Children who have
juvenile idiopathic arthritis (JIA) are first treated
with non-steroidal anti-inflammatory drugs (NSAIDs) that
often provide relief and reduce inflammation. NSAIDs are considered the
first-line treatment for JIA. Second-line drug therapy-known interchangeably as
disease-modifying antirheumatic drugs (DMARDs) and as slow-acting antirheumatic
drugs (SAARDs)-for JIA may be recommended when a child continues to have joint
pain, swelling, or both despite rest, exercise, use of NSAIDs, and physiotherapy.
DMARDs/SAARDs include azathioprine,
cyclosporine, etanercept, methotrexate, and sulfasalazine.
a lot in common.
They are slow to take effect. It may take 8 to 24
weeks for the drug to show a benefit.
They have a small risk of
serious side effects (on blood cells, eyes, kidney, or liver). Side effects can
be detected with close monitoring and are reversible if the drug is
They have a moderate risk of side effects that may be
uncomfortable but are not serious (nausea, skin rash, mouth sores, diarrhea,
While these medicines offer effective treatment for
many children, they are not a reasonable treatment option for others. Side
effects or ineffectiveness, or both, are common reasons that children are
withdrawn from DMARD/SAARD treatment.
NSAIDs are often used
together with one of these medicines.
Although these medicines are often called
"disease-modifying," it has been hard to prove that they truly prevent
long-term joint damage. But they often relieve pain and swelling.
ByHealthwise Staff Primary Medical ReviewerSusan C. Kim, MD - Pediatrics Brian D. O'Brien, MD - Internal Medicine Martin J. Gabica, MD - Family Medicine Kathleen Romito, MD - Family Medicine Specialist Medical ReviewerJohn Pope, MD - Pediatrics