Juvenile Rheumatoid Arthritis

Drug Type/Name(s) Dosage Possible Side Effects Cautions
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
(ibuprofen, naproxen, tolmentin, aspirin, choline magnesium, trisalicylate, indomethacin)		 Taken one to four times per day in pill or liquid form. Must be taken three to four weeks to determine if helping to control pain and inflammation.  Possible side effects include occassional stomach pains, nausea and vomiting, anemia, headache, blood in the urine, fluid retention, thinning and scarring of the skin (especially with naproxen), difficulty concentrating, stomach ulcer.

Aspirin
Possible side effects include pains or stomach bleeding. Toxic reactions can occur from too high a dose built up in your child's system (rapid or deep breathing, ringing in the ears, decrease in hearing, drowsiness, nausea, vomiting, irritability, unusual behavior and black stools). A rare complication called Reye's syndrome can occur in children who have the chicken pox or the flu and are taking aspirin.

 Young children should not suck or chew on aspirin as this may damage the chewing surfaces of the teeth and irritate the gums. Instead, try crushing the dose and having the child swallow it in a small amount of a favorite food such as applesauce or yogurt.

The different NSAIDs should never be combined without doctor's instructions.

 
Disease-Modifying Anti-Inflammatory Drugs(DMARDS) 
(hydroxychloroquine,  sulfasalazine, penicillamine, gold compounds) 		Hydroxychloroquine
(Plaquenil)
Given in pill form. May take 3 to 6 months to work. 

Sulfasalazine
(Azulfadine)
Given in pill form. Takes 6-12 weeks to work.

Gold Compounds
(Auranofin, Ridaura, Myochrysine, Solganol)
Oral form taken daily. Injections usually given weekly for 5 or 6 months, then once or twice a month for as long as necessary. Take 3 to 6 months to work. 

Penicillamina
(DePen, Cuprimine)
Given in pill form. Takes up to 6 months to work. 

 Hydroxychloroquine
(Plaquenil)
Side effects may include upset stomach, skin rash. Rare complication, eye damage. 

Sulfasalazine
(Azulfadine)
Side effects may include stomach uoset, achiness, diarrhea, dizziness, headache, light sensitivity, itching, appetite loss, liver abnormalities, lowered blood count, nausea, vomiting or rash.

Gold Compounds
(Auranofin, Ridaura, Myochrysine, Solganol)
Side effects may include skin rash, mouth sores, kidney problems, a low blood count, anemia. 

Penicillamina
(DePen, Cuprimine)
Side effects may include diarrhea, skin rash, hives or itching, low blood counts, mouth sores, nausea or vomiting, stomach pain, loss of taste or appetite, swollen glands, unusual bleeding or bruising, weakness. 

 Hydroxychloroquine
(Plaquenil)
Child should have his/her eyes checked every six months by an opthalmologist familiar with this medication. 

Sulfasalazine
(Azulfadine)
Can sometimes have more side effects in children with systemic onset JRA.
Immune System Medications 
(methotrexate, azathioprine, cyclophosphamide, cyclosporine, leflunomide)

Methotrexate
(Rheumatrex)
Given weekly either orally in pill or liquid form or by injection. Takes 4-8 weeks to work.

Azathioprine
(Imuran)
Given in pill form. Takes about 3 months to work. 

Cyclophosphamide
(Cytoxan)
Given daily in pill form or in a single dose intravenously, usually once a month. 

Cyclosporine
(Sandimmune) 
Given in liquid or pill form. Blood levels often checked to determine best dosage. May take one to two months to work. 

Leflunomide
(Arava) 
Given once a day as a tablet. It may take 6-12 weeks to be effective.

Methotrexate
(Rheumatrex)
Side effects may include nausea, mouth sores, moodiness, diarrhea, low white blood cell count, lung irritation, infections and liver irritation.

Azathioprine
(Imuran)
Side effects may include cough, fever and chills, loss of appetite, nausea or vomiting, skin rash, unusual bleeding or bruising, unusual tiredness or weakness, possibly sterility. 

Cyclophosphamide
(Cytoxan)
Side effects may include blood in the urine or burning on urination, confusion or agitation, cough, dizziness, fever and chills, infertility, loss of appetite, nausea or vomiting, unusual bleeding or bruising, unusaul tiredness or weakness, increased risk of cancer. 

Cyclosporine
(Sandimmune) 
Side effects may include bleeding, tender or enlarged gums, fluid retention, high blood pressure, increased hair growth, kidney problems, loss of appetite, trembling or shaking of hands. 

Leflunomide
(Arava) 
Side effects may include liver irritation, diarrhea, hair loss, infections, low white blood counts.

 Methotrexate
(Rheumatrex)
Avoid all alcohol intake and smoking while on this medication.
Glucocorticoids
(prednisolone, prednisone, dexamethasone, methylprednisolone, cortef)		 If prescribed, the lowest possible dose should be used for the shortest length of time. 

Normally administered orally in pill or liquid form but can also be administered intravenously.

 Possible side effects include high blood presssure, osteoporosis (brittle bones), Cushing's syndrome (weight gain, moon face, thin skin, muscle weakness) cataracts, slowed growth rate, reduced resistance to infection, sudden mood swings, increased appetite and weight gain, increased risk for ulcers.

Many of these side effects only occur when the dose is more than 7.5 to 10 mg a day (dose for an average size adult).

 Glucocorticoids should never be stopped suddenly if they have been taken for more than a month. A schedule to slowly discontinue or taper these medications should be given by your doctor. A child taking glucocorticoids should wear a medical bracelet or necklace. 
Analgesics
(acetominophen, tramadol)		 Should be taken only under a physician's advice in conjunction with other medications.  Acetominophen
(Tylenol, Panadol)
Few side effects when taken in small doses. Very high doses (overdoses) can cause liver damage. 

Tramadol
(Ultram)
S ide effects may include dizziness, nausea, constipation, headache, sleepiness.