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Juvenile Arthritis Treatment:
Treatment for juvenile rheumatoid arthritis focuses on helping your child maintain a normal level of physical and social activity. To accomplish this, doctors may use a combination of strategies to relieve pain and swelling, maintain full movement and strength, and prevent complications.
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. . . Medications
For some children pain relievers may be the only medication needed. Juvenile arthritis treatment for others may require medications designed to limit the progression of the disease. Typical medications used include:
Nonsteroidal anti-inflammatory drugs These medications, such as ibuprofen (Advil, Motrin, others) and naproxen (Aleve, Naprosyn), reduce pain and swelling. Because children can develop side effects such as bleeding and liver and stomach problems, be sure to use these medications under a doctor's supervision.
Celecoxib (Celebrex). This drug is part of a class of NSAIDs known as COX-2 inhibitors, which are believed to be gentler on the stomach. The Food and Drug Administration has approved celecoxib for children age 2 and older with JRA. Celecoxib hasn't been studied in children younger than 2 and in those with the systemic form of the disease.
Side effects may include cough, cold, upper respiratory tract infection, abdominal pain, headache, fever, nausea, diarrhea and vomiting. COX-2 inhibitors have been found to increase the risk of heart problems in adults. Studies are being conducted to determine whether celecoxib increases heart risks in children.
Disease-modifying antirheumatic drugs (DMARDs). Doctors use these medications when NSAIDs alone fail to relieve symptoms of joint pain and swelling. They may be taken in combination with NSAIDs and are used to slow the progress of juvenile rheumatoid arthritis. Commonly used DMARDs for children include methotrexate (Rheumatrex) and sulfasalazine (Azulfidine).
Side effects of methotrexate may include nausea, mouth sores and liver problems. Methotrexate may also lower the number of white blood cells in your blood, leading to an increased risk of infection. Side effects of sulfasalazine may include gastrointestinal problems, such as nausea, vomiting and diarrhea, as well as headache and sore throat.
Tumor necrosis factor blockers These biologic response modifiers block an immune system protein called tumor necrosis factor, which acts as an inflammatory agent in some types of arthritis. By targeting this protein, TNF blockers can help reduce pain, morning stiffness and swollen joints. Two TNF blockers used for treating JRA are etanercept (Enbrel) and infliximab (Remicade).
Some people experience side effects during or shortly after these drugs are injected, including chest pain, dizziness and difficulty breathing, as well as redness, itching and swelling at the injection site. Additional side effects of biologic response modifiers may include abdominal pain, headache, respiratory infections such as tuberculosis, and other infections. These medications may also increase your risk of demyelinating disorders, conditions that damage the protective covering that surrounds nerves in your brain and spinal cord.
Corticosteroids These prescription medications are for children with more severe juvenile rheumatoid arthritis. They're used to control symptoms until a DMARD takes effect or to prevent complications, such as inflammation of the sac around the heart. Corticosteroids, such as prednisone, may be administered by mouth or by injection. But they can interfere with normal growth and increase susceptibility to infection, and generally should be used for the shortest possible duration. Stopping long-term use of corticosteroids suddenly can be dangerous, so it's important to follow a doctor's instructions on usage.
. . . Therapies
Your doctor may recommend that your child work with a physical therapist to help keep joints flexible and maintain range of motion and muscle tone. A physical therapist or an occupational therapist may make additional recommendations regarding the best exercise and protective sports equipment for your child. A therapist may also recommend that your child make use of special supports or splints to help protect joints and keep them in a good functional position.
Juvenile Arthritis Treatment . . . SELF-CARE:
Caregivers can help children learn self-care techniques that help limit the effects of juvenile rheumatoid arthritis. Techniques include:
Getting regular exercise Exercise is important because of Juvenile arthritis treatment because it promotes both muscle strength and joint flexibility. Swimming is an excellent choice because it places minimal stress on joints.
Applying cold or heat Stiffness affects many children with juvenile rheumatoid arthritis, particularly in the morning. Although some children respond well to cold packs, most children prefer a hot pack or a hot bath or shower.
Eating well Some children with arthritis have poor appetites. Others may gain excess weight due to medications or physical inactivity. A well-balanced diet can help maintain an appropriate body weight.
Adequate calcium in the diet is important because children with juvenile rheumatoid arthritis are at risk of developing osteoporosis due to the disease, the use of corticosteroids, and decreased physical activity and weight bearing.
