Intense liver involvement and the potential development of macrophage activation syndrome could make the use of non-steroidal antiinflammatory drugs quite hazardous. The use of indomethacin in a child with systemic JRA who died, most likely from macrophage activation syndrome and DIC, led to the prohibition of the use of indomethacin in children for over a decade. So as we think about Before I discuss specific medications, I feel it s important to clarify the goals for treatment of childhood arthritis, for these have changed over the past two decades as we more thoroughly understand the persistent, destructive nature of juvenile rheumatoid arthritis juvenile rheumatoid arthritis, rumatoid arthritis, rhumatoid arthritis. We need to treat for remission of disease. It is not going to go away by puberty.
Active synovitis leads to destruction in children just as it does in adult patients.
Children should have normal growth, normal development and normal function. This means that we should treat them so that they can go to school every day, get to school on time, dress themselves, participate in PE, play sports, go shopping with their friends, raise their hand in class, walk from class to class, bicycle, run, go up and down stairs, hang from the monkey bars, etc. Before discussing new medications, I feel that familiar disease modifying agents should be used to their fullest extent. Methotrexate, as you know, can be given subcutaneously or even intravenously or intramuscularly. And many patients will respond better when switched to these routes.