Juvenile Arthritis (cont.)
Polyarticular juvenile rheumatoid arthritis
Polyarticular juvenile rheumatoid arthritis is the form in which four or more joints are
involved after six months of illness. This form is more severe both because of
the greater number of joints involved and the fact that it tends to
get worse over time. These children may have a great deal of
difficulty with normal activities and need to be treated
aggressively.
From a doctor's point of view, the most important thing
is to bring inflammatory arthritis under control as quickly as possible. Typically, this involves at least medications that reduce inflammation, nonsteroidal antiinflammatory drugs (NSAIDs).
This may also require use of some fairly strong medications, but it's important
to recognize that they are necessary to reduce symptoms and prevent permanent
damage. One thing to watch out for is using steroids (for example,
prednisone). In severe cases, this may be necessary, but it is not a
"real" solution. Steroids make patients with arthritis feel
wonderful, but it's like sweeping dirt under the rug. Everything looks
good, but it really isn't. Taking too much steroid for a long period
causes lots of problems, like short stature and weak bones. Whenever
we are required to put a child on steroid medications, we want to wean them as quickly
as possible. Nonsteroidal antiinflammatory drugs are enough for many
children with polyarticular juvenile rheumatoid arthritis, but more severe cases may require more aggressive "second-line" medications, such as
gold shots, sulfasalazine, or
methotrexate. Severe cases requiring steroids or second-line
medications should be under the care of experienced physicians.
A newer form of medication, biologics called TNF-blockers, is now available.
Tumor necrosis factor alpha (TNF-alpha) is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, TNF-blockers reduce the signs and symptoms of inflammation. Etanercept (Enbrel) is a self-injectable TNF-blocker that is injected into the skin twice weekly and is indicated for reduction in signs and symptoms of moderately to severely active polyarticular-course juvenile rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying medicine(s). Infliximab (Remicade) is an intravenously infused antibody that blocks the effects of TNF-alpha. Remicade is given by intravenous infusion every
two months. Remicade is effective for treating juvenile rheumatoid arthritis and can result in a significant and prompt reduction in disease activity and improved quality of life. Adalimumab (Humira) is also a self-injectable TNF-blocker that reduces the signs and symptoms of moderate to severely active polyarticular juvenile inflammatory arthritis in children 4 years of age or older.
Next: Systemic-onset juvenile rheumatoid arthritis »
- Nonsteroidal Antiinflammatory Drugs (NSAIDs) - Describes Nonsteroidal Antiinflammatory Drugs (NSAIDs), which are medications used primarily to treat inflammation, mild to moderate pain, and fever.
- Complete Blood Count (CBC) - A complete blood count (CBC) measures the concentration of white blood cells, red blood cells, and platelets in the blood and aids in the diagnosis of conditions and diseases such as anemia, malignancies, and immune disorders.
- Rheumatoid Arthritis - Learn more about rheumatoid arthritis, an autoimmune disease that causes chronic joint inflammation, which has symptoms that include stiffness, fever, muscle and joint aches, loss of appetite, and fatigue. Treatment of rheumatoid arthritis incorporates the use of first-line drugs (aspirin and corticosteroids for pain and inflammation) and second-line drugs (methotrexate and hydroxychloroquine to prevent joint destruction and promote remission).
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