If NSAIDs do not relieve symptoms of juvenile rheumatoid arthritis, the doctor is likely to prescribe a medication belonging to a class of medicines known as disease-modifying anti-rheumatic drugs (DMARDs). DMARDs slow the progression of juvenile rheumatoid arthritis, but because they may take weeks or months to relieve symptoms, they are often taken in combination with a NSAID. Various types of DMARDs are available. Doctors are likely to use one type of DMARD, methotrexate (Rheumatrex^®), for children with juvenile rheumatoid arthritis.

 

Arthritis research scientists have determined that methotrexate is safe and effective for some children with rheumatoid arthritis whose symptoms are not relieved by other medications. Because only small doses of methotrexate are needed to relieve arthritis symptoms, potentially dangerous side effects rarely occur.

 

The most serious complication with these drugs is liver damage, but it can be avoided with regular blood screening tests and doctor follow-up. Careful monitoring for side effects is important for people taking methotrexate. When side effects are noticed early, the doctor can reduce the dose before serious health problems develop.

 

In children with very severe juvenile rheumatoid arthritis, stronger medicines may be needed to stop serious symptoms, such as inflammation of the sac around the heart (pericarditis). Corticosteroids, like prednisone, may be added to the treatment plan to control severe symptoms. This medication can be administered either intravenously (directly into the vein) or by mouth.

 

Corticosteroids can interfere with a child's normal growth and can cause other side effects, such as a round face, weakened bones, and increased susceptibility to infections. Once the medication controls severe symptoms, the doctor may reduce the dose gradually and eventually stop it completely. Because it can be dangerous to stop taking corticosteroids suddenly, it is important that the patient carefully follow the doctor's instructions about how to take or reduce the dose.