What is the treatment for idiopathic chronic arthritis?

From the Guidelines

The treatment for idiopathic chronic arthritis should ideally start with methotrexate as the anchor drug, unless contraindicated, and be initiated as early as possible, ideally within 3 months, to reduce the risk of persistent disease. This approach is based on the 2016 update of the EULAR recommendations for the management of early arthritis 1. The management of idiopathic chronic arthritis involves a comprehensive strategy that includes pharmacological and non-pharmacological interventions.

Pharmacological Interventions

• Nonsteroidal anti-inflammatory drugs (NSAIDs) can be used for symptomatic relief but should be prescribed at the minimum effective dose for the shortest duration possible, considering gastrointestinal, renal, and cardiovascular risks 1.
• Systemic glucocorticoids may be used as a temporary adjunctive treatment to reduce pain, swelling, and structural progression, but their use should be limited due to cumulative side effects 1.
• Disease-modifying antirheumatic drugs (DMARDs), with methotrexate as the preferred initial choice, should be started early in patients at risk of persistent arthritis, even if they do not meet the classification criteria for an inflammatory rheumatologic disease 1.

Non-Pharmacological Interventions

• Dynamic exercises and occupational therapy are recommended as adjuncts to drug treatment to maintain joint mobility and functional ability 1.
• Patient education on the disease, its outcome, and treatment options is crucial, along with programs aimed at coping with pain, disability, and maintaining social participation 1.
• Lifestyle modifications, including smoking cessation, dental care, weight control, and management of comorbidities, are essential components of overall patient care 1.

The primary goal of treating idiopathic chronic arthritis is to achieve clinical remission or low disease activity, thereby preventing long-term disability and improving the patient's quality of life. Regular monitoring of disease activity, adverse events, and comorbidities is necessary to guide treatment decisions 1.

From the FDA Drug Label

1.2 Juvenile Idiopathic Arthritis HUMIRA is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis in patients 2 years of age and older. HUMIRA can be used alone or in combination with methotrexate. The treatment for idiopathic chronic arthritis (also known as juvenile idiopathic arthritis) is adalimumab (HUMIRA), which can be used alone or in combination with methotrexate 2.

• The recommended dosage is based on weight, with options for:

• 10 mg every other week for patients weighing 10 kg to less than 15 kg
• 20 mg every other week for patients weighing 15 kg to less than 30 kg
• 40 mg every other week for patients weighing 30 kg or greater

• Etanercept (Enbrel) is also an option for treating polyarticular juvenile idiopathic arthritis in patients 2 years of age and older 2 3.

From the Research

Treatment Options for Idiopathic Chronic Arthritis

The treatment for idiopathic chronic arthritis typically involves a combination of medications to manage pain, inflammation, and stiffness. Some of the treatment options include:

• Nonsteroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation 4, 5
• Disease-modifying antirheumatic drugs (DMARDs) such as methotrexate, hydroxychloroquine, sulfasalazine, and leflunomide to slow clinical and radiographic progression of the disease 4
• Biological-response modifiers such as infliximab, etanercept, and adalimumab to selectively inhibit specific molecules of the immune system 4
• Glucocorticoids to control pain, inflammation, and stiffness 4, 6
• Acetaminophen as a first-line therapy for mild-to-moderate pain management, especially for patients who cannot tolerate NSAIDs 7, 6

Safety of Non-Steroidal Anti-Inflammatory Drugs

The safety of using concurrent non-steroidal anti-inflammatory drugs (NSAIDs), including aspirin, or paracetamol (acetaminophen), or both, with methotrexate in inflammatory arthritis has been studied. The evidence suggests that:

• The concurrent use of NSAIDs with methotrexate appears to be safe provided appropriate monitoring is performed 8
• The use of anti-inflammatory doses of aspirin should be avoided due to potential adverse effects on liver and renal function 8
• Acetaminophen is a safe alternative for pain management, especially for patients who cannot tolerate NSAIDs 7, 6