Treatment for juvenile arthritis is not without risks
BY DR. KOMOROFF Universal Uclick
Thursday, December 20, 2012
12/20/12 at 2:16 AM
Dear Doctor K: My young granddaughter has juvenile rheumatoid arthritis. I worry about the effects of the powerful medications she has to take.
Dear Reader: Modern medicine has created real miracles. But we are not yet smart enough to create tests and treatments that are free of side effects.
Treating children with this condition is a delicate balance. It's true the treatment can cause immediate side effects and there can be long-term risks. However, doctors want to do everything they can to promptly relieve their young patients' suffering and to protect them against long-term bone damage.
With juvenile rheumatoid arthritis, the lining of the joint becomes inflamed and enlarged, limiting movement and causing pain and tenderness. Enzymes released by the inflamed membranes erode the bone and cartilage. This joint and bone damage can cause problems in a growing child; bones may develop abnormally in shape or size.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first medications used to relieve joint inflammation. But NSAIDs can cause ulcers. COX-2 inhibitors may be safer for the stomach.
Doctors may use corticosteroids, which are fast-acting anti-inflammatory agents. But they can cause weakened bones, increased susceptibility to infections and stunted growth.
Drugs known as DMARDs often provide relief if other medications have failed. The most widely used is methotrexate. These drugs can cause liver damage or other complications.
Powerful newer treatments, including adalimumab (Humira), etanercept (Enbrel), infliximab (Remicade) and others, can be highly effective. But they also have the potential for side effects, particularly the reactivation of bacterial and fungal infections.
For many children, symptoms of juvenile rheumatoid arthritis gradually lessen or disappear as they enter adulthood.
Write Dr. K at www.AskDoctorK.com or c/o Universal Uclick, 1130 Walnut, Kansas City, MO 64106