Juvenile Arthritis Treatment - Ask The Pharmacist

Jul 12, 2016
Specialist pharmacists share information about understanding and treating juvenile arthritis.
  • Inflammatory Conditions
  • Children

Francie Article

Arthritis is often thought of as an age-related condition, primarily affecting older people. However, more than 300,000 children and youth in America suffer from juvenile arthritis (JA).

JA is a group of autoimmune and inflammatory conditions that can develop in those 16 years old and younger.

Juvenile Idiopathic Arthritis

The most common type of JA is juvenile idiopathic arthritis (JIA), which is characterized by swelling in one or more joints for at least six weeks.

There is no known cause for JIA, but some research points toward a genetic predisposition that could indicate that a child’s genetic makeup could cause the onset of arthritis when triggered by other factors.

The specialist pharmacists in the Express Scripts Therapeutic Resource Center® help patients understand their symptoms and manage their condition.

Getting a JIA diagnosis can be challenging. Patients and caregivers often have to consult multiple physicians before the condition is diagnosed. There is no single blood test to diagnose, so a careful physical exam and medical history is important.

Parents should keep careful track of the symptoms to help the physician make an accurate and timely diagnosis. A pediatric rheumatologist is often in the best position to offer a diagnosis. The physician will likely prescribe lab tests and X-rays, in part, to rule out other potential causes.

Treating Juvenile Arthritis

There is no cure for JA, and the goal of treatment is to relieve inflammation, control pain and improve quality of life. A combination of medication, physical activity and healthy eating is necessary for healthier outcomes. Some forms of JA also can cause eye inflammation, which if left untreated can result in cataracts, glaucoma and even blindness. This often occurs without symptoms, so regular visits to an ophthalmologist are recommended.

There are several medication options, and they can generally be divided into two groups:

  • Those that help relieve pain and inflammation such as nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids and analgesics
  • Medications that can alter the disease state, put it into remission and prevent joint damage, which include disease-modifying anti-rheumatic drugs (DMARDs), biologic response modifiers (biologics) such as tumor necrosis factor (TNF) blockers and immune suppressants

Corticosteroids include medications such as prednisone and may be used to control symptoms until a DMARD takes effect or to prevent complications such as inflammation of the sac around the heart (pericarditis). They may be administered by mouth or by injection directly into a joint. But these drugs can interfere with normal growth and increase susceptibility to infection, so they generally should be used for the shortest possible duration.

DMARDs are used to slow the progress of juvenile rheumatoid arthritis and may be taken in combination with NSAIDs. Commonly used DMARDs for children include methotrexate and sulfasalazine. Side effects may include nausea and liver problems.

TNF blockers – such as etanercept and adalimumab – can help reduce pain, morning stiffness and swollen joints. These types of drugs increase the risk of infections and also may carry a slightly higher risk of getting some cancers such as lymphoma.

Because juvenile rheumatoid arthritis is caused by an overactive immune system, medications that suppress the immune system, such as abatacept, rituximab, anakinra and tocilizumab, can help manage the condition. Immune suppressants also increase the risk of infections and, rarely, some types of cancer.

For other medication management or JA questions, contact your physician or pharmacist.

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