How Juvenile Arthritis Is Treated

While there is no cure for juvenile arthritis, early diagnosis and proper treatment can lead to remission, a state of little to no disease activity or symptoms. A treatment plan for juvenile arthritis can include medication, lifestyle modifications, complementary therapies like acupuncture, and sometimes surgery.

Juvenile arthritis encompasses inflammatory and rheumatic diseases that develop in children under the age of 16. These diseases include juvenile idiopathic arthritis, juvenile lupus, juvenile myositis, juvenile scleroderma, vasculitis, and fibromyalgia.

Treatment goals are to reduce pain to improve quality of life, slow or stop disease progression, preserve joint function, prevent or avoid joint and organ damage, and minimize long-term health effects. Healthcare providers who treat juvenile arthritis do their best to ensure children can stay as active as possible.

The most common symptoms are joint pain, skin rashes, dry, painful, or sensitive eyes, difficulty breathing, fatigue, diarrhea, bloating, and sometimes a spiking fever.

Over-the-Counter (OTC) Therapies

For relief of pain and inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) may be given as the first line of approach to treating juvenile arthritis. These medications can also reduce fever in patients who experience elevated temperatures.

While there is some risk of gastrointestinal side effects, many of these drugs have a long-term safety record. The most common NSAIDs used in treatment are:

• Motrin (ibuprofen)
• Advil (ibuprofen)
• Aleve (naproxen)

Aspirin may also be used to treat pain and inflammation. Previously, aspirin was used before NSAIDs, but NSAIDs are now the standard option due to the ease of administration and the presence of fewer side effects. There is a risk of developing Reye's syndrome if a child or adolescent takes aspirin while they have chickenpox or the flu.

Prescriptions

NSAIDs have been the first line of defense in treating children with juvenile arthritis. After that, prescription drugs will be used. The main objective of medications is to reduce pain and inflammation in the joints and slow the disease’s progression.

Children who experience a more severe course of the disease are sometimes prescribed drugs that suppress the body’s immune system. More recently, as science has advanced, biologic drugs have also been used to treat juvenile arthritis.

DMARDs

Disease-modifying anti-rheumatic drugs (DMARDs) are used to help control the course of the disease. Methotrexate has been used for well over 20 years in the treatment of juvenile idiopathic arthritis.

Patients with oligoarthritis (four or fewer joints affected) experience the most benefits while on methotrexate, and there is some evidence to show that methotrexate can reduce the rate of progression of joint damage. Children on methotrexate should avoid live vaccines.

Corticosteroids

Corticosteroids are fast-acting anti-inflammatories that can also be used to treat juvenile arthritis. Given as an injection at a healthcare provider's office, they are typically used to manage the disease until other prescribed drugs begin to work.

Administering corticosteroids while simultaneously beginning treatment with a DMARD or biologic is known to create a bridge effect. This type of treatment aims to quickly control inflammatory symptoms while waiting for the effects of other treatments to begin.

Biologics

If NSAIDs, DMARDs, and corticosteroids fail to slow the disease's progression or bring it into remission, biologics may be prescribed either on their own or in conjunction with one of the other prescription therapies.

Biologics work by slowing down the body’s immune response. There is an increased risk of infection while on these drugs, so healthcare providers should monitor children well.

These drugs include, but are not limited to:

• Enbrel (etanercept)
• Humira (adalimumab)
• Orencia (abatacept)

Home Remedies and Lifestyle

Living with juvenile arthritis can be stressful. Symptoms may be overwhelming at times, but encouraging affected children to take good care of themselves can help reduce the stress and relieve some of those symptoms.

It is important to help your child maintain a healthy routine and engage in normal childhood activities. Regular attendance at school, participation in sporting activities, and playing with friends should all be encouraged.

Watching for any psychosocial effects on your child and engaging the help of a pediatric psychologist when necessary can also have a positive effect on their well-being.

Exercise

Exercise is safe for children with juvenile arthritis and should be encouraged. While it’s important for all children, exercise is especially vital for those with juvenile arthritis. Arthritis in childhood has been connected to muscle weakness around affected joints and low bone mass and strength.

In one study, children who engaged in a tailored six-month exercise program showed improvement in fatigue, which led to more physical activity.

Diet

There is some evidence that a Mediterranean diet that focuses on anti-inflammatory foods like fatty fish, fruit, vegetables, and whole grains can decrease inflammation and increase mobility in arthritis patients. Avoiding inflammatory foods like sugar or processed foods can also help.

