Treatment for Juvenile Rheumatoid Arthritis (JRA)
What Is the Treatment for Juvenile Rheumatoid Arthritis? continued...
The goals of treatment for JRA are to preserve a high level of physical and social functioning and maintain a good quality of life. The doctor will recommend treatment to reduce swelling, maintain full movement in the affected joints, relieve pain, and identify, treat, and prevent complications. Most children with JRA need medication and physical therapy to reach these goals.
Medications for JRA
Several types of medications are available to treat JRA. They include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs), including Advil (ibuprofen), and Aleve (naproxen), and other prescription drugs. NSAIDs are often the first type of medication used. Most doctors don't treat children with aspirin because of the possibility that it will cause bleeding problems, stomach upset, liver problems, or Reye's syndrome. But for some children, aspirin in the correct dose, measured by blood tests, can control JRA symptoms effectively with few serious side effects.
- Disease-modifying anti-rheumatic drugs (DMARDs) are often used if NSAIDs don't provide sufficient relief. DMARDs slow the progression of JRA, but because they take weeks or months to relieve symptoms, they often are taken with an NSAID. Methotrexate is usually the main DMARD used for JRA.
- Corticosteroids, such as prednisone, may be used in children with severe JRA. These drugs can help stop serious symptoms such as inflammation of the lining around the heart (pericarditis). Steroids for JRA can be given either directly into the vein, into joints, or by mouth. Steroids can interfere with a child's normal growth and can cause other side effects, such as a round face, weight gain, weakened bones, and increased susceptibility to infections.
- Biologic agents such as Enbrel may be given to children if other drugs don't work. Enbrel blocks the action of tumor necrosis factor (TNF), a naturally occurring protein in the body that causes inflammation. Enbrel is given as a shot that is taken at home. The FDA has approved another biologic, Orencia. The drug is given intravenously or by an injection and, like Enbrel, Orencia can be used alone or with methotrexate.
Physical Therapy for JRA
Physical therapy for JRA is a critical part of a child's treatment plan. It can help maintain muscle strength and preserve and recover the range of motion of the joints. A physiatrist (rehabilitation specialist) or a physical therapist can design an appropriate exercise program for a child with JRA. The specialist also may recommend using splints and other devices to help maintain normal bone and joint growth.