New Guidelines for Juvenile Idiopathic Arthritis

OTC and prescriptions updated for early JIA relief

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) Juvenile Idiopathic Arthritis (JIA) may involve chronic inflammation of one or more of the patient’s joints.  Most patient see inflammation before the age of 16.  Recent treatment advances have improved lifestyle and long-term results for these patients.

Timothy Beukelman, MD, MSCE led a research team charged with identifying the best therapies for patients with JIA. They considered appropriate patient care by combining the best available scientific evidence. After completing their review, the team gave their recommendation to the The American College of Rheumatology (ACR). This is the first set of guidelines established by ACR for JIA.

dailyRx Insight: JIA patients should talk to their child’s doctor about new medicines.

Dr. Beukelman’s team, comprised of clinicians, researchers and one patient advocate reviewed 200 JIA studies and evaluated 1,500 clinical situations that illuminated the decision making process in caring for JIA patients. As JIA presents different in each person, they put in groups with patients similar to their disease characteristics. There were five different groups with similarly situated patients.

The team recommended five medicines to use for JIA: Tylenol, steroid joint injections, anti-rheumatic drugs, and prednisone.

Pertaining to the specificly grouped patients the recommendations include: prescribing the disease-modifying antirheumatic drug TNF-o to children with a history of arthritis in four or fewer joints.  Significant active arthritis despite treatment with methotrexate, prescribing the same disease-modifying antirheumatic drug TNF-alpha to children with a history of arthritis in five or more joints.

And any active arthritis following an adequate trial of methotrexate, and prescribing a different antirheumatic drug, anakinra, in children with systemic arthritis and active fever whose treatment requires a second medication in addition to prednisone.

There are approximately 1.3 million rheumatoid arthritis sufferers in the United States, about 75 percent of whom are women. Rheumatoid arthritis damages the joints, most commonly in the hands, feet, and cervical spine. Inflammation can also affects other organs and systems in the body such as the skin, lungs (fibrosis), kidneys (amyloid protein deposits), and cardiovascular system (increased risk for heart attack and stroke, as well as fibrosis and pericarditis). There are many prescription medications used to treat rheumatoid arthritis such as hydroxychloroquine (Plaquenil), chloroquine (Aralen), leflunomide (Arava), and methotrexate (Rheumatrex ). Non-pharmacological treatment includes psychical therapy, orthoses, and nutritional therapy but these do not stop progression of joint destruction. Analgesics (painkillers) and anti-inflammatory drugs, including steroids, are used to suppress the symptoms, while disease-modifying antirheumatic drugs (DMARDs) are required to inhibit or halt the underlying immune process and prevent long-term damage. Recently the newer group of biologics, such as abatacept (Orencia), adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade), and rituximab (Rituxan) have increased treatment options. A clinical diagnosis can be made on the basis of symptoms, physical exam, radiographs, x-rays and lab tests.

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Last Updated:
March 31, 2011