Heat

For stiff joints, heat may be beneficial. Heat and cold have been the common home remedies for arthritis pain or stiffness, and there is scientific evidence that these treatments can provide relief from symptoms.

Surgeries and Specialist-Driven Procedures

The need for surgery has been reduced over the past 20 years as more powerful therapies have been developed and earlier diagnosis has become more common. With treatment and early diagnosis, there is a much lower risk that your child will develop extensive joint damage that requires surgery.

If disability occurs or pain interferes with daily mobility, surgery may become necessary. There are four main types of surgery depending on the effects of juvenile arthritis on the body.

Epiphysiodesis

Sometimes arthritis can disrupt the normal growth of the femur bones of the legs. When this occurs, children will have legs of different lengths. Children who have a leg length discrepancy of greater than 2 centimeters and who have at least two years of growth remaining may become candidates for this type of surgery.

The operation involves closing the longer femur’s growth center so that the shorter one can catch up. Recovery for this type of surgery is brief, with few complications.

Joint Fusion

When there is a joint deformity, joint fusion can correct it by removing the cartilage between two bones that form a joint and holding the bones together with a rod or pin. Over time these bones fuse, making them one solid, immobile bone.

Joint fusion can make the joint more stable, relieve pain, and help the child better bear weight. However, once a joint is fused, your child will not be able to bend it. This can place stress on nearby joints and is not recommended for hips or knees. Common locations for this type of surgery are the ankle and foot, hand and wrist, and spine.

Joint Replacement

Joint replacement is usually used as a last resort for joints that have severely deteriorated. It does come with complications such as stunted growth and premature failure of the artificial joint. However, total joint replacement can significantly reduce pain and restore mobility and function.

Most healthcare providers will try to delay the surgery as long as possible so that the child will have the best possible outcome. Joint replacement usually occurs in the hip or knee.

Synovectomy

The synovium is a thin membrane that lines a joint. With juvenile arthritis, chronic inflammation can cause the membrane to thicken and produce more fluid. This can affect joint structure and function.

When the synovium doesn’t respond to treatment such as corticosteroid injections, the synovectomy procedure removes it. Synovectomy can produce immense relief in children and restore function. However, the synovium can grow back, causing the pain to return.

Some children may be in such pain with severe swelling that even a brief period of relief is worth it. If the surgery is successful, the procedure can be repeated. Often, synovectomy is performed on the knee, wrist, and elbow.

Physical and Occupational Therapy

Physical therapy and occupational therapy can be beneficial to children with juvenile arthritis. A therapist can help your child learn appropriate exercises for their body and ways to adjust to any limits they may be experiencing in their daily life.

A therapist may also recommend splinting or orthotics to correct deformities or misalignments that can cause pain. Therapists can help increase regular physical activity as well, which has been shown to reduce joint pain and increase range of motion.

Complementary and Alternative Medicine (CAM)

In addition to lifestyle modifications and medications, there are nontraditional therapies that have been studied and proven to be effective at helping to manage some of the symptoms of juvenile arthritis.

Acupuncture

In one study, children and teens between the ages of 2 and 18 who were given acupuncture treatments reported an improvement in pain. The average reduction in pain lasted three days, which suggests that if you choose to use acupuncture to control your child’s pain, you may need to work with the practitioner to develop a continued program with frequent treatments.

Massage

Massage can be used as a complementary treatment for easing pain and anxiety in children with juvenile arthritis. However, it has little research-backed proof of effectiveness. A systematic review found only one older study of very low quality showing reduced stress hormone levels, pain, and anxiety.

Yoga

As with exercise and other activities, yoga can help by keeping the body moving. Yoga is a mind-body technique that incorporates breathing, moving in and out of poses, and an awareness of thoughts. In one study, yoga was found to help with the intensity of pain, the amount of stiffness experienced, and the duration of morning stiffness.

A Word From Verywell

Caring for a child with juvenile arthritis can be overwhelming, but understanding that there are treatment options can ease some stress. Not all treatments will be right for each child, and it may take time to find what works best for yours.

Staying proactive with prescribed treatments with the help of your healthcare providers and encouraging your child to remain active and take part in childhood activities like school and playing with friends can help improve their quality of life.

There may not be a cure for juvenile arthritis, but there are ways to enjoy childhood with the disease. Encourage your child to find them.