JUVENILE RHEUMATOID ARTHIRITIS (JRA)

There is no curative treatment available. The goal of therapy is to reduce the arthritis, maximize joint function and prevent joint destruction and deformity. Therapy consists of a combination of medications, physiotherapy and patient education. Therapy is customized according to disease activity, types of joints involved, general health and age of the patient.

Medications – consists of anti-inflammatory drugs (NSAIDS) such as aspirin, ibuprofen and even corticosteroids to decrease pain and inflammation.
Other drugs such as methotrexate, chloroquine and gold salts are used to induce remission and prevent progressive joint destruction.
The drug used for a patient depends on severity of the disease and is individualized.
The most common side effects of the NSAIDS (non-steroidal anti-inflammatory drugs) are gastr it is and stomach ulcers. Hence, they are usually taken with food. Corticosteroids are useful to short periods during severe disease activity when the disease is not responding to NSAIDS. They are given as tablets or injected directly into joints. They are very potent in reducing inflammation and restoring joint mobility and function. However, they have several side effects and hence are given under a doctor’s guidance and regular monitoring.
Calcium and Vitamin D supplements may be required to prevent thinning of bones due to osteoporosis.

Physiotherapy – Proper exercise is important to maintain joint mobility. It involves passive movement of the joint during acute disease state and active mobilization of the joint when the disease is recovering to maximize joint mobility. Immobilizing the joint with splints may be required to prevent deformities during active stage due to overuse of the joint.

Surgery – It is recommended to repair damaged joints. Total joint replacement may be required in painful joints with limited movement and deformity.

JRA is a chronic disease characterized by periods of flares and remission. With combined exercise, joint protection and medications - the residual damage and deformity of the joint is minimized.

Newer therapy such as monoclonal antibody therapy is being developed where these monoclonal antibodies are directed against a special factor causing disease called the tumor necrosis factor (TNF-alpha). Also studies involving various types of collagen are in progress.

Last updated on 31-05-2004