· Non-Steroidal Anti-inflammatory Drugs (NSAIDs) - Most treatment approaches will start with this type of medication. They include a variety of medications that affect the processes involved in inflammation by reducing pain, swelling and stiffness. These drugs alone often allow a child with JA to participate in normal day-to-day activities. These are not addictive, and their effect on inflammation does not wear out over time. Some commonly prescribed medications in this group include Naprosyn¨ (naproxen), Tolectin¨ (tolmetin sodium), Indocid¨ (indomethacin), and Ibuprofen. The choice of medication is based on the disease type, how easy it is to take and what the doctor suggests. Sometimes it may take 8 to 12 weeks to see improvement. Often, one NSAID works while another doesn't, and it may necessary to try several types of NSAIDs to find which one works best for a child. The most common side effects that may occur with all drugs in this class is stomach upset, avoided by taking it with
food. Some side effects are seen only with specific medicines, and are reviewed with a parent and/or child and the healthcare team. In order to ensure that there are no side effects from NSAIDs, the doctor may monitor their effect with blood and urine tests.
Acetylsalicylic acid or ASA (Aspirin) used to be the most commonly prescribed drug for JA, some of the other NSAIDs are more convenient to take and better tolerated. In children taking this form of medicine, there is a very small risk of Reye's syndrome following infection with chickenpox or influenza. It is always wise to ask the doctor their advice.
Injections of steroids directly into a joint can be very helpful for the child with persistent JA in a few joints that does not respond to initial drug treatment. Side effects of steroids do not occur with this type of treatment as they do with steroids taken orally, and one joint injection does not mean that injections will have to be repeated. Careful injection under sterile conditions with local or general anesthetic has little risk of side effects and may improve the injected joint(s) for months or even longer; with an initial improvement often very noticeable. If effective, other medications can be stopped early.
Second-Line Drugs or DMARDs are used for children with prolonged arthritis in several joints that may lead to permanent damage, and are often prescribed. Drugs in this group
include Rheumatrexª (methotrexate), Salazopryn¨ (sulfasalazine), gold injections, Quenil¨ (hydroxychloroquine), and Cuprimine¨ or Depen¨(penicillamine). These agents, also called disease-modifying anti-rheumatic are "slow acting" and can take up to six months to work. They are used to obtain better control of JA than that achieved by NSAIDs alone. With all of these drugs, treatment must be continued for a long time, often months to years, even after the disease is controlled, in order to avoid a recurrence. When they are started, the doctor reviews the specific medication with a parent and child in- depth.
