child develops a severe type of
juvenile idiopathic arthritis (JIA), your child's
treatment team will initiate treatments for more aggressive disease.
Physical therapy will be an important part of
treatment if your child is experiencing severe JIA. Regular physical exercise
will help maintain joint range and muscle strength and prevent
contractures. If your child is 4 years old or younger,
an adult will need to move the child's joints through the
range-of-motion exercises. Range-of-motion exercises
may be painful during a flare-up of arthritis, so it is very important to be
physical therapist can help set up an exercise program
for your child, either for the child to do alone or to do with help from an
adult. Exercises should be done every day and periodically reviewed by the
physical therapist.6 The therapist will be sure the
exercises are being done correctly and decide whether any exercises should be
added, dropped, or changed.
Occupational therapy will also be important. Working with an occupational therapist, a child learns to be as independent as possible, and find ways to play and participate in school activities.
methotrexate with other medicines such as sulfasalazine, hydroxychloroquine, or
etanercept-may be used to treat children with severe JIA.
Biologic therapy (also called biological therapy) is a new option for treating JIA, particularly
polyarticular JIA, that does not respond to other
treatments. The biologic agent
etanercept has had some success in relieving symptoms and decreasing the number
of flare-ups. Other biologics, such as infliximab, are also used.
Surgery may be used in a very small number of
children with JIA who have severe joint deformity, loss of movement, or pain.
Inflammatory eye disease can develop as a complication
in children with JIA. Regular eye examinations with an
ophthalmologist need to be included in your child's
treatment plan. Most children who develop eye disease are treated with
corticosteroids and prescription eyedrops called mydriatics. More severe or
continuing eye disease may require other medicines such as methotrexate. If eye
disease does not respond to these treatments either, cyclosporine or biologics such as etanercept may help.6
What To Think About
Some children with JIA suffer a
loss of appetite severe enough that malnutrition becomes a medical concern. If
your child has little appetite for food, consult a nutritionist for help with
your child's basic nutritional needs.
Very few children with JIA have joint damage that
requires surgery. If at all possible, joint reconstruction is delayed until
childhood bone growth is complete (about 18 years of age).