The goals of medical treatment for juvenile rheumatoid arthritis (JRA) are to reduce your child's joint pain and to prevent disability. Physical therapy and medication are the basis of medical treatment for JRA, also called juvenile idiopathic arthritis (JIA) or juvenile chronic arthritis.

Treatment is determined by the type and severity of JRA. Even when JRA is uncomplicated, an affected child still needs many years of medical treatment. To make sure your child's care is appropriate for the stage of disease, work closely with the medical team. Learn as much as you can about your child's disease and treatments, and stay on schedule with medication and exercise.

Because pain, stiffness, and swelling can change from day to day, it is important to learn how to assess your child's condition. It can be hard to know if children are having pain. Some children are not able to say what they feel, while others are afraid to say they feel pain if they think they will have to go to the doctor or think they will make their parents upset. Children also simply learn to cope with pain by sleeping or playing. To know a child is in pain, you may need to look for changes such as stiff movements, rubbing a joint or muscle, or avoiding movement.⁹ You may also notice your child is irritable or easily upset.

Initial treatment

Treatment for juvenile rheumatoid arthritis (JRA) usually begins after your health professional has eliminated other causes for your child's symptoms. A good indicator of JRA is if your child's pain, swelling, and stiffness in the joints have persisted for at least 6 weeks. Your health professional may set up a treatment team, often including a pediatrician, rheumatologist, and physical and/or occupational therapist.

Physical exercise is a crucial part of treatment for a child with JRA. Your child's physical and occupational therapists can teach you and your child exercises to do at home to prevent contractures and maintain joint range and muscle strength. Moving your child's arthritic joints regularly through their full range of motion helps prevent stiffening or deformity. Many children with JRA don't want to move painful joints and need encouragement to continue with daily physical therapy.

Medication will likely be an important factor in your child's treatment.

• Unless your child's condition is life-threatening or involves severe eye or joint inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) are likely to be the first line of medication treatment to reduce inflammation and any pain. If you see no improvement after 6 weeks, your health professional may try a different NSAID; some children gain relief from one NSAID but not another.
• In cases of severe JRA, your health professional may prescribe medications referred to as disease-modifying antirheumatic drugs (DMARDs) or slow-acting antirheumatic drugs (SAARDs). DMARDs/SAARDs that may be prescribed for JRA include methotrexate, either alone or in combination with other medications, and/or a newer DMARD called etanercept (Enbrel), which is a tumor necrosis factor (TNF) inhibitor.
• A corticosteroid injection into a joint also may be used to reduce inflammation, particularly if your child has pauciarticular JRA (oligoarthritis).