From the Guidelines
Juvenile arthritis should be treated promptly with a combination of non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), and biologic agents to prevent permanent joint damage and improve health-related quality of life, as recommended by the 2019 American College of Rheumatology guideline 1. The treatment approach for juvenile idiopathic arthritis (JIA) depends on the severity of the disease and the presence of extraarticular manifestations.
- First-line treatment typically involves NSAIDs, such as ibuprofen or naproxen, to control symptoms and reduce inflammation.
- For more severe cases, DMARDs like methotrexate may be prescribed to slow down disease progression and prevent joint damage.
- Biologic agents, such as etanercept or adalimumab, may be necessary for cases that do not respond adequately to DMARDs.
- Corticosteroids, like prednisolone, can be used to manage acute flares and reduce inflammation. Key considerations in the treatment of JIA include:
- Prompt initiation of therapy to prevent permanent joint damage and improve outcomes
- Regular monitoring of disease activity and adjustment of treatment as needed
- A multidisciplinary approach to care, including physical therapy, pain management, and proper nutrition
- Early diagnosis and treatment are crucial to prevent joint damage and growth problems, as JIA can persist into adulthood and cause ongoing significant morbidity and impaired quality-of-life 1.
From the FDA Drug Label
2 Polyarticular Juvenile Idiopathic Arthritis Enbrel is indicated for reducing signs and symptoms of moderately to severely active polyarticular juvenile idiopathic arthritis (pJIA) in patients 2 years of age and older.
6 Juvenile Psoriatic Arthritis Enbrel is indicated for the treatment of active juvenile psoriatic arthritis (JPsA) in pediatric patients 2 years of age and older.
Etanercept (Enbrel) is indicated for the treatment of juvenile arthritis, specifically:
- Polyarticular Juvenile Idiopathic Arthritis (pJIA) in patients 2 years of age and older.
- Juvenile Psoriatic Arthritis (JPsA) in pediatric patients 2 years of age and older 2.
From the Research
Juvenile Arthritis Treatment
- The primary goals of pharmacotherapy in juvenile rheumatoid arthritis (JRA) are to suppress chronic synovitis, control systemic effects of inflammation, relieve pain, and limit the psychological impact of the disease 3.
- Available treatment methods include nonsteroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), oral or intravenous corticosteroids, immunosuppressants, and experimental therapies 3.
Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
- NSAIDs, such as ibuprofen and naproxen, are commonly used as first-line therapy for oligoarticular JIA 4.
- A study comparing the efficacy and safety of ibuprofen and naproxen found that both drugs had similar efficacy, but ibuprofen had a better safety profile with no adverse events reported 4.
- A systematic review and network meta-analysis of nine NSAIDs found that celecoxib had the highest probability of being the most effective, while rofecoxib and piroxicam demonstrated a higher probability of safety 5.
Biologic Agents and Pain Management
- Biologic medications are highly efficacious in juvenile idiopathic arthritis, but a subgroup of children treated with anti-TNF agents may experience persistent pain despite good disease control 6.
- Monitoring pain symptoms during treatment with modern DMARDs is essential to address this issue 6.
Safety of NSAIDs
- A study assessing the long-term safety of celecoxib and nonselective NSAIDs in JIA patients found that the safety profile of both was similar, with adverse events frequently observed with NSAID treatment 7.
- The results of this study and others provide evidence that the benefit-risk of celecoxib treatment in JIA remains positive 7.