Does Juvenile Arthritis Last Forever?

Arthritis may seem like a cruel fate for a young person, but many children cope admirably with their disease. With treatment and support, they have a good chance of staying active and happy.

Fortunately, juvenile arthritis isn't always permanent. According to a review of JA studies reported in Pediatrics, about one-third of all patients went into remission from the disease (that is, they no longer showed symptoms of JA). Some forms of JA are easier to manage than others. As reported in a study, the Pediatrics article reviewed, an impressive 74 percent of children with systemic arthritis go into remission within five years. In contrast, only 34 percent of children with pauciarticular arthritis and 25 percent with polyarticular arthritis went into remission during that time period.

What are the possible complications?

Many children with juvenile arthritis recover without any long-term effects. In some children, however, the condition can cause permanent damage to joints.

Without treatment, other complications may arise. Roughly 20 percent to 30 percent of children with one type of pauciarticular arthritis develop inflammation of the eye, a condition that can lead to blindness without proper treatment. JA can also cause joints to grow too quickly or too slowly, making one limb shorter than the other. In some cases, a child's overall growth is stunted.

What medicines are used to treat juvenile arthritis?

Often, simple over-the-counter painkillers like ibuprofen (Advil, Motrin) and naproxen sodium (Aleve) can greatly ease a child's symptoms and help them get back to a normal life. But just because these drugs are available at the convenience store doesn't mean you should take matters into your own hands. Your child's doctor can help you choose the right medication for your child.

Be aware that over-the-counter painkillers can cause severe problems if misused. Aspirin, for instance, can cause liver damage or bleeding stomach ulcers; when given to a child with a viral infection, it can cause Reye's syndrome, a potentially life-threatening disease. Because of this, children should not take aspirin. Whatever type of medication the doctor recommends, watch out for possible side effects (such as black stools or abdominal pain and cramping) and report them to your physician promptly.

A doctor may prescribe a drug that attacks the disease itself, rather than simply controlling the symptoms. So-called disease-modifying anti-rheumatic drugs (DMARDs) can keep the body from turning against itself and help prevent further damage to bones and joints.

The most commonly prescribed traditional DMARD is methotrexate, a drug that slows down the immune system. According to Pediatrics, studies show that 60 to 80 percent of JA patients improve while taking methotrexate. In small doses, methotrexate is generally safe.

However, about 13 percent of kids have stomach trouble, and there's always a chance that

liver damage may occur, though it's much less common in kids than in adults. Many doctors recommend regular liver tests for any child taking the drug. And because methotrexate weakens the immune system, a doctor may refrain from giving live-virus vaccines to a child on the drug. Check with your doctor about other drugs that can be used to treat juvenile arthritis.

As with methotrexate, it pays to be cautious with any medicine that affects the immune system. Many DMARD drugs have a black box warning -- the most serious drug warning the Food and Drug Administration issues. Children should be current on all of their immunizations before taking the drug, and they shouldn't take the drug within three months of receiving a live-virus vaccine. To be extra safe, they should briefly stop taking the drug if they've been exposed to chickenpox. (Always check with a doctor before stopping any drug.)

Some biologic drugs, including Enbrel, have also been used as second-line treatments for juvenile arthritis. Enbrel has been been associated with certain infections, including tuberculosis; it has also been associated with an increased risk of lymphoma when used in children and teens and has a black box warning, according to the FDA.

In severe cases of JA, doctors might combine powerful drugs called corticosteroids with other treatments. These drugs can dramatically reduce inflammation. However, long-term use of the drugs can cause many serious side effects, including weakened bones and a vulnerability to infections. Once symptoms are under control, a doctor will slowly reduce the dose to lower the risk of complications.

What else can I do to help my child?

First of all, treat your child normally. Their arthritis shouldn't change your love, discipline, or expectations. Your child may need to rest during flare-ups, but he or she should stay as active as possible when symptoms fade. Regular exercise will help keep their joints strong and flexible. A physical therapist can help recommend exercises and activities that will be especially helpful.