### Instruction:  Disease name:

    Juvenile arthritis

: Treatment

The main goal of treatment is to control inflammation to stop further damage to the joints, and to control symptoms so that the child can function well. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first medications tried to relieve joint inflammation. They work by decreasing the amount of an enzyme found in affected joints that promotes inflammation. This same enzyme, however, helps to protect the stomach, so NSAIDs often cause stomach irritation and ulcers. Low doses of NSAIDs are available over-the-counter, including ibuprofen (Advil, Motrin and other brand names) and naproxen (Naprosyn, Aleve and others). Celecoxib (Celebrex) is a newer prescription drug, called a COX-2 inhibitor that is thought to be safer for the stomach because it does not have as much of an effect on the enzyme that protects the stomach. In moderate to severe cases, children with juvenile arthritis may be treated with more powerful medications or a combination of medicines. Corticosteroids (such as prednisone) are fast-acting, anti-inflammatory agents that may be used to stop dangerous inflammation, such as when the lining of the heart has become inflamed (pericarditis) or to stabilize a child in an acute stage of the disease. However, these drugs can have very serious side effects, including weight gain, weakened bones, an increased susceptibility to infections and interference with growth. They usually are prescribed for only a short time. They must be taken exactly as directed. Other drugs, called disease modifying anti-rheumatic drugs (DMARDs) — such as methotrexate (Rheumatrex and others) — act more slowly, but often provide relief if other medications have failed. These drugs can cause liver damage or other complications, so doctors will carefully monitor blood tests in children taking DMARDs. Other medications may be effective, including hydroxychloroquine (Plaquenil), sulfasalazine (Azulfidine), leflunomide (Arava), azathioprine (Imuran) and cyclosporine (Neoral, Sandimmune). Thalidomide may be effective for certain children with JRA, but care must be taken to avoid pregnancy while taking this drug and it can cause nerve damage. Newer, injectable treatments, including adalimumab (Humira), etanercept (Enbrel), abatacept (Orencia) and tocilizumab (Actemra) may be effective for juvenile idiopathic arthritis. Infliximab (Remicade), anakinra (Kineret), canakinumab (Ilaris) and rituximab (Rituxan) can also be highly effective for some children with juvenile idiopathic arthritis. Surgery sometimes is required if joint damage is severe or joint deformity has developed. Children with juvenile arthritis should be encouraged to maintain as normal a life as possible. Although there may be pain, exercise is important to help the joints keep moving and functioning well. Once symptoms are under control, it's good for your child to engage in usual play and sports activities. In severe cases, physical therapy may be recommended to keep the joints moving as freely as possible. Tutoring or special attention from teachers may be needed if the child misses many weeks of school due to illness. Also, counseling might be recommended to help the child deal with the emotional aspects of having a long-lasting (chronic) illness.