Material provided by the National Institute of Arthritis and Musculoskeletal and Skin Diseases. You may visit their website at www.nih.com.

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For juvenile idiopathic arthritis, the main goals of treatment are to preserve a high level of physical and social functioning and maintain a good quality of life. To achieve these goals, doctors recommend treatments to reduce swelling, maintain full movement in the affected joints, relieve pain, and identify, treat, and prevent complications.

Most children with JIA need medication and physical therapy to reach these goals.

This article will focus on the possible medications a child with JIA may have to take.

Non-steroidal Anti-inflammatory Drugs (NSAIDs) for Juvenile Idiopathic Arthritis
Aspirin, ibuprofen (Motrin, Advil, Nuprin) and naproxen or naproxen sodium (Naprosyn, Aleve) are examples of NSAIDs. They often are the first type of medication used.

Most doctors do not treat children with aspirin because of the possibility that it will cause bleeding problems, stomach upset, liver problems, or Reye's syndrome. But for some children, aspirin in the correct dose (measured by blood test) can control JIA symptoms effectively with few serious side effects.

If the doctor prefers not to use aspirin, other NSAIDs (non-steroidal anti-inflammatory drugs) are available. For example, diclofenac and tolmetin are available with a doctor's prescription. Studies show that these medications are as effective as aspirin with fewer side effects.

An important side note: When taking medication, all side effects should be reported to the doctor, who may change the type or amount of medication.

Corticosteroids: A Medication Option for Juvenile Idiopathic Arthritis
In children with very severe juvenile idiopathic arthritis, 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.

Disease-modifying Anti-rheumatic Drugs (DMARDs) for JIA
If NSAIDs do not relieve symptoms of JIA, the doctor is likely to prescribe this type of medication. DMARDs slow the progression of JIA, but because they take weeks or months to relieve symptoms, they often are taken with an NSAID.

Various types of DMARDs are available. In the past, doctors prescribed hydroxychloroquine, oral and injectable gold, sulfasalazine, and d-penicillamine; however, doctors are now much more likely to use methotrexate for children with JIA (see below).

Methotrexate: Another Medication for JIA
Researchers have learned that this type of DMARD is safe and effective for some children with rheumatoid arthritis whose symptoms are not relieved by other medications. Because only small doses of methotrexate are needed to relieve arthritis symptoms, potentially dangerous side effects rarely occur. The most serious complication is liver damage, but it can be avoided with regular blood screening tests and doctor follow-up.

Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose and eliminate side effects.

Talking to Your Doctor about JIA Medications
When discussing your child's treatment options for juvenile idiopathic arthritis, make sure you ask as many questions as needed to understand the management plan. What are the side effects of the recommneded medication(s)? Will progressively higher doses be needed? How will you know if it's not working?

Those are good examples of questions to ask your doctor about juvenile idiopathic arthritis medications, but remember: ask whatever you need to so that you fully grasp the treatment plan.

Note: Juvenile idiopathic arthritis (JIA) was previously known as Juvenile rheumatoid arthritis (JRA).