Medicines play a major role in the management of JIA. Some are tablets taken by mouth, while others are given as an injection. In some cases the injection may be directly into a joint. Medicines are an important part of the treatment of JIA and your child may need to take more than one type of medicine.
Knowing about the medicines
For each medicine prescribed, you child’s rheumatologist should talk to you about:
- risks and benefits
- what the medicine is called
- why the medicine is needed and how it can benefit your child
- how it works
- how the medicine should be taken (dose, frequency, etc)
- what side effects it may have and what to do if they occur
- what tests (if any) are needed while taking this medicine
- how long it takes to achieve the maximum benefit
- how long your child will need to stay on the medicine
- when and how the doctor will review the progress of the medicine.
If you do not feel you are fully informed about any of the points above and you have other questions or concerns about the medicines being used by your child, don’t be afraid to discuss these with the doctor who prescribed the medicine.
Most medicines will need to be prescribed by your child’s doctor. But some, such as simple pain relievers, may be purchased at a pharmacy or supermarket (over-the-counter products).
Medicines used to treat JIA aim to:
- alter or slow the progression of the illness
- control inflammation
- relieve pain
- reduce fever
- reduce other symptoms of the disease
- assist in the maintenance of your child’s ‘normal’ growth.
As a parent you may feel anxious about the prospect of your child taking these medicines. Your child may not want to take these medicines either, particularly when their symptoms improve. However, many of the medicines used today not only reduce the symptoms but also slow the progress of the illness. For these medicines to be effective, it is important they are taken exactly as your child’s doctor prescribes. Many of them need to continue even when the child’s symptoms improve, so they maintain the improvement and also lessen the risk of damage to the joints.
Like all medicines, they can have side effects. These are usually easily recognised. While your child is on these medicines, the doctors will be closely watching for any of these side effects. To make sure any potential problems are detected and rectified as early as possible, your child may need to have regular tests, such as blood tests.
You should always tell your child’s doctor about any new symptoms or changes in your child, as well as anything else that concerns you.
Some medicines can interact with other medicines. It is important you tell each doctor or healthcare professional your child sees about each and every medicine they are taking, even if the medicine is not being used to treat their arthritis. This also includes any medicine available without prescription, such as over-the-counter pharmacy medicines, natural, herbal and complementary medicines.
All medicines have benefits as well as side effects, but, without medicines, permanent joint damage and a poorer prognosis is more likely.
Finding the right medicine
Until recently, the medicines available to treat JIA have been limited. However, new medicines are now being developed so that doctors have a much larger choice. As JIA can vary greatly from child to child, the larger number of available medicines means doctors are now better able to manage each child’s specific symptoms over tine. The downside is it can take longer to find the best medicines for your child.
The type of medicine(s) recommended for your child will depend on a number of factors, including:
- type of JIA
- severity of the illness
- child’s ability to tolerate the medicine.
Most common types of medicines used to treat JIA
- pain relievers (analgesics)
- non steroidal anti-inflammatory drugs (NSAIDs)
- disease modifying anti-rheumatic drugs (DMARDs)
- biological medicines.
Pain relievers (analgesics)
Analgesics are medicines that can relieve mild to severe pain by blocking pain signals from being sent to the brain or by preventing the brain from receiving or working out what these signals mean.
These medicines do not relieve the inflammation present in JIA.
Analgesics for milder pain are available as non-prescription (over-the-counter) brands. In case of severe pain, your doctor will prescribe a pain relief medicine. Your doctor can also advise you which analgesic medicines are appropriate for your child. Analgesics are generally well tolerated.
NSAIDs (non steroidal anti-inflammatory drugs) are a widely prescribed group of medicines for JIA. They can have significant advantages over analgesics because they can relieve both the inflammation and consequently the pain around the joint. However, NSAIDs do not slow the progression of the illness or reduce the risk of joint damage.
As everyone reacts differently to medicines, your child may need to switch to a different NSAID to find the one that best controls their symptoms with the least side effects. Your doctor or pharmacist can advise you on how these medicines may affect your child.
DMARDs (disease modifying anti-rheumatic drugs) can slow or inhibit the progression of JIA. Although researchers don’t fully understand how some DMARDs work, they believe they hinder the immune system’s attack on joint tissues, which in turn may slow the destruction of joints.
DMARDs are often used as an initial treatment for JIA – in combination with an NSAID. Like NSAIDS, the DMARDs do not stop pain mechanisms, but they do act against the underlying inflammation – and so indirectly reduce levels of pain. It can take several weeks for DMARDs to reach their maximum effectiveness – your child’s rheumatologist can discuss this with you.
Corticosteroids are man-made forms of the naturally occurring hormones produced by the body. They can provide rapid and powerful reduction of pain and inflammation for children with arthritis.
Steroids are sometimes injected directly into the joints for local relief during flare-ups. Steroids are usually prescribed in low dose in tablet form. This type of steroid is quite different to the other types of anabolic steroids used in bodybuilding.
Unlike the older, more traditional DMARDs, biologic medicines have been developed specifically for the treatment of arthritis. They are injected just below the skin or can be injected directly into a vein using a slow infusion (a specialised infusion bag on a stand).
Biologic medicines (eg, etanercept) work by directly targeting the inflammatory process that has become over-stimulated and is attacking the joints. Your doctor will be able to give you more information about biologic medicines and when their use is suitable in JIA.