The aim of treatment for juvenile idiopathic arthritis (JIA) is to:
- control the symptoms of arthritis
- enable you to lead an active life at school or college
- enable you to enjoy an active family and social life
- help you become an independent adult.
It’s important to do all of these things but at the same time try to reduce any side-effects caused by the medicines.
Drugs for JIA
Drugs can’t cure arthritis, but they can control the symptoms and help to reduce the possibility of joint damage. An increasing number of medicines are now available.
- These drugs help to control the pain of arthritis.
- Common painkillers include paracetamol, codeine or combinations e.g. co-codamol.
- They have to be taken regularly for maximum effect, which lasts hours not days.
- Side-effects include constipation, drowsiness and feeling a bit spaced-out.
Read about painkillers.
Non-steroidal anti-inflammatory drugs (NSAIDs)
- These often help to reduce pain, stiffness and swelling.
- Examples of the many NSAIDs include ibuprofen, piroxicam, naproxen and diclofenac.
- These have to be taken regularly to get maximum effect, which lasts hours not days.
- Side-effects include indigestion and other stomach problems. The risk of this happening can be reduced by always taking them with food. You should tell your doctor or rheumatology nurse specialist if you develop any stomach pains or cramps.
Read about non-steroidal anti-inflammatory drugs.
Disease-modifying anti-rheumatic drugs (DMARDs)
- These drugs dampen down inflammation and can reduce the joint damage caused by arthritis.
- Methotrexate is the most commonly used DMARD in JIA. It can be given as a weekly dose by mouth or injection.
- Side-effects of methotrexate are rare, but you’ll need regular blood tests to check for them.
- These drugs are slow to become effective and you may not notice any benefit for several months.
Read about disease-modifying anti-rheumatic drugs.
Biological therapies is a name given to some newer drugs that have been available for about 10 years. Just like DMARDs, they slow down the progress of arthritis and reduce pain, swelling and stiffness. Like DMARDs they work by suppressing the immune system, and they’re called biological therapies because they were developed from research into the biology of arthritis. These drugs are used if you don’t respond to DMARDs such as methotrexate.
The main biological therapy used for JIA is etanercept, but others such as infliximab and adalimumab are now becoming more available for children and young people with the condition.
These drugs control inflammation, pain and stiffness. They can be given as tablets, by injection into a joint or by a drip into a vein.
A common treatment for young people is a steroid injection into the affected joint.
- Injections are very effective for many months, are very well tolerated and cause very few side-effects.
- In younger children these injections will be done under general anaesthetic, but as you get older these may be done under sedation, with gas and air (entonox) or awake with a local anaesthetic. In adult clinics, joint injections are always given with a local anaesthetic when you’re awake.
Steroid tablets are used less for young people than steroid injections.
- Side-effects are more common with large doses and longer courses (over weeks and months).
- Short courses (for a few days or up to a week) or low doses tend to have few or no side-effects. Your doctor will try and limit side-effects by putting you on a low dose or short course.
- Your doctor will give you a steroid card which tells people you’re on steroids. Always carry this with you.
- Steroids should never be stopped suddenly (except if you’ve only been on them for under 2 weeks) as you can become very ill.
These will be used if you have eye inflammation. They’re used to reduce the inflammation, prevent the swollen iris from sticking to the lens and to reduce pressure inside the eye. Some of the medicines used for the arthritis, such as methotrexate and the biological therapies, can be used to treat eye inflammation if the eye drops alone aren’t enough.
Key points about your drug treatments
The risk of chickenpox – Chickenpox can be more severe if you’re taking steroids, methotrexate or biological therapies. If you haven’t had chickenpox (or aren’t sure) then tell your doctor or rheumatology nurse. They’ll give you advice on what to do if you get chickenpox or have been around someone with the condition. You may be able to have a vaccine.
Avoid certain vaccines – You must not have certain vaccines (live vaccines) if you’re taking methotrexate or biological therapies. These include vaccines against rubella (German measles) and BCG for tuberculosis (TB). However, most other vaccines are well tolerated and effective and it’s a good idea to have them. Check with your nurse or doctor.
Avoid drinking alcohol – Alcohol makes your liver more sensitive to the effect of methotrexate, which increases the risk of liver damage. You may be advised not to drink alcohol at all, but in truth many young people do drink some alcohol without apparent side-effects with their liver. It’s important to discuss what safe limits are with your doctor as this will vary with your age and size.
Use reliable contraception – If you’re taking certain drugs for your arthritis and are sexually active, it’s important that you use effective contraception. Some drugs can damage sperm in a man and eggs in a woman, or could cause serious harm to the developing baby. Discuss this with your doctor or nurse, who will be able to give you advice. If you do have unprotected sex then you should seek advice urgently from your nurse, GP or local sexual health clinic.
Using condoms is important to prevent sexually transmitted infections (STIs) even when using hormonal contraception.
Physiotherapy and occupational therapy for JIA
Physiotherapy and occupational therapy can:
- help your arthritis
- relieve pain
- improve your ability to get on with life
- provide exercises to stretch soft tissues and build up muscles
- improve your heart and lung fitness.
Your physiotherapist and occupational therapist will assess you and will develop a programme for your individual needs so that you’re able to do the activities you want and need to be able to do in your daily life. They may give you exercises and coping strategies and sometimes they may provide equipment to make daily activities easier.
Let’s have a look at some of the things your therapist can help you with:
There are various ways to relieve pain, such as hot and cold pads, TENS, acupuncture, massage, hydrotherapy and relaxation. Your physiotherapist will be able to advise you on these. If your sleep is affected, it’s good to have a regular routine and some method of pain relief before bed.
Physiotherapists will help you with daily exercise by giving you a plan to follow that suits your needs. Your exercise plan will aim to make your muscles stronger and more flexible, which may help prevent damage to your joints and improve your movement. If you have a flare-up or a specific joint problem your physiotherapist will help you to improve or regain your strength.
A good upright posture is important to keep your body working efficiently. This means keeping the muscles strong enough to keep the back straight, with the shoulders relaxed but held back and the head up. This is particularly important when you’re sitting using a computer. Your therapists can give you tips to improve your posture and exercises to strengthen the ‘core’ of your body (the muscles of your stomach and back).
Splints and insoles
Splints will help stabilise your joints and give support to allow you to keep going for longer periods.
A podiatrist will be able to provide you with insoles, which will give added support to your feet and ankles and can often help to relieve pain in your knees and hips.
Protecting your joints
It’s important to be aware of joint protection. The muscles and soft tissues which hold your joints in place can be put under strain as you use them. Use supports for the joints if necessary and ensure that your muscles are as strong as possible. Your therapists will give you advice about the best ways to protect your joints when out and about or performing certain tasks.
Your therapists can provide equipment to help with your daily routine of washing and getting ready. An occupational therapist can give advice and provide equipment to help you be independent – for example, an aid to get in and out of the bath, if necessary.
Most young people with JIA have normal mobility. However, you may need to allow extra time to get from place to place, especially if you have to use stairs. You may need crutches to help with walking, or a wheelchair if walking distances becomes a problem. Your therapy team will advise you on what mobility aids you may need and give you tips for getting about.
To ensure you get the right wheelchair for your needs an assessment will be necessary. Remember that a wheelchair is an aid to your mobility, not a replacement for it.
Will I need surgery?
Some young people with severe arthritis will benefit from surgery when other treatments haven’t helped. However, such procedures are now much rarer due to the more effective drug therapies available.
Please note that the information on our drugs pages has been written for adult use and may be different for young people. Speak to your rheumatologist for more specific information about medication and young people.