Treatment of JIA

These are often used early in treatment as they can work quickly to reduce pain, stiffness, and inflammation in the joints. They are generally well tolerated.

If your child cannot take tablets, NSAIDs are also available in liquid form—just ask your healthcare team. For school-aged children, Naproxen can be a helpful option as it lasts longer in the body and is usually taken twice a day, meaning it often does not need to be given during the school day.

NSAIDs help control symptoms but do not treat the underlying cause of the arthritis, so additional medications may be needed.

Steroids are often used to quickly control inflammation, either while waiting for other medications to take effect or to treat a flare. They are highly effective and can improve symptoms within hours to days.

Steroids can be given in several ways:

• Joint injections directly into affected joints.
  • In younger children, this is usually done under general anaesthetic as a day case
  • In older children, it may be done in clinic using local anaesthetic and Entonox (laughing gas), sometimes with distraction techniques such as virtual reality (VR) headsets
• By mouth or infusion (through a cannula) if multiple joints are affected
• Eye drops for uveitis

Steroids work well but are not suitable for long-term use, so other medications are usually introduced if ongoing treatment is needed.

Steroids given by mouth or infusion should not be stopped suddenly. Your child’s team will provide a plan to gradually reduce (wean) the dose safely and will support you through this.

Some children may experience side effects, especially with longer courses, and your medical team will discuss these with you.

DMARDs are usually the first preventive medications given to children with JIA. They help control inflammation and prevent joint damage over the long term. These medications have been widely used in children for many years and have an excellent safety record.

Because some DMARDs can take several weeks to reach full effect (up to 12+ for methotrexate for example), steroids may be used temporarily to control symptoms while waiting for them to work. Regular blood tests are required to check the immune system and liver function. In most cases, if blood results are slightly out of range, a short break from the medication is enough to allow things to settle, after which the child can resume treatment. See our Tips & Tricks – Blood Tests Leaflet for more info.

Methotrexate is the most commonly used DMARD for JIA. It can be given as tablets, liquid, or by injection using an auto-injector pen. Many children tolerate methotrexate very well, but if side effects occur, your team can advise on ways to manage them.

Folic acid is usually prescribed alongside methotrexate (taken on a different day) to help reduce side effects such as nausea, fatigue, or mouth ulcers. Anti-nausea medications such as Ondansetron can also be prescribed. It’s important to contact your healthcare team as soon as any side effects appear so they can be managed early.

Other DMARDs are available if methotrexate is not suitable or needs to be supplemented, and your child’s team will guide the best choice for your child.

Biologic medications are used when DMARDs, such as methotrexate, do not work well enough for an individual. They target specific parts of the immune system that cause inflammation, rather than affecting the immune system more broadly.

Biologic medications have been used in the treatment of JIA since the early 2000s and are given by injection or infusion. Biologics are often used alongside a DMARD, as this can improve how well the treatment works and reduce the risk of the body developing antibodies against the biologic (which can make it less effective).

Biologic medications are generally well tolerated. Healthcare professionals follow National Institute for Health and Care Excellence (NICE) guidance when prescribing these treatments. Ongoing research aims to identify which biologic works best for each individual, so some children may need to try more than one medication to find what works best for them.

Children taking biologic medications may have an increased risk of infections and will be regularly monitored during treatment. Some children experience mild injection site reactions, which can be managed with antihistamines if needed.

Biosimilars are highly similar versions of biologic medications. They are safe and effective alternatives to the original biologic treatments.

They are usually less expensive, and switching from an original biologic to a biosimilar is generally safe, with no meaningful difference in how well the medication works or its side effects.

In the UK, biosimilars are carefully assessed by the Medicines and Healthcare products Regulatory Agency (MHRA) to ensure they match the original biologic in quality, safety and effectiveness. Guidance on their use is provided by the National Institute for Health and Care Excellence (NICE).

If your child is switched to a biosimilar, they will be monitored to make sure the treatment continues to work well.

medications are used to treat JIAThese medications reduce inflammation but work differently from biologic therapies. They act inside immune cells to block inflammatory signalling pathways.

They are taken by mouth (as tablets or liquid) and are generally well tolerated. They may be used alone or alongside DMARDs, depending on the patient.

As with biologic medications, children taking JAK inhibitors need regular monitoring, as they may have an increased risk of infections. In some cases, they may also develop raised cholesterol levels and regular blood tests are used to check for this.

Many medications used for JIA mean that live vaccinations should be avoided. For more information,  see “are vaccinations safe for my child?” question