DMARD with a short course of Steroids
DMARD after initial 3 months of NSAIDs
Monotherapy with TNF drugs
Ans:C-DMARD after initial 3 months of NSAIDs
Given condition is Juvenile Rheumatoid Arthritis
- Juvenile Rheumatoid arthritis or Juvenile Idiopathic Arthritis(JIA) is a chronic autoimmune multisystemic inflammatory disease that affects many organs but predominantly attacks the synovial tissues and joints.
- It occurs between the age of 20 to 50 years.
- Women are affected about 3 times more commonly than men.
- Oligoarticular or polyarticular arthritis of a duration of six weeks or longer must be present to diagnose JIA.
- Patients may present with an acute onset of symptoms or a more gradual onset. Symptoms are often worse in the morning but typically persist to some extent throughout the day.
- In patients with systemic-onset (also known as Still disease), intermittent spiking fevers are typically noted, which helps distinguish JIA from other diseases such as infection, other inflammatory diseases, and malignancy. Migratory salmon-colored light pink rash involving the trunk and/or extremities and hepatosplenomegaly are also frequently observed in patients with systemic-onset.
- A proportion of patients have serum rheumatoid factor9.
Findings on x-ray include soft tissue swelling, osteopenia, loss of joint space, erosions, growth disturbances (epiphyseal overgrowth or “ballooning”) and joint subluxation.
Cervical spine radiographs may demonstrate:
- atlantoaxial subluxation
- odontoid erosions
- ankylosis, especially of the facet joints
Hepatosplenomegaly may be seen on abdominal radiographs, and pericardial or pleural effusions may be seen on chest radiographs.
Treatment and prognosis
- Treatment of RA is aimed at improving the symptoms and slowing disease progression.
- Therapy is with a combination of corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), and TNF antagonists (e.g. etanercept).
- DMARDs are used when NSAIDs alone fail to relieve symptoms of joint pain and swelling or if there is a high risk of damage in the future.
- DMARDs may be taken in combination with NSAIDs and are used to slow the progress of juvenile idiopathic arthritis. The most commonly used DMARD for children is methotrexate (Trexall).