Drug Treatments
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Analgesics are medications that can relieve pain, but do not necessarily reduce inflammation. They can be effective at
reducing mild to severe pain. Analgesics work either by preventing pain signals from being sent to the brain or by
preventing the brain from receiving or interpreting these signals. They typically take effect within 1 hour and can provide
relief that lasts between 4 and 6 hours. Analgesics may either be nonprescription (over-the-counter) or prescription
medications. One example of a nonprescription analgesic is Tylenol® (acetaminophen). Nonprescription analgesics are
generally well tolerated when taken as listed on the package. The most common side effects of some prescription
analgesics may include nausea and constipation. Some pain medicines available in both prescription and nonprescription
forms (Advil® [ibuprofen], for example) can also reduce inflammation.
NSAIDs: Fighting pain and inflammation
Nonsteroidal anti-inflammatory drugs (commonly called “NSAIDs”) are the most widely used and prescribed medications.
They may have significant advantages over analgesics because they can relieve not only pain but inflammation as well.
However, NSAIDs do nothing to slow the progression of joint damage in JRA itself. NSAIDs regulate the production of
chemicals in the body that help trigger inflammation. Unfortunately, this may lead to unwanted side effects, which can
include stomach ulcers, which may cause bleeding, tearing of the stomach lining, or other side effects. Fortunately, newer
developed drugs may help patients avoid stomach problems that may be caused by traditional NSAIDs while providing the
same benefits.
Steroids: Reducing inflammation
Steroids are synthetic forms of naturally occurring hormones produced by the adrenal glands. They can provide rapid and
powerful reduction of pain and inflammation for many people. Steroids may be given as injections into the joints to treat
flare-ups. These injections can provide short-term pain relief and reduce inflammation. Low doses of steroids in pill form
are also used often. Steroids can benefit patients, but their use can also carry risks. They can cause such things as blood
sugar elevations, cataracts, hypertension, growth retardation in children, increased susceptibility to infection and bruising,
osteoporosis, and weight gain depending on the dosage and length of treatment.
DMARDs: Slowing the progression of JRA
Disease-modifying antirheumatic drugs or DMARDs can slow the progression of JRA. In some cases, they may even inhibit
the progression of the disease. Although much remains unknown about how many of these drugs work, DMARDs appear
to inhibit inflammation of the joint, which in turn may slow the destruction of joints and cartilage. Once used as a last resort
after other treatments failed, DMARDs are now recommended as initial therapy along with NSAIDs. Taking effect over a
period of time that can range from weeks to months, DMARDs can reduce both pain and inflammation. Unlike NSAIDs,
DMARDs do not block the basic pain mechanisms, but instead act against the underlying inflammation that causes pain.
Although scientists do not have a clear picture of how some DMARDs work, they believe that DMARDs inhibit attacks on
connective tissues by the body’s own immune cells. Originally, some DMARDs were used—and are still being used—to
treat other conditions. Methotrexate was initially used to treat leukemia. Cyclosporine was used to prevent organ rejection
in people who had undergone transplants. Hydroxychloroquine sulfate was used to treat malaria. Only after years of use for
these other conditions were they approved for the treatment of JRA. DMARDs drugs may have side effects, which can
include among other things diarrhea, eye damage, liver damage, nausea, and vomiting. Side effects will depend on the
DMARD taken.
Corticosteroids
In children with very severe JRA, stronger medicines may be needed to stop serious symptoms such as inflammation of the
sac around the heart (pericarditis). Corticosteroids like prednisone may be added to the treatment plan to control severe
symptoms. This medication can be given either intravenously (directly into the vein) or by mouth. Corticosteroids can interfere
with a child's normal growth and can cause other side effects, such as a round face, weakened bones, and increased
susceptibility to infections. Once the medication controls severe symptoms, the doctor may reduce the dose gradually and
eventually stop it completely. Because it can be dangerous to stop taking corticosteroids suddenly, it is important that the
patient carefully follow the doctor's instructions about how to take or reduce the dose.
Biologic agents
Children with polyarticular JRA who have gotten little relief from other drugs may be given one of a new class of drug
treatments called "biologic agents." Etanercept (Enbrel), for example, is such an agent. It blocks the actions of tumor
necrosis factor, a naturally occurring protein in the body that helps cause inflammation.