On this page, we cover:

There are various treatments and therapies for JIA which help control symptoms and reduce the risk of joint damage. The combinations of medicines used may vary from child to child depending on their particular requirements.

Medication helps control the symptoms of arthritis and sometimes more than one medicine is needed to do this. The aim is to improve pain and mobility.

Side effects from some medication are not uncommon. Treatments may be modified if the side effects are too severe but this must be balanced against the potential for serious issues if the disease is left uncontrolled.

In the early stages or during a flare-up some medicines may be used in higher doses to help get the condition under control as quickly as possible.  The doses and types of medication may then be changed to keep your child well while minimising side effects.

See our medication tips for parents section

Analgesia (Pain Killers)

Non Steroidal Anti-inflammatory Drugs (or NSAIDS)

This group of medication helps reduce swelling, ease stiffness and offers pain relief.  It includes drugs such as Ibuprofen, Diclofenac (Votarol), Naproxen (Naprosyn) and Piroxicam (Feldene).

Paracetamol

This is given for mild to moderate pain and to help reduce a fever but doesn’t help reduce inflammation. It is often used alongside NSAIDS.

Medicines to combat side effects

Folic Acid

Information to be added.

Ranitidine

Information to be added.

Omeprazole

Information to be added.

Ondansetrone

Information to be added.

Steroids

Steroids are powerful anti-inflammatory drugs. They can be given as an infusion (Methylprednisolone), orally (Prednisolone) or by injection (Triamcinolone hexacetonide) into a joint. Several joints can be injected at one time and is usually done under a general anaesthetic or with Entonox (gas & air). Joint injections can be repeated if necessary.

Steroids work by blocking some chemical messages involved in the inflammatory process and therefore work quickly and effectively to reduce inflammation. However, they are not without side effects. For most the benefits of taking steroids usually outweigh the side-effects and if taken for short periods of time there are usually no side effects. Weight gain, mood swings, acne and excess hair growth are the more common side effects with longer courses. It is important to note that these effects settle when the medication is stopped – but you should never stop steroids abruptly, always seek medical advice.

Disease – Modifying Anti Rheumatic Drugs (DMARDs)

This type of drug reduces activity in the immune system which may be overactive.  The one most commonly used in JIA is Methotrexate. It is slow acting and the benefits may not be seen for several months. It can be given by tablet or injection.

Regular blood tests are done as this drug can occasionally affect liver and bone marrow function. Methotrexate is sometimes given in combination with the vitamin folic acid as this may help to reduce side effects.

More on methotrexate

Biologics

The immune system produces chemicals to help fight infection. In children with JIA too many chemicals are released causing inflammation. One of these is a protein called tumour necrosis factor (TNF) and some biologics work by blocking TNF with a dramatic reduction in inflammation. Other biologics act on other parts of the immune system.

Adalimumab, Etanercept & Infliximab

Adalimumab, Etanercept & Infliximab are biologics which block TNF. Anakinra, Abatacept, Tocilizimab and Rituximab are some of the other biologics used. This group can be used either short or long term and is always administered by injection. Frequency varies from daily to fortnightly and in some cases is given by intravenous infusion. The Biologics can cause side effects which may include infection, local injection site reactions, allergic reactions, feeling and being sick, diarrhoea and rashes. They may also be painful and may very rarely cause long term problems with white blood cells.

Blood Monitoring

This is done regularly for both Methotrexate and the Biologics to monitor the body’s white blood cell count. If this becomes suppressed it reduces the body’s ability to fight infection. Blood Monitoring will also check that the drugs are not making the liver work too hard.

Treatment for Uveitis

If your child has uveitis which doesn’t settle quickly on eye drops the doctors will suggest methotrexate and possibly some of the biologic drugs described above as we now know that they can be very effective at controlling the eye inflammation as well as the arthritis.

Therapies

Physiotherapy

Physiotherapists have an important role in the rheumatology team. With an exercise plan they can help your child maintain flexibility, range of movement, joint function and muscle strength.

Occupational Therapy

The occupational therapist (OT) can help your child if they are having difficulty with every day activities. This could be in the home with getting dressed or in school with writing.

Podiatry

A podiatrist is someone who looks after foot problems. For the child with JIA they can help alleviate pain, prevent deformity and give footwear advice.

Hydrotherapy

This involves doing special exercises in a warm pool and is usually done within the physiotherapy department of a hospital.