Pharmacological therapy for initial symptoms of rheumatoid factor-positive polyarticular JIA
The approach to managing rheumatoid factor (RF)–positive polyarticular juvenile idiopathic arthritis (JIA), and the role of drugs for initial symptom management in it, is described in Management for rheumatoid factor positive JIA.
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used for initial symptom management (ie to reduce pain and stiffness); they usually only have a short-term role while awaiting the effects of disease-modifying antirheumatic drug (DMARD) therapy. For children and adolescents with confirmed disease who have significant pain and stiffness despite the use of an NSAID at an appropriate dose, an oral corticosteroid may be started while awaiting response to DMARD therapy. In most situations, this should only be done after seeking specialist advice.
All of the NSAIDs listed below are equally effective, and drug choice should be based on patient factors (eg comorbidities), available formulations, and ability to dose around daily schedule. Give:
1celecoxib 2 to 4 mg/kg (for overweight children, use ideal body weight) up to 100 mg orally, twice daily until symptoms subside1 celecoxib celecoxib celecoxib
OR
1diclofenac 1 to 1.5 mg/kg (for overweight children, use ideal body weight) up to 75 mg orally, twice daily until symptoms subside1 diclofenac diclofenac diclofenac
OR
1ibuprofen immediate-release 5 to 10 mg/kg (for overweight children, use ideal body weight) up to 400 mg orally, 3 times daily until symptoms subside2 ibuprofen ibuprofen ibuprofen
OR
1indometacin 0.5 to 1 mg/kg (for overweight children, use ideal body weight) up to 50 mg orally, 2 or 3 times daily until symptoms subside1 indometacin indometacin indometacin
OR
1meloxicam 0.125 mg/kg (for overweight children, use ideal body weight) up to 15 mg orally, daily until symptoms subside1 meloxicam meloxicam meloxicam
OR
1naproxen immediate-release 5 to 7.5 mg/kg (for overweight children, use ideal body weight) up to 500 mg orally, twice daily until symptoms subside3 naproxen naproxen naproxen
OR
1naproxen modified-release (child 50 kg or heavier) 750 to 1000 mg orally, daily until symptoms subside naproxen naproxen naproxen
OR
1piroxicam 0.2 to 0.4 mg/kg (for overweight children, use ideal body weight) up to 20 mg orally, daily until symptoms subside4. piroxicam piroxicam piroxicam
If oral corticosteroid therapy is considered appropriate, use:
prednisolone (or prednisone) 0.25 to 1 mg/kg up to 60 mg orally, daily. prednis ol one prednis(ol)one prednis(ol)one
Patients started on corticosteroids should be reviewed frequently and the dose tapered according to response.