Drugs help control arthritis symptoms
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There are several families of drugs used as treatment once a child is diagnosed with juvenile rheumatoid arthritis.
The first line of treatment is nonsteroidal anti-inflammatory drugs, or NSAIDs, including over-the-counter drugs like ibuprofen, aspirin and naproxen.
The second line of treatment is disease-modifying anti-rheumatic drugs, or DMARDs. Best known is methotrexate, used in chemotherapy for cancer since the late 1940s.
"The thing with methotrexate is that it suppresses many chemical reactions in the body and it's non-specific, so it can have side effects like mouth sores or nausea," said Paul Rosen, clinical director of rheumatology at Children's Hospital of Pittsburgh.
According to arthritis literature, other rare but potentially dangerous side effects like liver damage also can occur, so careful monitoring is necessary.
Corticosteroids such as prednisone may be needed to stop serious symptoms such as inflammation of the pericardium, or the sac around the heart. But, whether given by mouth or intravenously, corticosteroids also can cause side effects. They can interfere with a child's normal growth and result in a round face, weakened bones and increased susceptibility to infections. Arthritis fact sheets say that it also can be dangerous to stop taking the drugs suddenly, so the patient must be tapered off them gradually under a doctor's careful watch.
For cases that don't respond to other treatments, the first biologic to become available was Enbrel (generic name etanercept) in 1999. Biologics are genetically engineered proteins derived from human genes, designed to stop specific parts of the immune system that cause inflammation. "That way there were fewer side effects," Dr. Rosen said.
A second biologic, Humira (generic name adalimumab) was approved for juvenile arthritis in 2008. Though effective in controlling symptoms, the safety of these drugs continues to be investigated.
More recently, "there are drugs coming out that block other proteins," Dr. Rosen said, "So medications are just getting better and better." One of the newest is rituximab, sold as Rituxan. "The main side effect is that it lowers the immune system. If there's an infection we treat it, but it's hard to counteract." The Juvenile Arthritis Alliance says, however, that only one biologic can be used at a time.
First Published May 19, 2010 12:00 am