Corticosteroids for juvenile rheumatoid arthritis

Taken by mouth (pill form, oral)

Injected

Eyedrops

Corticosteroids are similar to natural hormone substances produced by the body that help to reduce inflammation.

Corticosteroids are often used to treat juvenile rheumatoid arthritis. Corticosteroids that are taken by mouth or injected are most often used to control the initial stages of systemic juvenile rheumatoid arthritis (JRA), also known as juvenile idiopathic arthritis (JIA). Corticosteroids may also be used in children who have pauciarticular (oligoarthritis) or polyarticular disease with severe morning stiffness or night pain.

A short "burst" therapy (initially high doses of oral corticosteroids that are tapered off) may be useful when inflammation around the heart (pericarditis) or fever is present in children with systemic JRA.

Corticosteroids may also be used as "bridge" therapy when starting a stronger second-line medication, such as methotrexate, to control symptoms while the new medication takes effect. After a period of time, the corticosteroid is slowly withdrawn to see whether the other medication is effective.

Injections of corticosteroids may be used to treat specific joints when conservative therapy has controlled symptoms well except in those specific joints.

Corticosteroid eyedrops are used in children who develop inflammatory eye disease.

Corticosteroids can provide rapid, dramatic improvement in some people with JRA.¹

• Oral corticosteroids are often useful:
  • For children with systemic JRA who have fever and inflammation of the protective sac around the heart (pericarditis).
  • For controlling night pain or morning stiffness in JRA.
  • For controlling a flare-up of symptoms in polyarticular JRA.
  • While waiting for another drug such as methotrexate or etanercept to take effect. Methotrexate and etanercept are disease-modifying antirheumatic drugs (DMARDs).
• Injected corticosteroids usually help when they are injected into the painful joints of children with limited arthritis, especially in children who have not responded to nonsteroidal anti-inflammatory drugs (NSAIDs) or who cannot tolerate NSAIDs.
• Intravenous corticosteroids can help manage joint disease, but they are usually used only in children who have life-threatening complications such as pericarditis.
• Corticosteroid eyedrops usually act quickly to control a flare-up of eye inflammation.

Side effects of high or long-term corticosteroid doses in children include:

• Growth suppression.
• Bone thinning (osteoporosis).
• Easy bruising.
• Moon-face appearance with fluid retention and weight gain (cushingoid appearance, related to Cushing's syndrome).
• Mood swings.

Long-term use of corticosteroids causes significant side effects, including a weakened immune system and weakened muscles.

You can help reduce side effects, including growth problems, by giving your child this medication in the morning rather than at night. A low dose at bedtime is sometimes used to treat severe morning stiffness.¹

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

Long-term use of corticosteroids is not advisable due to the significant side effects. Low-dose corticosteroids have fewer side effects and may be appropriate for longer use in difficult cases.

In some cases the dose of corticosteroids that controls symptoms is too high for long-term use. The best dose may be a balance between a higher dose that controls symptoms well but causes significant side effects and a lower dose that doesn't control all symptoms completely but causes fewer side effects.

If your child is given corticosteroid treatment for 2 weeks or more, the medication should be gradually reduced (tapered), rather than abruptly stopped. Although tapering helps the body adjust to the change, some children have a temporary increase in pain when corticosteroid treatment is stopped.

Following a corticosteroid joint injection, your child should use the joint as little as possible for a day or two. A cast or splint may be put on the joint of a young child to protect the joint from excess movement.

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Citations

1. Giannini EH, Brunner HI (2005). Treatment of juvenile rheumatoid arthritis. In WJ Koopman, LW Moreland, eds., Arthritis and Allied Conditions, 15th ed., vol. 1, pp. 1301–1318. Philadelphia: Lippincott Williams and Wilkins.