Juvenile Idiopathic Arthritis (JIA)

Hala Etayari
JIA - Treatment
The goals of JIA treatment is to achieve long lasting remission, prevent joint destruction and deformities and maintain growth and development.
Achieving these goals requires multidisciplinary approach with the cooperation of rheumatologist, physiotherapist, occupational therapist and ophthalmologist. This is the best way to meet the child medical, psychological and educational needs.
Nowadays with the better understanding of the pathophysiology of the disease and the advent of biological drugs as a new modality of treatment, JIA patients have more options for treatment and better outcome.
Here are the commonly used drugs in treating JIA:
They are the first line drugs used in the treatment of JIA and they are well tolerated in children. Naproxen is one of the most commonly used agents. Their side effects include gastrointestinal symptoms as nausea, vomiting, and abdominal pain, and pseudoporphyrial rash.
Disease modifying agents (DMARDs):
Methotrexate is the most commonly used DMARD with good efficacy, and it is well tolerated. Its side effects include gastric upset, elevated liver enzymes, and pancytopenia. Patients should be monitored periodically for these side effects by CBC and liver function tests.(2,6)
When cost, availability, or concerns regarding lack of longer term outcome data with biologics are raised, sulfasalazine or Leflunomide may be considered as alternative or additional therapy.
Biological drugs:
These agents are monoclonal antibodies developed to target special pathological processes (Anti TNF, Anti IL1, and Anti IL6). They are used as third line treatment when first and second line treatment fail to control the disease.
Before using them patients should be screened for latent TB by chest x-ray and tuberculin test and CBC and liver function should be monitored throughout the treatment period.
Methotrexate and biological agents lowers body immunity and should be withheld during infections.
They are usually used as a bridge therapy to help induce remission before the DMARDs started to take effect and maintain the remission.

JIA is a heterogeneous group of diseases sharing in common the presence of chronic arthritis and vary in age of onset, clinical manifestations and outcome.
Better understanding of the pathophysiology of the disease lead to the development of newer modalities for treatment hence improving the outcome of patients.

Juvenile Idiopathic Arthritis (JIA) Juvenile Idiopathic Arthritis (JIA) 5/11/2016
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