MEDICATION
Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs)
are traditionally the main treatment for all forms of juvenile idiopathic arthritis (JIA) and other pediatric rheumatic diseases. They reduce inflammation and fever. The most commonly used drugs are diclofenac, naproxen and ibuprofen; aspirin is not used as much, mainly because of the risk of serious side effects. It is possible that a particular NSAID may not have any effect while another may be very effective. The effect cannot be accurately predicted. The optimal effect with regard to inflammation is seen after several weeks.
In general, children tolerate NSAIDs well: stomach upset, the most common side effect in adults, is much less common in children. However, if a stomach upset does occur, gastroprotective agents may be prescribed.
In general, children tolerate NSAIDs well: stomach upset, the most common side effect in adults, is much less common in children. However, if a stomach upset does occur, gastroprotective agents may be prescribed.
Corticosteroids
Corticosteroids (such as prednisone) are the most effective, available anti-inflammatory drugs, but their use is limited. This is because corticosteroids can cause many side effects, including osteoporosis, obesity, high blood pressure, a form of diabetes, and delayed length growth.
are of great value in the treatment of rheumatic diseases that can involve inflammation of organs, such as the kidneys, lungs, heart and brain. Corticosteroids also reduce fever, which can be very high in people with a rheumatic disease. Corticosteroids are also used to prevent life-threatening complications. Finally, corticosteroids are used to tide over the period of time it takes for other medications to start working.
Local corticosteroids
Eye drops
Are used for the treatment of iridocyclitis. In more severe cases, peribulbar injections of corticosteroids (into the eyeball) or the administration of systemic corticosteroids may be required.
Joint injections
Injections into the joints may be required if one or several joints are inflamed, if there is a loss of mobility, or if the child’s joint hurts a lot. The drug injected is a corticosteroid, which often provides relief for several months. Because the drug is injected locally into a joint, barely entering the body, it has minimal side effects. Depending on the child’s age, the joint type and the number of joints to be treated, the joint injection can be given under local anesthesia or general anesthesia (often for very young children). It is generally not recommended to receive more than 3-4 injections per year into the same joint. Joint injections are often combined with other therapies to ensure rapid improvement in pain and stiffness or until the other medication begins to have an effect.
Colchicine
Colchicine or acetyltrimethylcolchicine is a substance extracted from the autumn crocus. In the past, colchicine was used in the treatment of cancer. The medicine works well in the prevention and treatment of gout flares.
Colchicine works in the treatment of gout because it has inhibitory effects on neutrophil granulocytes. The medicine is used successfully in the treatment of Familial Mediterranean Fever (FMF). It has also been successfully tested for the treatment of acute pericarditis. The most common side effects are abdominal pain, nausea, vomiting, diarrhoea.
Biologics
In recent years, we have seen the introduction of many medicines with new targets called “biologics”. Doctors use this term for drugs that are derived from living cells and that, unlike methotrexate or leflunomide, primarily target specific cytokines or receptors.
Biologics are generally expensive and the long-term side effects are not fully known. For these reasons, biologics are not prescribed lightly. The most common side effects of biologics are an increased risk of infections and allergic reactions. Before someone can start with certain biologics (especially anti-TNF agents), extra tests will be carried out to make sure there are no latent (dormant) infections (such as TB). If you are using biologics, you can’t get certain some vaccinations. It is recommended to consult with the treating physician in advance.
Anti-TNF drugs (infliximab, adalimumab, etanercept, golimumab)
Anti-TNF drugs selectively block TNF, an essential factor in the inflammation process. They are used alone or in combination with methotrexate. The effect of anti-TNF is noticeable after 4-8 weeks, depending on which TNF inhibitor is given. Etanercept is taken once or twice a week as an injection under the skin, adalimumab every other week under the skin, and infliximab once every 4-8 weeks via intravenous infusions. Other medications include golimumab and certolizumab, and there are other molecules currently being studied in adults that may become available for children in the future.
Anti-interleukin-1 (anakinra and canakinumab) and anti-interleukin-6 (tocilizumab)
These medicines are particularly relevant for the treatment of autoinflammatory diseases, such as systemic JIA and periodic fever syndromes.
Anakinra is given once a day by an injection under the skin, is prescribed for children with systemic childhood arthritis (S-JIA) and for children with periodic fever syndromes. Canakinumab is the long-acting form of anti-IL1, and only needs to be given once every 4 to 8 weeks. Tocilizumab can be given through an infusion or as an injection under the skin. One of the most common side effects of Anakinra is a local skin reaction that occurs after about 7-10 days of injections. To reduce the symptoms of this drug, an antihistamine or local steroid ointment may be prescribed. It is important to continue with the injections. The skin reaction will disappear by itself.
For detailed information about medication, please visit www.gronitis.nl