Juvenile Arthritis (cont.)

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What is the treatment for juvenile idiopathic arthritis?

While there currently is no cure for JIA, an integrated and coordinated approach has been shown to be helpful in lessening the morbidity (nonlethal side effects) of JIA. Goals include lessening pain, joint contractures, and growth disturbances (see above). Monitoring for the development of iritis and aggressive treatment are also paramount. Often patients are best served at a pediatric teaching hospital where access to pediatric rheumatologists, physical and occupational therapists, pharmacologists, and social support providers may allow "one stop shopping."

Therapies for JIA patients include the following:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as the first line of therapy due to their positive effect on mild arthritis and relatively few side effects. Medications such as ibuprofen (Advil, Motrin), naproxen (Aleve), and indomethacin (Indocin) are examples of this class of therapy.

2. Steroids are another common class of medications for those experiencing moderate to severe arthritis or nonarthritis inflammatory consequences of JIA. These medications may be administered orally, intravenously, or injected directly into an involved joint. Side effects of steroids may be considerable, and pediatric rheumatologists strive to have the lowest possible dosage schedule. Side effects are most commonly seen at dosages over 20 mg/day and may include immune system depression, increased appetite resulting in weight gain, acne, mood changes, osteoporosis, cataracts, glaucoma, and diabetes.

3. Antirheumatic medications are needed to control the joint changes of JIA in approximately two-thirds of children. These medications are generally considered when the medications previously described are not providing effective control of the patient's illness. Medicines in this category include methotrexate (Trexall, now considered the "gold standard" for those with JIA), sulfasalazine (Azulfidine), azathioprine (Imuran), cyclosporine (Sandimmune, Neoral), and several others. These medications may be administered orally or intravenously. Antirheumatic medications are more potent in effect but are also more problematic in side effects. Problems include immune suppression, which may result in an increased risk of infection and rarely certain cancers, pulmonary toxicity, liver function abnormalities, abdominal pain, and decrease in appetite.

4. Biologic agents have more recently developed a substantial following due to their ability to lessen the morbidity (nonlethal side effects) for those children with JIA. All of these agents are administered either by superficial injection under the skin or intravenously. Their general chemical classification is that of "monoclonal antibodies" that work by targeting various mechanisms of the immune system and as such carry the potential for serious bacterial infections and (rarely) development of certain malignancies. As such, close clinical monitoring and various laboratory studies are required.

5. Autologous stem cell transplantation is reserved only for those children with JIA who have failed all of the above therapeutic options. This procedure requires hospitalization and is a two-step process. The initial portion is utilization of high-dose immune suppression medications to remove the patient's lymphocytes (a type of white blood cell) which are attacking the patient's joint(s). Once removed, new stem cells from the patient (autologous) that were previously harvested and treated are introduced back into the patient's body via the bloodstream. This process requires expertise found only in a few pediatric referral centers.

Medically Reviewed by a Doctor on 8/12/2014

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