Written by pharmacy student Amy Harrington, Medical University of South Carolina, College of Pharmacy, Class of 2021
What is Arthritis?
- A common disease affecting more than 50 million adults and 300,000 children in the US.
- A broad term used to characterize more than 100 types of arthritis and related conditions.
- The leading cause of disability in America.
- A disease that affects people of all ages, sexes, and races (though most frequently seen as people get older and more common in women).
What is Juvenile Arthritis?
Juvenile arthritis (JA), also known as pediatric rheumatic disease, is a term that encompasses the inflammatory and rheumatic diseases affecting children younger than 16 years old. Most types of JA are autoimmune or autoinflammatory diseases. Although the exact causes of JA are unknown, it is believed that genetics may play a role.
There are many types of JA, and the most common include juvenile idiopathic arthritis (most common), juvenile myositis, juvenile lupus, juvenile scleroderma, vasculitis, and fibromyalgia.
Symptoms of Juvenile Arthritis
While some types of JA exhibit few or no symptoms, most cases are accompanied by symptoms that manifest in the joints, skin, eyes, or internal organs.
- Joints may appear red or swollen, and feel stiff, painful, tender and warm.
- Skin symptoms may appear as a rash or as hardened patches.
- Eyes may exhibit dryness, pain, redness, light sensitivity, and vision problems.
- Internal organs such as the digestive tract, lungs and heart may be affected.
- Additional symptoms of JA may include fatigue, appetite loss, and high spiking fever.
Diagnosis of Juvenile Arthritis
A healthcare professional (pediatrician or rheumatologist) will typically ask questions about the child’s medical history and symptoms and look for signs of JA through a physical exam. Laboratory and imaging tests may also be used to diagnose JA.
Juvenile Arthritis Treatment
Traditional Prescription Therapies
Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) are used in treating JA. Below is a summary of the risks and benefits of each, based on medication class.
Topical Products for Arthritis Pain Management
Counterirritants (available OTC), distract from pain by creating a temporary hot and/or cold sensation. Examples include: menthol and camphor.
Salicylates (available OTC), which have mild anti-inflammatory effects, are often used in combination with counterirritants. Examples include: trolamine salicylate and methyl salicylate. Not recommended for use in children younger than 12 years old.
Capsaicin-containing products (available OTC) may have a role in blocking pain signals.
Lidocaine products (available OTC and by prescription) work as local anesthetics by interrupting pain signals to the brain.
Topical NSAIDs (available OTC and by prescription) may offer some advantages over their oral medication counterparts, such as reduced gastrointestinal side effects. Diclofenac gel is most commonly used in the US.
Non-Pharmacological Treatment Options
Regular, low-impact exercise (such as walking, swimming, biking, and yoga) is key to managing joint stiffness and pain. However, kids with well-controlled disease can participate in just about any activity they wish, if approved by their doctor. Physical therapy and occupational therapy may improve quality of life. Children with JA may require joint replacement surgery only in rare cases.
Compounded Options and Benefits for Juveniles
Medications may be compounded for patients with JA who are in need of a specific dosage or require a different dosage form. Additionally, more than one active ingredient can be combined in pharmacy compounding to meet a particular patient’s needs. Compounded topical products, especially, can provide customized medication options for pediatric patients with JA, which may not be available commercially.
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- Arthritis Foundation (n.d.). What Is Arthritis? Arthritis Foundation. https://www.arthritis.org/health-wellness/about-arthritis/understanding-arthritis/what-is-arthritis
- Arthritis Foundation (n.d.). Juvenile Arthritis. Arthritis Foundation. https://www.arthritis.org/juvenile-arthritis
- Ringold S, Angeles-Han ST, Beukelman T, et al. 2019 American College of Rheumatology/Arthritis Foundation Guideline for the Treatment of Juvenile Idiopathic Arthritis: Therapeutic Approaches for Non-Systemic Polyarthritis, Sacroiliitis, and Enthesitis. Arthritis Care Res (Hoboken). 2019;71(6):717-734. doi:10.1002/acr.23870
- Johns Hopkins Arthritis Center (n.d.). Rheumatoid Arthritis Treatment. Johns Hopkins Arthritis Center. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/
- de Falla, K (2016). Topical Pain Relief for Arthritis. Arthritis-Health. https://www.arthritis-health.com/treatment/medications/topical-pain-relief-arthritis
- Fields, S (2006). Compounding for Pediatric Patients. Pharmacy Times. https://www.pharmacytimes.com/publications/issue/2006/2006-09/2006-09-5890