Children and adolescents can develop juvenile idiopathic arthritis, which is a subtype of arthritis — a disease characterized by the inflammation of joints. While there is currently no cure for juvenile idiopathic arthritis, treatment can help relieve symptoms, ease pain, maintain range of motion, and prevent damage to the joints. While there are several subtypes of juvenile idiopathic arthritis, treatment across these subtypes tends to be the same.
For treatment of this disease, you will likely work with a rheumatologist. Your doctor will devise a treatment plan that includes a team of specialists including physical therapists, occupational therapists, social workers and others. It is likely the patient is going to be treated using a combination of medications, exercise and lifestyle changes to achieve their treatment goal.
Medications for juvenile arthritis
There are several different types of medications that can be prescribed to children to help ease symptoms of the disease. Some of these include:
- Nonsteroidal anti-inflammatory drugs (NSAIDs). These include common over-the-counter medications such as ibuprofen (Advil) or naproxen (Aleve). NSAIDs can help relieve inflammation and ease pain. Over-the-counter NSAIDs might not be strong enough, so the doctor can prescribe stronger NSAIDs. However, it is important to monitor your child when they are taking NSAIDs as side effects can include bleeding problems, an upset stomach, and liver issues.
- Corticosteroids. This type of medicine, which includes a commonly-used drug called prednisone, suppresses the immune system and therefore reduces inflammation. In fact, corticosteroids are often prescribed for serious inflammatory conditions such as inflammation of the lining of the heart. Corticosteroids can be administered intravenously (into the vein), orally (through the mouth as a tablet) or directly in the affected joint. Corticosteroids are not often prescribed because they are known to affect a child’s normal growth as carrying the potential to induce other side effects such as weight gain, weak bones, and a higher risk of infections.
- Disease-modifying anti-rheumatic drugs (DMARDs). This class of drugs, which includes methotrexate, is more potent. Therefore, it is generally prescribed in case NSAIDs are not strong enough to provide relief. DMARDs might also help prevent progression of the disease. Unfortunately, DMARDs can take a long time to have an effect, sometimes weeks to months. Therefore, they are often taken alongside NSAIDs.
- Biologic therapy. These drugs are a newer generation of medicines that are mostly still under investigation for treatment of juvenile idiopathic arthritis. Biologic therapies tend to target different parts of the immune system to suppress it. For example, a well-known biologic therapy, TNF-inhibitors, act to suppress the activities of TNF-alpha (an inflammatory molecule secreted at high levels by the immune system in people with autoimmune disease). As biologic therapy is still being studied, it is only prescribed in case the other medications don’t work. Biologic therapies may be prescribed either by themselves or alongside other medication.
Currently, there is a lack of safety data on most DMARDs and biologic therapies. Therefore, the FDA has not yet approved most of these drugs for treatment of juvenile idiopathic arthritis. This is important to keep in mind when designing a treatment plan for your child.
These are the non-medication related treatments that are also often recommended for treatment of this disease:
- Physical therapy. It is well-known in the rheumatology community that physical therapy can be very beneficial for patients with arthritis. Working with a physical therapist can help teach exercises that improve the child’s flexibility as well as help maintain range of motion in the joints that are affected by helping strengthen those joints. Hydrotherapy is one of the exercise regimens through which a patient can help improve flexibility and joint strength. This type of therapy involves performing exercises in a warm pool under the supervision of the physical therapist.
- Occupational therapy. Similar to physical therapy, your child will be working with an occupational therapist to help improve the performance of everyday activities that are giving them problems. For example, children with arthritis will often have problems holding an object if the joints of their hands are affected. In this case, an occupational therapist will help teach your child strategies to address this problem.
- Dietary changes. In some patients with juvenile idiopathic arthritis, making dietary changes helps improve their disease condition. Therefore, doctors may recommend adding nutritional supplementation to the diet. These nutritional supplementations can include taking vitamin D and calcium, which can help increase strength and health of bones. Additionally, some studies have shown that certain foods can trigger a flare-up of arthritis. Therefore, the doctor may ask you to keep a food journal to see if there any patterns of flares following intake of certain types of foods. If there is a pattern, then the doctor will recommend avoiding this trigger. Unfortunately, this can significantly vary from person to person and little research has been conducted in this area.
Other lifestyle changes that doctor may recommend are avoiding smoking around the children as smoke can be a trigger for a flare-up, eating a healthy diet, maintaining a healthy weight and exercising.