There is no cure yet for JIA. However, there are various treatment strategies to alleviate symptoms, prevent joint destruction and maintain joint function and mobility. There may be periods when the symptoms improve or disappear (remission) and times when symptoms get worse (flares).
NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, naproxen or diclofenac, are prescribed to reduce pain and stiffness, and therefore helpful in helping the child feel more comfortable. However, these drugs will not have any benefit in preventing long term progression of the disease. When only 1 or 2 joints are involved, steroid injected directly into the joint can also be very effective. Depending on the severity and progression of the disease, DMARDs (disease-modifying anti-rheumatic drugs) are often necessary and are added as a second-line treatment. These include methotrexate and sulfasalazine. Such drugs can slow the progression of the disease and prevent arthritis flares, but they do take several weeks to reach their full effect. Corticosteroids, such as prednisolone, may be used for short duration whilst waiting for the DMARDs to take effect. Due to the potential side effects, the duration of use of corticosteroids, such as prednisolone, should generally be kept as short as possible. There is also a group of more recently developed advanced therapy called biologic agents, such as etanercept, infliximab, and anakinra. These drugs are very effective for JIA and are given as injections. It is important to note that all these medications need to be monitored by your doctor for side effects and toxicity. Discuss with the rheumatologist treating your child on the best treatment for him/her.
In the management of JIA, physiotherapists and occupational therapists play important roles. Once the joint inflammation is controlled, it is important to regain muscle strength previously weakened by the arthritis. Exercise helps to build muscle strength and endurance which is needed for joint stability and recovery of range of motion. Splints and other devices are sometimes useful to prevent joint contractures and deformities. Most children with JIA can take part fully in physical activities and selected sports when the arthritis is under control. Swimming is particularly useful because it uses many joints and muscles without putting weight on the joints. During a disease flare, limiting certain activities may be necessary. An acutely swollen and painful joint should be rested. Once the flare is over, the child can start regular activities again.
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