Integrative Treatment Approaches for Juvenile Idiopathic Arthritis

Leslie M. Temple

Juvenile idiopathic arthritis (JIA), also known as juvenile rheumatoid arthritis, is a nonspecific type of arthritis appearing before the age of 16 years and lasting at least 6 weeks. JIA is the most common chronic arthritis in children. Two peaks of onset have been described at 2 to 4 and 6 to 12 years of age, most often in Caucasian and female patients. In 2011, the American College of Rheumatology (ACR) updated their recommendations for pharmaceutical management of patients with JIA to include the following treatments alone or in combination: non-steroidal anti-inflammatory drugs (NSAIDs), intra-articular glucocorticoid injections, methotrexate (MTX), sulfasalazine, tumor necrosis factor alpha (TNF-α) inhibitors (ie, etanercept [Enbrel] and adalimumab [Humira]), leflunomide, abatacept (Orencia), anakinra (Kineret), and systemic glucocorticoids.

Because of concerns of adverse events, the ACR recommends that NSAID and MTX safety monitoring consist of baseline serum creatinine levels, urinalysis, complete blood count, and liver function testing with repeat lab measurements over time. TNF-α inhibitors also require yearly pharmaceuticals and natural health products (NHPs) are sparse, so if the clinician decides to use some natural products with the above medications, the lab studies can help with safety monitoring of novel combinations.

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