Treatment. Juvenile rheumatoid arthritis

Treatment of juvenile idiopathic rheumatoid arthritis

Treatment of juvenile rheumatoid arthritis focuses on helping the child maintain normal levels of physical development and social activity. To accomplish these goals, physicians may recommend a combination of treatments to reduce the pain and swelling, preserve movement and strength, and prevent complications.

Medications for juvenile idiopathic rheumatoid arthritis treatment

In some cases, medication for pain is the only medication required for the treatment of juvenile idiopathic rheumatoid arthritis. Other times, medication is needed to help prevent the disease from progressing.
Common juvenile idiopathic rheumatoid arthritis medications include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs). These are medications like ibuprofen and naproxen, which are available over-the-counter. Because of their anti-inflammatory properties, they reduce swelling and inflammation, as well as relieve pain. Sometimes, doctors prescribe stronger NSAIDs for severely painful juvenile rheumatoid arthritis. Side effects of NSAIDs include stomach problems and problems with the liver. 
• Disease-modifying anti-rheumatic drugs (DMARDs). If NSAIDs don’t relieve the pain and swelling in the joints caused by juvenile rheumatoid arthritis, these drugs are sometimes prescribed to be taken along with the NSAIDs. 
  • DMARDs can slow down the progression of juvenile rheumatoid arthritis. Examples of these drugs which are commonly prescribed for children include methotrexate and leflunomide. Side effects of DMARDs may include stomach upset and problems with the liver. 
• Biologic agents. These drugs help to reduce swelling in the joints, pain, and stiffness. Included in this classification of medicines are TNF (tumor necrosis factor) blockers, like adalimumab (Humira) and etanercept (Enbrel).
  • Unfortunately, these medications increase the chances of infection, and they may also slightly increase the risk of developing some types of cancer, like lymphoma. 
  • Other biologic agents sometimes used to treat juvenile rheumatoid arthritis act by suppressing the body’s immune system. These include rituximab (Rituxin), abatacept (Orencia), tocilizumab (Actemra), and anakinra (Kineret).
• Corticosteroids. Steroid medications, like prednisone, are sometimes prescribed to help control the symptoms of juvenile rheumatoid arthritis until a DMARD becomes effective or to prevent serious complications, like inflammation in the tissues that surround the heart (pericarditis). 
  • Corticosteroids can be given orally, or they may be injected into an affected joint. Steroids can cause severe side effects. They can increase the risk for infection and can also interfere with a child’s growth, so they are not appropriate for long-term use. 

Therapies 

Physical therapy is sometimes recommended for children with juvenile rheumatoid arthritis. These therapists can work with a child to help maintain mobility, muscle strength and tone, and joint flexibility.
A physical or occupational therapist can also suggest a home exercise program or recommend assistive devices or protective equipment for a child with juvenile rheumatoid arthritis. Sometimes joint splints or supports are needed to provide support and protection for the joints. They can also help keep the joints in their correct functional position.

Juvenile rheumatoid arthritis surgery

If a child has very severe juvenile rheumatoid arthritis, surgery is sometimes recommended to correct the positioning of a joint.

Useful Advices 

Caregivers and parents can teach children techniques to help limit juvenile rheumatoid arthritis’s painful and potentially disabling effects. Some of these techniques may include:

• Regular exercise. Getting exercise on a regular basis is very important. It helps keep the joints flexible and the muscles that support them strongly. Swimming is one of the best possible choices because it causes very little joint stress. 
• Applications of heat or cold. Many children with juvenile rheumatoid arthritis have stiffness in the joints, especially when they get out of bed in the morning. Some young children can tolerate ice or cold packs, but most prefer warm packs or a warm bath or shower. 
• Eating a healthy diet. Juvenile rheumatoid arthritis can cause a decreased appetite and weight loss. Other children may gain weight due to physical inactivity or due to the side effects of some medications. A healthy and nutritious diet can help promote a healthy weight. Adequate amounts of vitamin D and calcium in the diet are especially vital because juvenile rheumatoid arthritis places a child at risk for fragile bones (osteoporosis) because of the disease itself, reduced physical activity, and some of the medications used to treat the condition. 

Other suggestions for parents who are helping their child deal with juvenile rheumatoid arthritis include:

• As much as you can, treat the child the same as other children in the family. 
• Allow the child to express feeling about the disease. Make sure the child understands he or she didn’t cause juvenile rheumatoid disease. It is not a punishment for something he or she did wrong or “bad.” 
• Following your doctor’s or therapist’s recommendations, encourage your child to remain physically active. Do his or her exercise alongside them. 
• Ensure your child’s school or daycare administration and staff are aware of any special concerns or precautions regarding your child. 

Outcome & Complications 

Juvenile rheumatoid arthritis can result in serious complications, but with careful monitoring and medical attention, the risk of these complications can be minimized. Complications of juvenile rheumatoid arthritis can include:

• Eye problems. Some types of juvenile rheumatoid arthritis may cause inflammation of the eyes. If not treated, this can cause glaucoma, cataracts, or blindness. Inflammation of the eye often occurs without producing symptoms. If your child has juvenile rheumatoid arthritis, it’s essential to have him or her be seen by an ophthalmologist on a regular basis. 
• Growth problems. Juvenile rheumatoid arthritis can cause delays in a child’s bone development and their normal growth. Some of the medications used in the treatment of juvenile rheumatoid arthritis can also interfere with growth.