Juvenile arthritis, a condition that begins before the age of 16, results from the immune system mistakenly attacking healthy body tissue and causing inflammation. This can lead to a range of symptoms, including swelling and pain in the joints.
There is no cure for juvenile arthritis, however, treatments are available that can control symptoms to help maintain an active and normal lifestyle. With current treatments, it is also possible to achieve remission (where the underlying cause is present, but the symptoms are not), especially if the disease is diagnosed and treated early.
Medication
Currently available medications focus on reducing pain, inflammation, and potential long-term joint damage. More than one type of medication may be prescribed to an individual to effectively treat the disease. This can include painkillers, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biologics, and corticosteroids.
Painkillers (analgesics)
Painkillers can be used to control the pain caused by arthritis. Mild painkillers, such as paracetamol, do not require a prescription. Depending on the severity of the disease, however, a doctor may prescribe a stronger painkiller, such as morphine. For chronic long-term pain, an antidepressant, such as a low dose of amitriptyline, may also be prescribed. Always check with a doctor before taking a painkiller alongside another type of medication.
Non-steroidal anti-inflammatory drugs (NSAIDs)
NSAIDs decrease pain and have an anti-inflammatory effect when given in high doses. They reduce the levels of hormones involved in the inflammation response. NSAIDs are generally given in combination with a more potent and long-acting anti-inflammatory. Examples include ibuprofen and naproxen.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs are effective in reducing inflammation and preventing joint damage, as they can slow the progression of the disease. DMARDs are generally slow-acting but can have an effect over a long period of time once they start working. Examples include methotrexate, Arava (leflunomide) and Azulfidine (sulfasalazine).
Biologics
Biologics (or biological therapies) are a subset of DMARDs. These therapies are a more recent development, and tend to show an effect faster than conventional DMARDs. Biologics are drugs that are generally designed to have a specific target, and in juvenile arthritis these targets often the immune system and causes of inflammation.
A common biologic target in juvenile arthritis is a protein called tumor necrosis factor (TNF). This protein is involved in the inflammation response in joints. “Anti-TNF” drugs such as Enbrel (etanercept), Remicade (infliximab) and Humira (adalimumab) act to block or reduce TNF, reducing inflammation and preventing joint damage.
Other biologics such as Orencia (abatacept), Rituxin (rituximab), Kineret (anakinra), Ilaris (canakinumab), and Actemra (tocilizumab) are designed to supress different aspects of the immune system.
As biologics tend to alter the immune system, they can carry an increased risk of infections and, rarely, some types of cancer.
Corticosteroids
Corticosteroids are potent anti-inflammatory agents, but are less effective in preventing joint damage compared to other treatments. They are not used long-term to treat juvenile arthritis as they may have damaging side effects, and can affect growth in children. They may be used for a short period of time while waiting for a DMARD therapy to take effect or if there is a risk of severe complications such as pericarditis, or the swelling of the thin membrane surrounding the heart. Examples include prednisone.
Equipment and aids
An occupational therapist may recommend various aids that can help relieve pain or correct a deformity in children with juvenile arthritis. These include custom-made splints that can keep joints in the correct position and provide support.
Physical therapy
Regular exercise can help to maintain a good range of motion and muscle strength in children with juvenile arthritis. A physical therapist can advise on the best program for the child to keep joints flexible and maintain a healthy level of fitness.
Surgery
Surgery is generally only recommended in cases of severe arthritis, when other treatments do not help. With available therapies improving, the need for surgery is rare but it may be suggested to correct leg length discrepancies, and to straighten or replace a bent, deformed, or badly damaged joint.
Note: Juvenile Arthritis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.