Treatment Options for Juvenile Arthritis

By Stephanie Watson | June 17, 2022

Juvenile arthritis (JA) is a term used to refer to various rheumatic diseases in children. What they have in common are that they all cause joint pain, swelling and stiffness, but they affect different joints. Some types also involve the eyes or other organs.

The most common juvenile arthritis is juvenile idiopathic arthritis (JIA), which comes in different forms. Treatment depends on ’which of the five types of JIA your child has:

• Oligoarticular JIA involves only a few joints
• Polyarticular JIA affects five or more joints
• Systemic JIA causes inflammation of the joints and organs like the heart and liver
• Enthesitis-related JIA is in the tendons, ligaments, joints and sometimes the spine
• Temporomandibular (TMJ) JIA affects the jaw

Starting the right treatment early is important to

• Reduce inflammation
• Relieve pain and stiffness
• Prevent joint and organ damage
• Maintain movement in the joint
• Achieve remission, which means there are no signs of inflammation in exams or tests
• Help the child grow and participate in activities like school and sports

Medication is the foundation of treatment, but lifestyle interventions like physical therapy and diet are important, too. Kids may need to see a team of specialists, including a rheumatologist to manage joint pain and an ophthalmologist for eye symptoms.

Work with your child’s medical team to find the treatment approach that fits best.

Medications

Medicines are the most important part of treatment for JIA. Without appropriate medication, the disease progress continues to cause irreversible damage to joints and possibly organs. Your child may take some or all of the following:

• NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) are often the first treatment doctors recommend. Some NSAIDs are available over the counter. Others require a doctor’s prescription. Medicines like ibuprofen (Advil, Motrin) and naproxen (Naprosyn) reduce inflammation and relieve pain and stiffness, but they shouldn’t be used long-term because of possible side effects like gastrointestinal problems and bruising.
• Corticosteroids. Injecting corticosteroids (steroids) directly into the affected joints quickly reduces inflammation and relieves pain. Doctors prescribe steroid pills for children at the lowest dose and for the shortest time possible to control symptoms. Taking oral steroids long term can slow a child’s growth and cause side effects like weight gain, weak bones and an increased risk for infections.
• Disease-modifying antirheumatic drugs (DMARDs). If many joints are involved or steroids and NSAIDs aren’t enough to calm inflammation, the doctor might add or switch your child to a DMARD. These medicines suppress the immune system to slow the progression of JIA and prevent joint damage. Methotrexate (Rheumatrex) is the DMARD most often used to treat JIA.
• Biologics. These newer DMARDs are an option when methotrexate and other treatments haven’t helped enough, or if the disease is very severe. Usually, doctors prescribe a type of biologic called a tumor necrosis factor (TNF) inhibitor. Adalimumab (Humira and its biosimilars), etanercept (Enbrel) and golimumab (Simponi Aria) are examples of anti-TNF drugs. Other options are canakinumab (Ilaris), an interleukin-1 (IL-1) blocker; tocilizumab (Actemra), an IL-6 inhibitor, and abacept (Orencia), which blocks substances or receptors that promote inflammation in other ways. Other biologics are used off-label, meaning they are not FDA-approved for JIA, but clinical experience shows they are effective. Which biologic is prescribed depends on the type of JIA your child has, your doctor's insight and your and your child's preference. 

Medication Monitoring

JIA medicines are strong, and they can cause serious side effects. It’s important for the doctor to monitor your child every few months with blood tests as well as liver and kidney function tests.

Follow the doctor’s instructions closely and report any side effects. Take your child for all recommended follow-up visits to make sure the medicine is working. If not, the doctor might adjust the dose or prescribe a different drug. When JIA is under good control, some kids can go off their medicine.

Living With JIA

Children with JA can go to school, play with their friends, participate in sports and do other activities. Working with a treatment team that includes a physical therapist (PT), occupational therapist (OT), social worker and other professionals can help them manage pain, fatigue and other symptoms.

Get Physical Therapy and Occupational Therapy

Movement is an important part of the treatment for JA. Physical therapy improves range of motion in the joints, strengthens muscles and helps prevent injuries. Occupational therapy teaches kids ways to do daily activities like dressing, schoolwork or playing with less pain. These specialists can also fit kids for splints or braces to prevent joints from tightening.

Balance Exercise and Rest

Walking, swimming, and other low-impact activities strengthen muscles and maintain flexibility without injuring joints. Activity is also good for relieving kids’ pain and improving their sleep and mood.

When your child is tired or their joints are sore and inflamed, encourage them to take a break. Alternating periods of rest with activity prevents overworking or injuring their joints.

Use Heat and Cold

Both heat and cold help joints feel better. A warm shower or heating pad eases tight muscles and loosens stiff joints. A paraffin bath eases stiff hands and feet. And an ice pack wrapped in a towel brings down swelling and relieves pain. Use whichever one feels best to your child, or alternate heat and cold.

Get Support

When you have questions, turn to your child’s treatment team. You can also ask a social worker or therapist for advice. Work with the school to get any special accommodations your child might need, like days off when symptoms flare or extra time to get from one class to another.

Living with a chronic condition can be very stressful. It’s helpful for kids to talk to a mental health provider or join a support group for children with arthritis, like our Connect Groups.

Follow A Healthy Diet

Although there isn’t a specific diet for JA, eating a mix of healthy nutrients will help children’s health overall. A well-balanced diet includes colorful fruits and vegetables, along with lean protein like fish and chicken, whole grains, and low-fat dairy products. Staying away from junk food, like highly processed foods full of sugar and fats, may help control inflammation and prevent extra weight, which can add stress to joints.

Stay Up to Date on Vaccinations

Vaccinations protect children from illnesses like the flu, measles and rubella. It’s important for all kids to get their recommended vaccines, especially if they take DMARDs or other biologic drugs that suppress their immune system and leave them more vulnerable to infections. However, they should avoid live vaccines such as the nasal spray for flu and the chickenpox and rotavirus vaccines. Those could cause an infection in children who have a weakened immune system.

Surgery

Kids with arthritis rarely need surgery. Treatment with DMARDs should protect their joints enough to avoid it. But when a joint is so damaged that it has become deformed, then surgery might be an option.