Juvenile rheumatoid arthritis (JRA) is often difficult to diagnose and treat. A team of specialists usually deal with patients with this condition. This is called the multi-disciplinary approach. The team includes:-
- Paediatricians or specialists in childhood diseases
- Paediatric nurses
- Occupational therapists
- Eye specialists
- Orthopaedic surgeons or specialists in bone and joint diseases
- Paediatric rehabilitation medicine physicians
- Paediatric rheumatologists who deal with rheumatic diseases in children
- Physical therapists
- Social workers
Aims of treatment
There are two aims of treatment:-
- to relieve the symptoms of the disease
- to prevent the disease progression and joint damage
Treatment of JRA
- To ease the symptoms pain relievers and anti-inflammatory agents are the primary mode of therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are the drugs used widely to control symptoms of rheumatoid arthritis.
- To prevent progression of joint damage and inflammation corticosteroids are used. However, these agents may hamper growth to a great extent and are usually used over short term to combat the features and symptoms of flare ups. In cases of severe polyarticular JRA, oral steroids are sometimes used while waiting for DMARD therapy to take effect.
- Around half of the children with JRA may need disease-modifying anti-rheumatic drugs or DMARDs. These agents have a varied mechanism of action and they act by reducing joint swelling and pain, decreasing markers of acute inflammation in blood and halt the progressive joint damage. DMARDs include Methotrexate, Sulfasalazine, Leflunomide, Hydroxychloroquine, Gold salts and Ciclosporin.
- The role of the new ‘biological agents’ etanercept, infliximab, adalimumab and certolizumab or monoclonal antibodies like abatacept, rituximab, and tocilizumab are being evaluated.
- Supportive treatment includes exercise, joint protection, psychological support to help deal with the associated symptoms and disability. Physiotherapy is an important part of therapy of debilitating arthritis. This helps maintain optimum joint flexibility and strength and encourage patients to remain physically active.
Assistive devices, such as a shoe inserts, braces or splints may help cope with disability. Such orthotic devices can rest or support joints, relieve pain and improve joint mobility.
Exercises especially swimming, walking and range-of-motion activities may help maintain activity and motion as well as act as recreation.
- Additional measures include weight control, minimizing strain on weight-bearing joints, reduce and treat loss of appetite, fatigue, fevers and delayed motor skills.
- Surgery may be performed rarely and sparingly. It can be used to release tissue causing joint contractures and remove inflamed tissue from joint linings
- For iritis or uveitis there may be red and painful eyes. Because symptoms might not appear until significant damage occurs, all children with JRA need to be checked regularly by eye specialists.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)