Treatment of juvenile rheumatoid arthritis consists of a combination of medication and physical therapy, which can help control the symptoms and prevent further damage but cannot actually cure the disease itself. In many cases, the preferred medication is aspirin in large doses, which decreases the extent of the inflammation. However, side effects rule out this course of treatment for one out of every six children with JRA. Fortunately, a number of other medications belonging to the same general type as aspirin (nonsteroidal anti-inflammatory drugs—NSAIDS) are available to combat the effects of JRA. These include ibuprofen (Advil, Motrin, etc.), Tolectin, Naprosyn, Feldene, Nalfon, and others.
For serious flare-ups that do not respond sufficiently to NSAIDS, various other medications may be used. Cortisone, given orally or as an injection at the site of inflammation, achieves the most dramatic improvement but is used with caution and generally only as a last resort due to potentially serious side effects and the fact that increasingly larger doses are needed in order for the drag to retain its effectiveness. Several slower-acting antirheumatic drugs, including gold salts, d-penicillamine, and hydroxychloroquine, work over a period of months to stop the breakdown of joint tissue. Methotrexate, a commonly prescribed cancer medication, has been effectively used as a fast-acting drag for severe cases of JRA.
Physical therapy is an important part of the treatment for JRA. In the past, children with JRA were kept in bed, sometimes in full body casts, leading to muscle and joint atrophy, as well as other problems—both physical and emotional—caused by immobility and isolation. Even if the arthritis itself was outgrown in adulthood (as it often is) the person was left with lifelong deformities that could only be treated by joint replacement. Today physicians and therapists regard this type of long-term damage as largely preventable through exercise—which strengthens and stretches the muscles surrounding the affected joints to prevent them from becoming weak, tight, or shorter from lack of use, and can also prevent a potential bone deformity called contracture. Although exercising can be painful and difficult for a child with stiff and swollen joints, it is extremely important to maintain a regular exercise schedule, either at a physical therapy facility or at home (or a combination of both). Several different types of exercise are helpful. Active exercise, consisting of activities such as knee bends, sit-ups, and toe-touching, strengthens the muscles. Passive exercise, in which another person moves the child's muscle groups through a range of motions, such as flexing and extension, helps maintain flexibility and prevents shortening of the muscles. Strength can also be attained through active resistive exercise in which the child moves a part of the body against resistance from another person. Aerobic exercises such as bicycling, swimming, and using rowing machines help maintain endurance. Swimming, as well as other forms of underwater exercise, are especially recommended because they relieve the joints of weightbearing pressure.
Although exercise is an indispensable part of the treatment for juvenile arthritis, daily periods of rest are also required. As a further treatment measure, heat is applied to relax muscles and help loosen stiff joints. Heat can help children with JRA through the period of morning stiffness they usually experience, and it can reduce pain and spasms from exercise. Moist heat may take the form of a warm bath, whirlpool, hot tub, hot pack, or heated paraffin bath. Saunas, ultrasound, sleeping bags, and diathermy (electrically produced deep heat) are effective sources of dry heat. Heated water beds can also provide comfort for a child with JRA. Some physicians have JRA patients wear a splint or brace to prevent deformity.
Often, the brace is worn only at night to decrease interference with daily activities.