Medication

signpostThe following article gives an overview of the medication commonly used to treat JIA. The article covers:

Dealing with pain
Dealing with inflammation
Dealing with both pain and inflammation
Controlling JIA with Disease Modifying Anti-Rheumatic Drugs (DMARDs)
Controlling JIA with Biologics

Dealing with pain

Paracetamol is one of the most common painkillers given in JIA and is available as a liquid for infants and liquid or tablets for older children.

Care must be taken to give the correct dose and strength according to the child’s weight and age.

Side effects are rare and usually relate to an overdose. 

 

Dealing with inflammation

Ibuprofen is one of the most common non-steroidal anti-inflammatory drugs (NSAIDs) given in JIA and is available as a liquid, tablet or cream. 

Ibuprofen works in 2 ways: 

  • As a simple pain killer, if taken occasionally 
  • To reduce the inflammation if a regular dose is taken over several days or weeks, dependant on the prescribing doctor’s advice 

Although heartburn, indigestion, stomach ulcers and skin rashes are possible side effects seen in adults, these are rare in children and young people. 

Alternative NSAIDs include: 

  • Naproxen 
  • Diclofenac 
  • Indomethacin 
  • Piroxicam 

 

Dealing with both pain and inflammation:

Corticosteroids (usually called steroids) act as powerful anti-inflammatory medications and with inflammation under control, the pain is lessened. 

Steroid preparations are available for joint injections, intra-muscular injections, tablets, creams and eye drops. 

The benefits of steroid treatments on the symptoms may or may not last long and the side effects can be significant especially when the dose is high for an extended period. 

Carefully controlled doses of steroids can be helpful in suppressing inflammation at the start of treatment before other medications have begun to work fully. 

 

Controlling JIA with Disease Modifying Anti-Rheumatic Drugs (DMARDs)

Adult and child thumbs upDMARDs have an effect on the underlying cause of inflammatory arthritis by: 

  • Dampening down the over-active immune system
  • Easing pain, swelling, stiffness
  • Preventing damaging changes within the joints 

Key facts: 

  • The benefit may take 8-12 weeks to be felt 
  • It is not unusual for 2, or occasionally 3, DMARDs to be used together 
  • DMARDs require regular hospital clinic visits, blood tests and other monitoring 

DMARDs include: 

 

'Biologic' drugs are targeted treatments against various inflammatory chemicals and cells of the immune system

TargetFor children and young people with an inadequate response to DMARDs, biologic treatments offer improved control. 

Etanercept is an ‘anti-TNFα drug’ and was specially designed to lower the inflammatory chemical, TNFα when there is too much in the joints. Too much TNFα stimulates joint inflammation, pain, swelling and possible damage. Etanercept is a small injection given just under the skin once or twice a week. 

Adalimumab is another form of anti-TNFα drug. This is is a small injection under the skin once a fortnight

Tocilizumab blocks the inflammatory chemical Interleukin-6 (IL-6), different to anti-TNFα, but there is also too much in inflamed joints. Tocilizumab is given monthly as an infusion into a vein

Abatacept prevents the T cells in the immune system from being fully activated and therefore dampens down inflammation. It is given as an intravenous infusion in hospital at 2 weekly intervals for 3 doses and then monthly. 

Canakinumab is a newly developed biologic drug and is currently only available from some specialist centres. It targets the inflammatory chemical Interleukin-1 (IL-1).   

 

By retired rheumatology clinical nurse specialist Nicky Kennedy BSc RN QN HV

Original article: 06/11/2015

Reviewed: N/A

Next review due: 06/11/2018