-line medications used less often

Sulfasalazine

Antimalarials (such as hydroxychloroquine sulfate [Plaquenil])

Adult therapies, such as cytotoxic (cell-destroying) drugs and intravenous human immunoglobulin, that may be used for rheumatoid arthritis in adults but are not yet proved to be safe and effective for children with JIA