Juvenile Idiopathic Arthritis

Most children with juvenile idiopathic arthritis (JIA) need to take medicine to reduce inflammation and control pain and to help prevent more damage to the joints. When inflammation and pain are controlled, a child is more willing and able to do joint exercises to improve joint strength and prevent loss of movement.

Many different medicines are used to treat JIA. No single medicine works for every child. Your doctor will try to find medicine that helps relieve symptoms and that has few side effects. This may take some time

Medicine choices

Although treatment varies depending on the needs of each child, certain medicines are often tried first (first-line medicines), while others are often saved to try later if they are needed (second-line medicines).

Medicines tried first

• Reference Nonsteroidal anti-inflammatory drugs (NSAIDs). Naproxen is the most often used NSAID treatment for JIA because of its low incidence of side effects compared to its effectiveness.^{Reference 3} Ibuprofen may be used instead. But in general, less than one-third of children will have significant relief from NSAIDs.^{Reference 1} If you see no improvement after 6 weeks, your doctor may try a different NSAID.

Medicines tried later

• Reference Corticosteroids. Injections can be used for children who have just a few joints affected or who have Reference enthesitis Opens New Window. Steroid medicines by mouth or through an IV are often used for widespread joint pain or systemic problems such as fever or Reference pericarditis Opens New Window. Steroid medicines work faster than some other drugs, so they may also be used until other medicines start working.
• Reference Disease-modifying antirheumatic drugs (DMARDs). These are also called slow-acting antirheumatic drugs (SAARDs). They include:
  • Reference Methotrexate.
  • Reference Sulfasalazine.
  • Reference Biologics such as adalimumab, etanercept, and infliximab.
• Reference Antimalarials, such as hydroxychloroquine.
• Reference Adult therapies, such as other cytotoxic (cell-destroying) drugs and intravenous human immunoglobulin. These may be used for rheumatoid arthritis in adults. But they aren't yet proved to be safe and effective for children with JIA.

Medicines to treat inflammatory eye disease

• Reference Corticosteroid Opens New Window eyedrops
• Reference Methotrexate and cyclosporine A
• Reference Mydriatics Opens New Window, which are eyedrops that dilate the pupil and keep the iris from sticking to the cornea or lens
• Reference Biologics

What to think about

Gold salts were one of the first treatments used for joint inflammation. You may still hear about them. But injected gold salts have been replaced by methotrexate for the treatment of JIA. Gold salts taken by mouth (oral) have not been shown to be effective for JIA.^{Reference 3}

Some children with JIA gain significant benefit from early methotrexate treatment, and this treatment is becoming more common in an effort to prevent joint and eye damage. Early treatment with methotrexate is often used for polyarticular JIA.^{Reference 1}

Biologic therapy is a newer option to treat JIA that doesn't respond to other treatments. Biologics such as etanercept have had some success in relieving symptoms and decreasing the number of flare-ups.

Combination therapy—such as using methotrexate with sulfasalazine, hydroxychloroquine, or etanercept—has been used on a limited basis to treat JIA. Most medical experience with combination therapy is with adults. Only children with severe JIA that has not improved with methotrexate or sulfasalazine are considered for combination treatment.

If your child is on aspirin therapy

Yearly flu shots are recommended for children who are on long-term aspirin therapy. Children on long-term aspirin therapy who get Reference chickenpox Opens New Window or the Reference flu Opens New Window are at risk for getting Reference Reye syndrome Opens New Window. Although there is a risk, Reye syndrome is very rare. Very few cases have been reported in children with chronic arthritis who were being treated with aspirin. If your child has been exposed to chickenpox or the flu, talk to the doctor about giving your child acetaminophen to control pain and relieve fever until the incubation period, or the illness itself, has passed.

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