How is juvenile rheumatoid arthritis treated?
Treatment for JRA is essentially the same as for adults with RA. Treatment usually includes medications along with exercise.
The goals of treatment for JRA include:
- Easing pain and swelling
- Increasing joint motion and strength
- Preventing joint damage and other complications that can occur.
Which medications are used to treat JRA?
Medications for juvenile rheumatoid arthritis may include:
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are used to reduce pain, fever and inflammation.
NSAIDs are given through a liquid or pill. These drugs are typically taken from one to four times a day. Some common NSAIDs on the market are naproxen (Naprosyn), ibuprofen (Motrin or Advil), tolmentin, and aspirin.
While NSAIDs may help ease pain and inflammation, they also have side effects. Some common side effects include stomach pain, nausea, vomiting, headache, and anemia. Sometimes the doctor will give another stomach-protecting medication to take with the NSAIDs to reduce the risk of stomach bleeding.
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs may be added to the medication regimen to alter the progression of the joint disease. These drugs also help with joint stiffness, pain, and swelling.
The true effects of DMARDs are not felt immediately and may take about 3-6 months to work. This is why DMARDs are referred to as “slow-acting.” Examples of DMARDs include Plaquenil, Azulfidine, and Rheumatrex.
Because DMARDs are strong medications, the child will need frequent tests to monitor the drug and side effects such as anemia, low blood count, and kidney and liver problems. Other side effects may include stomachaches, diarrhea, vomiting, nausea, headaches, rashes, loss of appetite, and weakness.
Biological modifying agents
Biological agents, or biologics, are also DMARDs. Biologics are made of synthetic proteins and antibodies that block TNF and other substances that cause inflammation.
Examples of biologics include Enbrel, Humira, Kineret, and Remicade).
Potentially serious side effects of the biologics include allergic reactions and an increased risk of infection including tuberculosis. Because some biologics have only been FDA-approved for use in adults, clinical trials are under way to check their effectiveness in children.
These powerful anti-inflammatory medications are usually only prescribed when the patient does not respond to other treatment or if the disease is severe.
Steroid medications come in pills or liquids. When a patient is only affected in a single joint, a steroid injection may be given directly into that joint.
Oral steroids are usually prescribed for short periods of time and in low dosages. There are some serious side effects associated with long-term usage. Side effects include stunted growth, ulcers, mood swings, weight gain, moon face, muscle weakness, high blood pressure, osteoporosis, cataracts, and infections.
Examples of steroids include dexamethasone, methylprednisolone, hydrocortisone, prednisolone, and prednisone.
What exercises are used to treat JRA?
Exercise and physical activity are important for children with JRA. Exercise helps reduce pain, increase muscle strength, keep joints moving in a normal range of motion, and improve endurance.
With the help of physical and occupational therapists, children with JRA learn simple ways to perform their activities of daily living. Therapists teach them range-of-motion exercises to help with flexibility and strengthening exercises for muscle building.
Hot and cold treatments performed before exercise can also help to make the therapy easier as well as relieve stiffness and pain. Examples of these treatments are hot or cold soak or applying hot or cold packs.
Therapists can also make splints for children to correctly position the joints and reduce pain. Splints are typically used on the knees, wrists, and fingers.
Children with JRA should be encouraged to participate in recreational activities. Contact sports are not recommended, but activities that are not stressful on the joints, such as swimming, are beneficial.
Are there complications with juvenile rheumatoid arthritis?
There can be complications with JRA and the medications used for treatment. Certain medications such as steroids can stunt growth. Poor growth may also occur as a result of a poor appetite.
Eye problems are associated with some forms of JRA. It’s important to have an ophthalmologist check the child’s eyes frequently.
JRA patients also have complications with dental care. Their oral health is compromised because of their limited jaw movement. This makes it difficult for patients to brush and floss properly. Dentists can recommend special toothbrushes and flossing equipment to help children take care of their mouths.
Patients with JRA often have temporal mandibular joint (TMJ) or jaw pain. Pain and stiffness of the jaw can be alleviated by certain exercises. A JRA sufferer may also develop an overbite if the lower jaw doesn’t develop correctly. This can usually be fixed by an orthodontist or, if necessary, by surgery.
Some patients with JRA need additional calories for growth because of the demands of their chronic disease. Other JRA sufferers may also gain too much weight because of their limited mobility and medication side effects. Too much weight can be dangerous because of the excess stress placed on the joints.
What’s the prognosis for juvenile rheumatoid arthritis?
Permanent damage from juvenile rheumatoid arthritis is now rare with proper treatment. Most children with JRA recover from the disease fully without experiencing any lasting disabilities if treated early.
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