Treatment for Juvenile Rheumatoid Arthritis (JRA)

Articles On Juvenile Rheumatoid Arthritis (JRA)

This condition is also called “JIA”, or juvenile idiopathic arthritis. (“Idiopathic” means that the cause isn’t known.)

It’s best to work with a pediatric rheumatologist, a doctor who specializes in caring for children with arthritis and other joint problems. If there isn’t one in your area, you can work with your child's pediatrician and a rheumatologist. Physical therapists, rehabilitation specialists called physiatrists, and occupational therapists can also help.

The doctor will recommend a treatment plan to ease 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

Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen, and other prescription drugs, are often the first type of medication used. Most doctors don't treat children with aspirin because it could 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 with few serious side effects.

Disease-modifying anti-rheumatic drugs (DMARDs) are often used if NSAIDs don't provide enough relief. DMARDs may keep JRA from getting worse. But because they take weeks or months to relieve symptoms, they’re often taken with an NSAID. Methotrexate is usually the main DMARD doctors prescribe for JRA.

Corticosteroids, such as prednisone, may help children with severe JRA. These drugs can help stop serious symptoms such as inflammation of the lining around the heart (pericarditis). Doctors can give children these medicines for JRA directly into the vein, into joints, or by mouth. Steroids can hamper a child's normal growth and can cause other side effects, such as a round face, weight gain, weakened bones, and a greater chance of infection.

Biologic drugs, which are genetically engineered, may be used in children if other drugs don't work. Injectables include abatacept (Orencia), adalimumab (Humira), canakinumab (Ilaris), etanercept (Enbrel), and tocilizumab (Actemra). Biologics suppress the overactive immune system, targeting proteins that trigger inflammation.

Physical Therapy

Your child’s JRA treatment should include physical therapy. It helps keep their muscles strong so that their joints can move as well as possible.

A physiatrist or a physical therapist can create an exercise program for your child. The specialist also may recommend using splints and other devices to help maintain normal bone and joint growth.

Alternative Medicine

Some alternative or complementary approaches for JRA, such as acupuncture, may help a child handle some of the stress of living with an ongoing illness. The National Institutes of Health (NIH) considers acupuncture an acceptable additional treatment for arthritis. Studies show it eases pain, may lower the need for painkillers, and can boost flexibility in affected joints. But it doesn’t stop joint damage from getting worse with some forms of JRA.

Let your doctor know if you want to try alternative treatments. Your doctor can check on what’s effective and safe.

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