Most children with
juvenile idiopathic arthritis (JIA) need to take
medicine to reduce inflammation and control pain and to help prevent more
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. Your doctor will try to find medicine that helps relieve symptoms and that has few side effects. This may take some time
One of the hardest things about having RA is that you never know when you may have a flare of symptoms. If you've gone a long time without one, it can come as a shock. During flares, some people feel frustrated and wonder if they did something wrong.
So let's clear the air at the start. No one can predict when and why flares occur. It's not your fault. The best way to keep flares at bay is to take your RA medications consistently. But there are some things you can do to reduce the odds of a flare...
Although treatment varies depending on the needs of each child, certain medicines are often tried first (first-line
medicines), while others are often saved to try later if they are needed
Medicines tried first
Nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is the most often
used NSAID treatment for JIA because of its low
incidence of side effects compared to its effectiveness.3 Ibuprofen may be used instead. But in general, less
than one-third of children will have significant relief from NSAIDs.1 If you see no
improvement after 6 weeks, your doctor may try a different NSAID.
Medicines tried later
Corticosteroids. Injections can be used for children who have
just a few joints affected or who have enthesitis. Steroid medicines by mouth or through an IV are often used for
widespread joint pain or systemic problems such as fever or pericarditis. Steroid medicines work faster than some other drugs, so they may also be used until other medicines start working.
Adult therapies, such as other cytotoxic (cell-destroying)
drugs and intravenous human immunoglobulin. These may be used for rheumatoid
arthritis in adults. But they aren't yet proved to be safe and effective for
children with JIA.
Gold salts were one of the first treatments used for
joint inflammation. You may still hear about them. But injected gold salts
have been replaced by methotrexate for the treatment of JIA. Gold salts taken
by mouth (oral) have not been shown to be effective for JIA.3
Some children with JIA gain significant benefit from early methotrexate
treatment, and this treatment is becoming
more common in an effort to prevent joint and eye damage. Early treatment with
methotrexate is often used for polyarticular JIA.1
Biologic therapy is a newer option to treat
JIA that doesn't respond to other treatments.
Biologics such as etanercept have had some success in relieving symptoms and decreasing the number of flare-ups.
Combination therapy—such as using methotrexate
with sulfasalazine, hydroxychloroquine, or etanercept—has been used on a
limited basis to treat JIA. Most medical experience with combination therapy is
with adults. Only children with severe JIA that has not improved with
methotrexate or sulfasalazine are considered for combination treatment.