Medications for Juvenile Arthritis

Experts at Hassenfeld Children’s Hospital at NYU Langone prescribe one or more medications to eliminate symptoms, such as pain and inflammation, in children and adolescents with juvenile arthritis, which is a group of autoimmune conditions that arise before age 16. Keeping symptoms under control is essential to staying active and preventing complications, such as joint damage and uveitis, an inflammation of the middle layer of the eye, including the iris. Uveitis can lead to glaucoma, an increase in eye pressure that can result in vision loss, and cataracts, which are cloudy patches in the lens that make it difficult to see clearly.

For some children, medication can help to put juvenile arthritis into remission, which is an absence of symptoms and disease activity for six months or longer. Others may need to take medication throughout life to control symptoms and prevent complications.

Nonsteroidal Anti-inflammatory Drugs

Your child’s doctor may recommend nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve minor joint pain and swelling. Some NSAIDs, such as ibuprofen or naproxen, are available without a prescription. Others, such as indomethacin or celecoxib, are only available by prescription. Your child can take these medications by mouth in pill or liquid form.

NSAIDs are usually well tolerated in children, but can cause gastrointestinal problems, such as stomach irritation and ulcers, when taken in high doses for prolonged periods of time. Your child’s doctor can advise you about the appropriate dosage needed to avoid gastrointestinal problems.

Disease-Modifying Antirheumatic Drugs

To treat more severe arthritis or uveitis, doctors may prescribe disease-modifying antirheumatic drugs, such as methotrexate or sulfasalazine, in combination with other medications, such as NSAIDs. Disease-modifying antirheumatic drugs prevent or slow the body’s production of the immune system cells that cause inflammation. Most of these medications can be taken by mouth, in pill or liquid form. It may take several weeks or longer for these medications to take effect. Because disease-modifying antirheumatic drugs suppress the immune system, children who take them may be at increase risk for infections.

Targeted Biologic Therapies

Targeted therapies, also called biologics, are newer medications that are often highly effective in eliminating severe joint pain and inflammation from arthritis. These medications block the activity of cytokines and other immune system cells that cause inflammation.

Targeted therapies may produce noticeable symptom relief within a few weeks. Your child can receive these medications through intravenous (IV) infusion at an outpatient clinic at Hassenfeld Children’s Hospital, or your doctor can show you how to inject the medication under the skin at home. Our doctors carefully monitor children who take these medications, because they may have an increased risk of infection.

Corticosteroids

Corticosteroids include medications, such as prednisone, that suppress the immune system. Doctors may prescribe these temporarily to reduce severe symptoms until other medications take effect. They can be taken by mouth to reduce inflammation throughout the body, or they can be injected directly into a swollen joint. Taking corticosteroids for long periods of time by mouth can prevent the absorption of vitamin D and calcium, which can lead to bone loss. These medications can also cause weight gain and can reduce the production of hormones that help to regulate the balance of salt and fluid in the body. However, steroid injections rarely cause side effects.

Children with juvenile arthritis who are being treated with any of these medications come to Hassenfeld Children’s Hospital for frequent follow-up tests, during which the doctor may perform blood tests to monitor for side effects and adjust medication dosages if necessary. Our specialists can also make referrals to an ophthalmologist if your child develops uveitis or to an orthopedic surgeon if your child develops severe joint damage from arthritis.