Most children and teenagers with JIA are treated first with non-steroidal anti-inflammatory drugs (NSAIDs). These are called first-line medications because they are usually the first type of medication a doctor will use to treat JIA. These medications do not contain steroids.
How do NSAIDs work?
How do anti-inflammatory medicines work?As you have already learned, JIA is joint inflammation. NSAIDs decrease the chemicals that cause inflammation and help to reduce pain, swelling and stiffness in the joints. These drugs can help your child to participate in normal day-to-day activities. It might take between eight to 12 weeks to see improvement.
To learn more about how NSAIDs work, check out the animation at the right.
One of the benefits of NSAIDs is that their effect on your child's pain, stiffness and swelling will not wear out over time.
The following are NSAIDs commonly used to treat JIA.
Naproxen
Most common brand name: Naprosyn
How it is given: By mouth, twice daily
How the medication comes: Liquid or pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Ibuprofen
Most common brand name: Advil; Motrin
How it is given: By mouth, 3–4 times daily
How the medication comes: Liquid or pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Indomethacin
Most common brand name: Indocid
How it is given: By mouth, 3 times daily
How the medication comes: Liquid or pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Diclofenac sodium
Most common brand name: Voltaren
How it is given: By mouth, 1–2 times daily
How the medication comes: Pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Piroxicam
Most common brand name: Feldene
How it is given: By mouth, once daily
How the medication comes: Pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Celecoxib
Most common brand name: Celebrex
How it is given: By mouth, twice daily
How the medication comes: Pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Meloxicam
Most common brand name: Mobicox
How it is given: By mouth, once daily
How the medication comes: Pill
Side effects:
Common:
- Stomach upset (pain, nausea)
Less common:
- Vomiting, diarrhea or constipation
- Bloody or tarry black stools
- Severe abdominal pain from stomach ulcers
- Dizziness, drowsiness, headaches
- Rash, hives or itching
- Fragility and scarring of the skin
- Nosebleeds, bleeding gums, easy bruising
- Anemia, mild abnormalities in liver or kidney function
Important safety points about taking NSAIDs
- NSAIDs should always be taken with food. This can make it easier on the stomach.
- One rare side effect of NSAIDs is stomach ulcers. If your child develops persistent stomach upset with NSAID medication, talk to their doctor. The doctor may prescribe a drug to help protect the stomach from developing ulcers. Signs of an ulcer may include vomiting blood or passing a bloody or black stool. If this occurs, you should stop giving your child NSAIDs and see the doctor immediately.
- The doctor may order blood and urine tests when your child goes to the clinic to make sure that the medication is not causing any problems in the body that your child might not feel.
- If your child needs to take another medication for pain or fever, give acetaminophen (Tylenol). DO NOT GIVE another NSAID (like ibuprofen: Motrin or Advil) because then your child would be taking too much anti-inflammatory medication, leading to more side effects.
Tips for managing side effects of NSAIDs
Have your child take NSAIDs with food. For example, try to pair giving pills with breakfast, lunch, or dinner. If they need to take your medications at school, have your child carry a small snack with them.
Some NSAIDs may make your child sun sensitive. Your child should use adequate sun protection, like sunscreen, while taking NSAIDs, especially if they are fair-skinned.