Juvenile Idiopathic Arthritis Treatment
There is no cure for JIA but with prompt diagnosis and early aggressive treatment, remission is possible. The goal of treatment is to relieve inflammation, control pain and improve quality of life. With early aggressive treatment, however, remission is possible.
The treatment plan may include medication, exercise, eye care, dental care and proper nutrition. Rarely, surgery may be necessary at later stages to help with pain or joint function.
The initial goals of drug therapy are to reduce inflammation and relieve pain. Long-range objectives are to prevent disease progression and destruction of joints, bones, cartilage and soft tissues such as muscles, tendons and joint capsules. More than one medication may be prescribed to treat a child’s disease. The idea is to hit the disease hard and fast to prevent further joint damage and stop the disease in its tracks as much as possible.
The American College of Rheumatology developed treatment recommendations for doctors who treat children with JIA. It helps doctors determine how to increase therapy quickly if current treatments aren’t effective enough. The recommendations also describe how doctors should monitor the safety and side effects of treatments.
Here are the most common classes of medications the doctor may prescribe:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These medicines include ibuprofen and naproxen and are a mainstay of early therapy for children with JA to ease pain and inflammation; however they do not prevent joint damage. Not all children respond to NSAIDs the same way, so a child’s doctor may try different ones for a child. Laboratory tests help doctors monitor side effects.
- Disease-modifying Antirheumatic Drugs (DMARDs). These are powerful anti-inflammatory medicines. They can prevent joint damage, such as cartilage and bone destruction, but can take a month or more to have an effect. They are often used in combination with other medications, like NSAIDs, corticosteroids or biologics. Children taking DMARDs need regular lab tests to monitor possible side effects. Methotrexate is the most commonly prescribed nonbiologic DMARD in both children and adults with arthritis. It can be taken by mouth or by injection. It has been used for nearly 30 years to treat JIA. Other nonbiologic DMARDs used to treat JIA include sulfasalazine, leflunomide and hydroxychloroquine.
- Biologic response modifiers. Biologics are a subset of DMARDs. They are used to treat a number of autoimmune diseases including JIA. These medications help to correct a faulty response by the immune system that causes arthritis inflammation. Biologics suppress the immune system and can make a child more likely to develop infections. Before a child receives a biologic, the doctor will order a tuberculosis (TB) test because biologics may activate old TB infections. Children taking biologics should not receive live vaccines such as MMR (measles/mumps/rubella) and varicella (chicken pox), which contain weakened yet active virus strains. Biologics that are FDA-approved for use in children include abatacept, adalimumab, canakinumab, etanercept and tocilizumab.
- Corticosteroids. These are strong anti-inflammatory medicines that work quickly compared to NSAIDs. Prednisone is one type. The doctor may prescribe small doses of corticosteroids to help quickly control inflammation while waiting for DMARDs to take effect. Corticosteroids can be given by mouth or by injection. Injections into the joint are preferred when only a few joints are involved or when a single joint is particularly bothersome. Because of the potential side effects, corticosteroids are used at the lowest dose for the shortest length of time as possible. A child’s doctor will help determine if the benefits of treatment outweigh the risks.
Surgery is rarely used to treat JIA early in the course of the disease. However, it can be used to correct leg length discrepancy, straighten a bent or deformed joint or replace a damaged joint.
Eye inflammation (uveitis) can occur in children with JIA, particularly in those with oligoarthritis. It is very important for children with JIA to have their eyes checked by an ophthalmologist at diagnosis and regularly as recommended by their doctor to reduce the chance of vision loss. Uveitis does not necessarily cause symptoms such as pain or red eye. The only way to confirm if uveitis is occurring is by eye examination. Uveitis inflammation can occur even if arthritis flares are under control.
JIA may affect the temporomandibular (jaw) joint, causing pain, stiffness and altered growth. This can make brushing and flossing difficult. A child’s dentist may suggest assistive devices or rinses to help teeth and gums stay healthy. More frequent, shorter dental visits may be necessary for children who are unable to keep their mouths open for long periods during dental work.
Splints and Orthotics
Splints help to keep joints in the correct position and relieve pain. They can be used to correct a deformity (bending in the wrong position). Splints are commonly used for knees, wrists or fingers. Orthotics, or shoe inserts, may help with differences in leg length and balance problems. An occupational or physical therapist can make a custom splint for a child.