Juvenile Arthritis (cont.)
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
In this Article
- Arthritis in childhood? Isn't that only an old person's disease?
- How common is arthritis in children?
- What are the signs, symptoms, and treatment of the different forms of juvenile rheumatoid arthritis?
- Pauciarticular juvenile rheumatoid arthritis
- Polyarticular juvenile rheumatoid arthritis
- Systemic-onset juvenile rheumatoid arthritis
- What are some other forms of arthritis which can affect children?
- What is the outlook (prognosis) for children with arthritis?
- Juvenile Arthritis At A Glance
- Find a local Pediatric Rheumatologist in your town
Polyarticular juvenile rheumatoid arthritis
Polyarticular juvenile rheumatoid arthritis is the form in which four or more joints are involved after six months of illness. This form is more severe both because of the greater number of joints involved and the fact that it tends to get worse over time. These children may have a great deal of difficulty with normal activities and need to be treated aggressively.
From a doctor's point of view, the most important thing is to bring inflammatory arthritis under control as quickly as possible. Typically, this involves at least medications that reduce inflammation, nonsteroidal antiinflammatory drugs (NSAIDs). This may also require use of some fairly strong medications, but it's important to recognize that they are necessary to reduce symptoms and prevent permanent damage. One thing to watch out for is using steroids (for example, prednisone). In severe cases, this may be necessary, but it is not a "real" solution. Steroids make patients with arthritis feel wonderful, but it's like sweeping dirt under the rug. Everything looks good, but it really isn't. Taking too much steroid for a long period causes lots of problems, like short stature and weak bones. Whenever we are required to put a child on steroid medications, we want to wean them as quickly as possible. Nonsteroidal antiinflammatory drugs are enough for many children with polyarticular juvenile rheumatoid arthritis, but more severe cases may require more aggressive "second-line" medications, such as gold shots, sulfasalazine, or methotrexate. Severe cases requiring steroids or second-line medications should be under the care of experienced physicians.
A newer form of medication, biologics called TNF-blockers, is now available. Tumor necrosis factor alpha (TNF-alpha) is a substance made by cells of the body that has an important role in promoting inflammation. By blocking the action of TNF-alpha, TNF-blockers reduce the signs and symptoms of inflammation. Etanercept (Enbrel) is a self-injectable TNF-blocker that is injected into the skin twice weekly and is indicated for reduction in signs and symptoms of moderately to severely active polyarticular-course juvenile rheumatoid arthritis in patients who have had an inadequate response to one or more disease-modifying medicine(s). Infliximab (Remicade) is an intravenously infused antibody that blocks the effects of TNF-alpha. Remicade is given by intravenous infusion every two months. Remicade is effective for treating juvenile rheumatoid arthritis and can result in a significant and prompt reduction in disease activity and improved quality of life. Adalimumab (Humira) is also a self-injectable TNF-blocker that reduces the signs and symptoms of moderate to severely active polyarticular juvenile inflammatory arthritis in children 4 years of age or older.
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