5. Medication at a glance

It’s important to say that whilst it can be a scary prospect to consider that your child may have to take medication for many years, not taking the drugs recommended by the health professionals can have long-term consequences. Unfortunately, the evidence shows that not taking the recommended medication can lead to damaged joints which never recover. Untreated or under-treated JIA in children could result in further health problems. Your child will be continuously monitored, and sideeffects can usually be effectively dealt with in several ways. It’s a good idea to mention any health supplements or complementary medicine that your child has been taking and any side effects from the prescribed medication.

“It can take a while to find the right combination of drugs for your child. For many parents this is the hardest and most challenging time. Each drug has to be given a fair amount of time to work (sometimes months) and it can be incredibly frustrating - I remember thinking that I wasn’t sure I trusted the docs any more as nothing seemed to work, until finally it did! Health professionals will not stop until the disease is under control, so you may have to be patient yet persistent.” Quote from a parent of a child with JIA.

Type Example Purpose & how medication is taken

Analgesics, also known as painkillers Paracetamol (co-dydramol & cocodamol) Help to control pain. Oral tablets and in liquid form

Non-steroidal antiinflammatory drugs (NSAIDS) Ibuprofen (suitable for all ages) Meloxicam Naproxen Ease pain and stiffness by reducing inflammation. Oral tablets and liquid form

Corticosteroids, also called steroids Prednisolone (often given by injection directly into affected joints) or by tablets Reduce inflammation and ease pain. Steroids are usually injected directly into the joint

Disease modifying anti-rheumatic drugs or DMARDs Standard DMARDs Methotrexate Usually the first Sulfasalazine (usually only given to older children) DMARDs prescribed on diagnosis. These reduce the immune system ‘attack’. They Hydroxychloroquine take time to work (usually only given to (weeks, even months). older children) DMARDs provide a way of controlling the disease over the long term, dependent on the type of JIA. Sulfasalazine and hydroxychloroquine are in tablet form only. Methotrexate comes in tablets, liquid form or sub-cutaneous injection Infrequent DMARD Leflunomide Only used occasionally and in tablet form

Biologic therapies Etanercept Adalimumab

Infliximab

Tocilizumab

Abatacept Anakinra

Canakinumab (rarely used) These drugs work by targeting particular chemicals or cells in the body’s immune system. They may be prescribed together with a standard DMARD. Etanercept and Adalimumab are given by sub-cutaneous injection and Tocilizumab and Abatacept are given by intravenous infusion