Treatment for Juvenile Rheumatoid Arthritis
Juvenile rheumatoid arthritis (JRA) usually is treated using a combination of medications, physical therapy, and exercise. The goals of treatment are to reduce inflammation and pain, prevent or limit joint damage, and improve or maintain joint and body mobility, so that the child can remain physically and socially active.
Medications to Treat JRA
Inflammation and pain typically are treated with nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen. Dosage levels of these medications can be increased or decreased, depending on how the child responds.
If NSAIDs are not effective, disease modifying antirheumatic drugs (DMARDs) can be prescribed. NSAIDs and DMARDs can cause serious side effects and should only be used as directed by a qualified physician. If JRA affects a single joint, treatment may involve a steroid injection directly to the joint, before other medications are prescribed.
In some cases, oral steroids are prescribed for a short period of time. Oral steroids can cause weight gain, stunted growth, and an increased risk for infection.
In April 2011, the U.S. Food and Drug Administration (FDA) approved tocilizumab (Actemra) to treat active systemic idiopathy arthritis (SJIA) or Still's disease. In this serious form of JRA, children experience severe inflammatory complications, such as high fevers, rashes, high blood counts and swelling of the lymph nodes, liver and spleen. Tocilizumab is approved for children over the age of 2, alone or in combination with methotrexate. This drug carries a black box warning for severe infection risk and may cause headache, sore throat, diarrhea and respiratory infections.
Physical Therapy to Treat JRA Symptoms
Physical therapy is an important part of the treatment plan for JRA. Physical therapists develop a program of activities and exercises for the child that is geared toward his or her specific condition. The goals of these activities are to improve joint flexibility and build strength and endurance. In some cases, the physical therapist constructs splints to control joint contracture (stiffness in the joint caused by structural changes in tissues surrounding joints, such as muscles, ligaments, and tendons, that prevent full extension) or deformity.
Exercise to Treat JRA Symptoms
Children who have JRA may avoid physical activity because of pain. However, regular exercise can help keep muscles strong, protecting joints and helping to maintain range of motion. Many activities are safe for children with JRA, including walking, swimming, and stationary bicycling. Parents and caregivers should consult with the child's medical team before enrolling him or her in any sports program, as some sports are too risky for children with weakened joints.
Other Treatments for JRA
Joint pain and stiffness sometimes can be alleviated with heating packs or a hot bath or shower. Children who have JRA should eat a well-balanced diet and maintain a healthy weight. Foods that contain adequate amounts of calcium (e.g., dairy products, tofu, beans, fortified orange juice, salmon) are important to help promote bone health.
Regular eye care and dental screenings are also important. Regular eye exams can help detect complications due to JRA, such as iritis. Children with JRA may have difficulty opening their jaws, making it difficult to brush or floss properly. Medications used to treat JRA also can affect teeth and gums.
Although it can be difficult to live with the effects of JRA, it is important for children who have the condition to be as involved in the normal routines of family and school Children who are as active as possible often have a better long-term outlook. Parents and caregivers should encourage the child to follow the exercise program developed by the physical therapist.
Federal Act 504 requires schools to work with families in making necessary adjustments to children's schedules and other school-related activities. Juvenile rheumatoid arthritis support groups may help families connect with others affected by the disease.
Surgery to Treat JRA
Surgery is rarely required to treat JRA. However, in severe cases, it may be used to reduce pain, release joint contractures, or replace a damaged joint. Joint replacement surgery is used primarily in older children who have achieved complete (or near complete) growth and who have extensive joint damage (usually in the hip, knee, or jaw).
Children who have juvenile rheumatoid arthritis typically experience long periods of remission, especially with the onset of puberty. Remission occurs in about 75 percent of cases, with minimal deformity or loss of function. JRA rarely is life threatening.